Archived: Carewatch (Brighton)

Carewatch (Brighton) is a domiciliary care agency and provides support with personal care to people living in their own homes in the Brighton and Hove area. At the time of the inspection 167 people received personal care from the service.

At this inspection we found the service to be Good overall. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿People told us they felt safe with the care and support provided. Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns.

¿People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, where possible at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

¿People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

¿People were supported with their food and drink and this was monitored regularly. People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. Staff received training that enabled them to deliver the support that people needed. Staff received support from the registered manager and the office staff.

¿People were supported by staff who knew them well. Staff understood people’s needs, choices and histories and knew what was important to each person. People were treated with kindness, respect and understanding. They were enabled to make their own decisions and choices about what they did each day.

¿People received support that was person-centred and met their individual needs, choices and preferences. Complaints had been recorded, investigated and responded to appropriately.

¿The registered manager was well thought of and supportive to people and staff. They had a good overview of the service. There were systems in place to assure quality and identify if improvements to the service were needed.

Rating at last inspection: Requires improvement. (Report published 13 June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, and younger disabled adults mainly in the Brighton and Hove area but also in West Sussex. Care was provided predominantly to older people, including people with a physical disability, learning disability, sensory loss, mental health problems or people living with dementia. There were around 217 people receiving a service.

At the last inspection on 12 December 2016 the service was rated as requires improvement overall. The formal systems of quality assurance to monitor the standard of the service provided had not been fully maintained and embedded in the service. Regular reviews of people’s care and support plans had not been fully maintained, care staff had not always had a regular appraisal and supervision or had spot checks carried out, and some refresher training was late in being provided to ensure the quality of the care provided to meet the provider’s policies and procedures. At this inspection we found staff training, supervision and appraisal had improved, but reviews of people’s care and support plans still had not been fully completed to meet the provider’s timescale to undertake reviews.

On the day of our inspection, there was a registered manager in post. 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.

People and staff told us it had been a difficult period with a number of staff changes. There had been a number of changes in care staff and vacancies had resulted in senior staff covering care calls at times. There had been a number of changes to the senior staff and office staff, and there were also a number of vacancies for senior staff which had affected the smooth running of the service. The registered manager told us there was ongoing recruitment to try to address this. This had not always ensured people’s choices had been considered and person centred care had been provided.

People told us they felt safe with the care provided in their home. People’s comments included, “They make sure they turn everything off, leave it tidy so I don’t trip over anything,” “I am absolutely safe with the carers, they are very efficient and kindly. It is always a pleasure to see them,” and “I am very safe, they buzz and I let them in.” However, people and their relatives told us they did not feel safe with the timing of the care calls, and not knowing who would be providing their care. People told us they did not always have their individual needs met in a timely manner and staff were regularly late for calls or people had experienced missed calls. One person told us care staff, “Come in at all times. Used to have a sheet with names of carers and times on don’t get them now. Never know when they are coming in. Sometimes 8.30 am, now 10.30 am not arrived yet.” Another person told us, “I do not know who is coming or at what time, it can be frustrating, weekends are chaos.” A third person said, “Good safe care because I see the same people. Not so sure when new carers come in. Don’t know who they are and don’t get lists, don’t introduce themselves.”

There were clear policies in place to protect people from abuse, and staff had a clear understanding of what to do if safeguarding concerns were identified. When new care staff were employed safe recruitment practices were in place to be followed. Assessments of risks to people had been developed. However, not all had been regularly reviewed. Staff told us they had received supervision, and been supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. People knew how to raise concerns or complaints.

The needs and choices of people had been clearly documented in their care plans. Care staff were able to tell us about the people they supported, for example their likes and dislikes and their interests. However, not all the care plans had been regularly reviewed to ensure any changes in people’s care and support needs had been identified. People's comments included, “They did my care plan ages ago but no one comes to check if it everything is alright,” and “Do phone sometimes to ask if everything is alright.” People told us they were involved in the planning and any review of their care. Where people were unable to do this, the manager told us they would liaise with health and social care professionals to consider the person’s capacity under the Mental Capacity Act 2005. Care staff had an understanding of the need for people to consent to their care and treatment.

