This inspection visit took place on 21st and 26th November 2018 and was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection around 50 people were using the service.

Not everyone using Apple HomeCare receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was a registered manager working at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of this service on 18 March 2016, we rated the service overall as good. Whilst there were positive elements to this inspection, the overall rating for the service has been changed to requires improvement. This is because the management of records did not consistently meet the Regulations or good practice guidance. The system in place to manage and administer people’s medicines was not safe and risks to people had not always been identified and mitigated. There were also shortfalls in the quality assurance systems designed to monitor the quality of care. Staff supervision did not take place regularly and improved performance management measures are required. Staff training was not always effective especially in relation to safeguarding, medication and the Mental Capacity Act. There were shortfalls in the service’s approach to person-centred care planning and end of life care planning.

For these reasons, the provider is in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We have also made two recommendations to the provider regarding their application of the Mental Capacity Act and their approach to End of Life care planning.

We saw evidence of two medication errors in the past two years, one of which was due to a poor risk assessment. There were also recording errors on medicines charts and medication logs. In one case it was unclear what a relative was administering and signing for on the relevant medication records.

The service only assessed risks relating to medication, moving and handling, health and safety and the person’s property. Some of the risk assessments we saw were lacking in detail so it was unclear whether safety concerns were routinely managed.

People received a person-centred service when supported by staff who knew them well. However, care plans failed to consistently contain person centred information. This put people at risk of receiving care that did not meet their needs in the event they were supported by agency staff or staff that did not know them well.

Record management was not robust and quality assurance systems did not identify issues of concern.

Local authority requirements regarding the reporting of safeguarding concerns were not always followed.

Two of the files we reviewed lacked information concerning assessments conducted under the Mental Capacity Act 2005 (MCA) and related best interests decisions.

The provision of regular and robust training for staff needed to be improved. The service needed to strengthen its approach to performance management and ensure formal supervision and appraisals take place.

Staff enabled people using the service to express their needs and wishes and be involved in decisions relating to their care. However, we found one example where the service could have done more to support a person to communicate.

Staff were recruited safely and there were enough staff to complete all of the visits.

Staff worked well with other health p

Apple Homecare provides care for people in their own homes. The service can provide care for adults of all ages and this includes people with a physical disability, special sensory needs and a learning disability. It can also provide care for people who have difficulties with their mental health and for people who live with dementia. At the time of our inspection the service was providing care for 57 people most of whom were older people. The service has its office in Blofield and covers Norwich, Broadlands and surrounding villages.

The service was first registered by us on 22 July 2014. We then re-registered the service on 19 February 2016 because a new private company had been formed to own and run the service. Although the new ownership arrangements did not affect how the service was run, we had to change the registration details so that they accurately described who was responsible for the administration of the service.

Staff knew how to recognise and report any concerns so that people were kept safe from abuse. People were helped to avoid having accidents and they were assisted to safely use medicines. There were enough staff to enable all of the planned visits to be completed on time and background checks had been completed before new staff had been appointed.

Staff knew how to care for people in the right way and they had received all of the training and support they needed. People had been supported to eat and drink enough and to access any healthcare services they needed.

The registered manager and staff were following the Mental Capacity Act 2005 (MCA). This law is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People and their relatives said that staff were kind and caring. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had received all of the care they needed including people who had special communication needs and were at risk of becoming distressed. People had been consulted about the care they wanted to receive and had been supported to pursue their interests and hobbies. There were arrangements in place to quickly and fairly resolve complaints.

Regular quality checks had been completed and people had been consulted about the development of the service. The service was run in an open and relaxed way, there was good team work and staff were supported to speak out if they had any concerns about poor practice. People had benefited from staff acting upon good practice guidance.