The Care Quality Commission
  • Services in your home
  • Homecare service

Archived: Carewatch (Black Country)

146 Crankhall Lane, Wednesbury, West Midlands, WS10 0ED (0121) 505 3700

Provided and run by:
All & Small Limited

Important: This service is now registered at a different address - see new profile

All Inspections

22, 29 January and 21 February 2014

During an inspection in response to concerns

When we last inspected the service, they were known as 'All and Small'. In April 2013, we found non-compliance with three outcomes. The service has since merged with and been taken over by Carewatch and has increased in size. At this inspection we saw that there were still shortfalls in previously assessed areas and in other outcomes assessed on this inspection.

The agency supports 370 people. We looked at 10 care files, five staff files, spoke with 10 staff, the manager, and 10 people that used the service and or their relative. We visited the agency's office and five people in their home who received care from the agency. We also sent questionnaires to people and or their relatives and asked them to tell us about their experiences about using the service.

The registered provider did not have appropriate systems in place to ensure that people's mental capacity to consent to their care was considered and recorded. People and their relatives told us they were involved in their care planning but that staff did not always ask for their consent before providing care. One person said, 'They sometimes ask my relative whether they want a wash or a shower. They don't always listen to what my relative says.' Another person said, 'I asked them to change me before they left but the carers said they didn't have time. This happens a lot on my bed time call.'

Some care plans and risk assessments had not been reviewed for over 12 months and lacked detail to enable staff to care for people safely. Risk assessments for moving and handling equipment that was used or for specific health conditions were not in place. This meant that people's safety and wellbeing were not protected and placed them at risk of harm.

Some people told us that they were happy with the care they or their relative received but that care calls were rarely on time. Some people told us that they were not happy about some aspects of their care and actions had now been taken to address this.

Some records did not show that medication had been given to people as prescribed by their doctor so as to ensure their health needs were met.

Staff training and supervision was not up to date. The newly appointed manager had implemented a plan to bring all training, supervision and care plans up to date by April 2014. This would ensure that people were supported by staff that had the skills, knowledge and information to meet people's needs safely in the way that they wanted.

Improved quality monitoring processes have recently been implemented. A call monitoring system had recently been introduced to ensure that care calls are delivered in line with peoples assessed plan of care. Audits have not yet been analysed to ensure that people receive a good, safe service.

Records made by care staff did not show what care had been given or that it was in line with their assessed plan of care.

23 April 2013

During a routine inspection

Our inspection was carried out at the agency's office. On the day of our inspection visit we were told that All and Small Limited was providing support to ninety people. During our inspection we looked at nine care records and spoke with the manager, care manager and training manager. We later spoke with five care staff and ten people that used the service or their relative.

People were involved in their care as far as possible and were encouraged to maintain their skills. One staff member told us, "I encourage the person I support to prepare meals with me."

Care plans and risk assessments were in place to give staff information they need to support people's needs. However, these were not always detailed enough.

Arrangements ensured that people were safeguarded against the risk of harm.

We saw the organisations policy on medication which provided staff with information about administering medication. Care records sampled showed that people were not always protected against the risks of unsafe management of medicines.

We saw the organisations system for handling complaints. One person told us, "I have all the information I need to contact someone if I have a concern."

We saw that systems were in place to audit and monitor the quality of the service being provided. However, actions were not always taken to improve the quality of the service being provided.

3 December 2012

During a routine inspection

Our inspection was carried out at the agency's office. During our visit, we looked at six care records and spoke with the manager, two senior care supervisors and four care workers. We later contacted eight people that used the service and / or their representatives.

People were involved in their care and were encouraged to do things for themselves as far as possible.

Care plans and risk assessments were in place to support people's needs. From those sampled, we found they were not personalised and did not meet all the person's needs.

Arrangements were in place to ensure that people were safeguarded from harm.

We saw the organisations policy on medication which provided staff with information about administering medication. Records sampled showed that people were not always protected against the risks with the unsafe management of medicines.

Staff were supported and trained in their roles. One staff member told us, "The induction was great".

We saw the organisations complaints policy. One person using the service told us, "I have no complaints at the moment". Records sampled showed us that the provider did not have an effective system in place for appropropriately handling complaints.

7 March 2012

During an inspection in response to concerns

We carried out this review of compliance in response to concerns that we received from a representative of people that used the agency.

We visited All and Small on 7 March 2012. During our visit we spoke with the manager, training officer and three staff. We looked at care records for three people that used the agency, and other records related to the operation of the service. We also spoke and heard from four relatives of people that used the agency.

We heard from one representative of a person that had used the service that they had concerns about how the agency had not assessed their relative's needs, which resulted in the service being withdrawn prematurely. The manager confirmed that this person's needs had not been assessed by the agency prior to commencement of the service. The manager told us that assessments of people referred to the agency had been carried out since they became aware of this concern.

We heard from another person's representative that they had concerns that staff had given medication incorrectly. This had been due to directions for administration not being followed on a number of occasions. The agency looked at ways to improve people's safety as a result after concerns came to our attention. They had worked with social services in respect of investigating these allegations following the safeguarding referral that we made. The manager told us that the first medication error was made in November 2011, which meant that there was a prolonged delay in a referral and investigation by social services.

We spoke to two other people's representatives about how the staff managed medication, and they told us that there had not been any problems with these.

We looked at the medication records for three people that used the service.

The directions within the care plan needed to be clearer where staff assisted with 'as required' medication, with clear protocols when medication was/was not needed so as to reduce the risk of errors.

We heard from some people's representatives that staff encouraged people to be as independent as possible, in some cases enabling them with daily living tasks, and not taking away their independence. They told us that people using the service got on well with the staff that visited. They also told us that the agency tried to ensure that there was a core of staff that visited people, so that they knew who was coming 'and they recognised their faces'. We heard this approach reassured people that used the service.

We looked at three care plans for people that used the service and found that these plans were not always easy to understand for people with communication difficulties. We spoke with two people's representatives who confirmed that care plans were generally accurate and reflected what it was agreed staff should do to support people. We did find that there were some discrepancies in the care plans that we saw and what people and staff told us happened. We heard this was due to changes made to reflect what people wanted from the agency were not always updated in care plans.

People's representatives that we spoke with said that the staff that visited them were usually ones that people knew. One person told us 'Will ring if carer is going to be late' ' 'If carer late will call they are there in 5 minutes'. Another said that staff responded well when their relative was ill so as to ensure their health needs were met, adding that staff 'Were brilliant'.

We spoke with two representatives of people who used the agency and they told us that that people who used the service felt safe with the staff. They told us that if they felt concerned or worried, they were able to contact the management and were confident in raising concerns with them.

Two people's representatives that we spoke to told us that they were kept up to date by the agency, one telling us they were 'always on the ball with me'.