The provider continued to have arrangements in place for the safe administration of medicines. People were supported to get their medicine safely when they needed it. If needed, people were supported with their food and drink and this was monitored regularly. People’s comments included, “Food cooked well. I put meals in the freezer all labelled,” “Sort and microwave all my meals. Really good support with meals,” and “Will make sandwiches and leave them for my supper.” People continued to be supported to maintain good health.

People and their relatives told us they were supported by kind and caring staff. One person told us, “Do what I want, very nice people, and no complaints.” Another person told us, “Can’t praise my carer enough. Very kind and thoughtful.” A third person said, “Most of the carers are brilliant. Good relationship with four or five of them. If it wasn’t for them I would have left the company. Do their job well.”

Senior staff carried out a range of internal audits, and records confirmed this. These had identified areas in need of improvement, which staff were working to address.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

Carewatch (Brighton) is a domiciliary care service and provides personal care and support for adults living in their own home in the Brighton and Hove and West Sussex area. Care was provided predominantly to older people, including people with a physical disability, learning disability, sensory loss, mental health problems or people living with dementia. There were around 267 people receiving a service.

On the day of our inspection, there was no registered manager in post. 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. A new manager had been recruited and was present during the inspection. A registered manager application had been made to the Care Quality Commission (CQC) for a new registered manager for the service.

The formal systems of quality assurance to monitor the standard of the service provided had not been fully maintained and embedded in the service. Some checks of quality were taking place, for example, the medication administration records (MAR) for any errors and the financial transaction forms to ensure the correct process was being followed. However, regular reviews of people’s care and support plans had not been fully maintained, care staff had not always had a regular appraisal and supervision or had spot checks carried out, and some refresher training was late in being provided to ensure the quality of the care provided to meet the provider’s policies and procedures. These are areas of practice in need of improvement.

People told us they felt safe with the care provided. One person told us, “They do everything for me I have no problems about feeling safe.” Another person told us, “I definitely feel safe. There are no incidents where I have not felt safe.” A relative told us, “Most definitely (safe). She has lost her mobility recently, they look after her, make sure they stand near when she is mobile.” Detailed risk assessments were in place to ensure people were safe within their own home and when they received care and support. The times that care staff arrived to support people enabled people to have the agreed support provided. For example, to take their medicines at the right time. One person told us,” The service is punctual, caring they try and to fit in around our needs. The service we receive is very, very good.” Another person told us, “I feel relaxed about it all once we got into a pattern everything was fine I would recommend them to anybody, they are kind and reliable and very willing.” There were clear policies in place to protect people from abuse, and staff had a clear understanding of what to do if safeguarding concerns were identified. When new care staff were employed safe recruitment practices were in place to be followed. People knew how to raise concerns or complaints.

Medicines were managed safely and people received the support they required from staff. There were systems in place to ensure that medicines were administered and reviewed appropriately. Where people had help with their medicines they told us this had worked well. One person told us, “They do my tablets and prescriptions and they record it all down what they do for me.” A relative told us, “They do help with her medication and she gets it on time.”

People and their relatives told us they were supported by kind and caring staff. One person told us they were happy with the care and support provided by the member of staff providing their care and said, “The carer it’s all down to her, she is goes above board, she is very, very good.” Another person told us, “They are just like friends (carers) and they have professional boundaries.” A third person said, ”They are very kind and caring. If I drop something they will pick it up for me.” A further person told us, “I think they are very caring, they do anything you ask them to do.” People told us they were involved in the planning and any review of their care. Where people were unable to do this, the manager told us they would liaise with health and social care professionals to consider the person’s capacity under the Mental Capacity Act 2005. Care staff had an understanding of the need for people to consent to their care and treatment.

The needs and choices of people had been clearly documented in their care plans. Care staff were able to tell us about the people they supported, for example their likes and dislikes and their interests. People told us they always got their care visit, that they were happy with the care and the care staff that supported them. One person told us, “Well satisfied.” Another person told us, “They reckon I am lovely and I can have a laugh and a joke with them and we have a sing song.”

Senior staff provided good leadership and support to the care staff. They were involved in day to day monitoring of the standards of care and support that were provided to people using the service. One member of staff told us, “What I’ve found is that co-ordinators and supervisors always help with the calls, always on the phone” (for advice). Another member of staff told us their supervisor was, “Fantastic.”