Archived: Carewatch (Morecambe)

Carewatch Morecambe is a domiciliary care agency. It provides personal care to 172 older adults living in their own houses and flats.

There was a registered manager in place. 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 in May and June 2017, we found four breaches of regulation. We found breaches in the regulations related to Safe care and treatment, Good governance, Staffing and Fit and proper persons employed. We issued requirement notices for these breaches in regulation.

We also noted improvement were required around the use of language that promotes respect and protects people's dignity and positive communication and leadership. We made recommendations in relation to these.

Following the inspection in May and June 2017 we asked the registered provider to act to make improvements in the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements.

At this inspection, we found the service met the required fundamental standards and would be rated 'Good' in all areas.

During this inspection, we noted the registered provider planned visits to allow staff enough time to reach people and complete all tasks required. We did see occasions when staff left before the allocated time was complete. The registered manager told us sometimes this was at the request of the client. We have made a recommendation about this.

The registered provider had regularly completed a range of audits to maintain people's safety and welfare. We noted some documentation took time to travel from people’s homes to the office. This impacted on the timeliness of audits taking place. We have made a recommendation about this.

We found staff had received training to safeguard people from abuse. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of adults who may be vulnerable. Staff we spoke with told us they were aware of the safeguarding procedure.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There was an appropriate skill mix of staff to ensure the needs of people who used the service were met. New staff worked alongside experienced staff members whilst they learnt their role.

People told us staff respected their privacy and dignity during their visits. One person commented, “They always close the bathroom doors, they wear gloves and aprons and they are very respectful to me.”

Care plans identified the care and support people required. We found they were personalised and informative about the care people received. They had been kept under review and updated when necessary. They reflected any risks and people's changing needs.

Staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. The registered provider completed spot checks on staff to observe their work practices were appropriate and people were safe.

Staff were provided with personal protective equipment to protect people and themselves from the spread of infection.

The registered provider had procedures around recruitment and selection to minimise the risk of unsuitable employees working with people who may be vulnerable. Required checks had been completed before any staff started work at the service. This was confirmed during discussions with staff.

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

When appropriate, meals and drinks were prepared for people. This ensured people received adequate nutrition and hydration.

Care records contained information about the individual's ongoing care and rehabilitation requirements. This showed us the registered provider worked with other health care services to meet people's health needs.

People said they had a team of regular carers with whom they and had built up good relationships. For example, one person told us, "They are very compassionate and caring and involve me in all decisions.”

Staff we spoke with understood the support needs of people they visited. They knew how individuals wanted their care to be delivered. One person stated, “They come and do what they should, but its more than that, they are interested in me. They ask how I am, what I’ve been doing, that sort of thing.”

A complaints procedure was available and people we spoke with said they knew how to complain. We noted the registered manager addressed all concerns in a structured and timely manner.

The registered manager had sought feedback from people receiving support and staff for input on how the service could continually improve.

The service demonstrated good management and leadership with clear lines of responsibility and

accountability within the management team.

Carewatch (North) provides personal care and support to people living in their own homes. The agency covers a wide range of dependency needs including older people with a physical or learning disability and older people living with dementia or mental health problems. The agency's office is located close to Morecambe town centre. At the time of our inspection there were 403 people receiving a service from Carewatch (North).

The service had a registered manager in place. 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 this inspection visit carried out in May and June 2017, we found breaches in the regulations relating to Safe care and treatment, Good governance, Staffing and Fit and proper persons employed.

We looked at how Carewatch (North) managed risk. We were informed that moving and handling procedures had not followed identified risk management plans. This meant the registered provider failed to follow processes that protected the safety and welfare of people and staff.

We looked at the administration of medicines and creams. Documentation did not guide staff on the proper and safe management of medicines and creams.

We looked at how Carewatch (North) recruited staff. We found recruitment policies were not followed to ensure staff were of good character and be able by reason of their health to perform their role.

We looked at recordkeeping and auditing. We found robust systems were not in place to assess the service consistently to deliver and drive improvement.

We looked at care plans and found the registered provider had failed to provide every person with a clear treatment plan. Not all people had documentation in their home to guide staff.

We looked at staff training. There was a structured induction and ongoing training plan in place. Staff told us they had received safeguarding adults from abuse training. They told us they knew how to recognise signs of abuse and who to alert. However, the registered provider failed to provide learning and development opportunities to develop necessary skills to meet the needs of the people they care for and support.

We have made a recommendation about the use of language that promotes respect and protects people’s dignity.

We have made a recommendation about positive communication and leadership.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA).

We found people had the opportunity to have support to access to healthcare professionals.

People made positive comments about the staff including their attitude and respectful manners. Staff showed an awareness of promoting people’s rights to privacy, dignity and independence.

End of life care was available, flexible and tailored around the needs of the people who required the support.

Where appropriate, people were supported to sufficient to eat and drink and maintain a balanced diet.

Consultation had taken place with people and care plans were reviewed.

Staff were given support and the opportunity through supervision and staff meetings to give feedback on their role and experiences.

You can see what action we have asked the registered provider to take at the back of the main body of the report.