Archived: Carewatch (Camden & Haringey)

During our visit on 2 June 2014, we found that the service was in breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which requires providers to obtain, and act in accordance with, consent from people before providing care and support. We also found that the service was in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which requires providers to ensure that people were protected from receiving care that was inappropriate or unsafe, or did not ensure their safety or welfare.

During our visit of 10 September 2014, we found that risks associated with people's care and support had been appropriately assessed, and measures were in place to support staff to reduce those risks and to keep people safe. People's care plans had also been updated to better reflect the care and support they needed.

However, we also found that appropriate consent had not been sought from people before care and support was provided, in line with the requirements of the Mental Capacity Act 2005 (MCA).

Is the service safe?

Staff were appropriately vetted before they start work to ensure they were not barred from working with vulnerable adults. However, one person who used the service told us that staff were not always trained to provide the support they needed to move around safely.

Staff were trained in appropriate techniques to reduce the risk and spread of infection, and followed these. Personal protective equipment was readily available for staff to use.

Risks associated with people's support were not always assessed, and measures were not always put in place to reduce risks. Where people did have risk assessments, these were not always updated when people's needs changed.

Is the service effective?

Some people's care plans were comprehensive and included appropriate guidelines for their support, however others were not. Feedback from people who use the service and their relatives varied widely. One person who used the service told us "The care workers are just lovely and they help me a great deal", while another told us they were considering changing support providers as they weren't happy with the service. They said "The care doesn't always meet my needs".

We found that support for staff had improved, including a team meeting held for all staff, more frequent supervision for care workers, and appraisals were planned. Supervisors and the coordinator told us they felt well-supported in their roles.

We saw that an extensive audit of all aspects of service provision had been undertaken by the manager and a quality assurance person from the provider organisation's head office. This resulted in a comprehensive action plan for the service which the manager and staff were working towards.

Is the service caring?

Feedback from people who use the service and their relatives was positive. One person told us "They are always very nice".

We found that people were not always asked for their consent before care and support was provided, and the requirements of the Mental Capacity Act 2005 were not always followed.

Is the service responsive?

Regular spot checks were undertaken of staff work, and staff told us these were effective and helped them to improve their practice.

We found that people's care plans were not always reviewed and updated when their needs changed.

Is the service well-led?

Since our previous visits in February and March 2014 in which we found that the service's Registered Manager had not had day-to-day responsibility for managing the service for some time, a new manager had been appointed who told us they planned to apply for registration with CQC soon. The newly-appointed manager had implemented many changes, and had more planned. A staff member told us "Things are better now - we have been through so many managers and supervisors it's hard to keep track, but things have definitely improved in the last few months".

At both visits, the registered manager was absent. At the first visit, we spoke with the deputy manager and reviewed the care records of the person whose relative had contacted us. We concluded that the person's care needs had not been appropriately assessed and reviewed to ensure their safety and welfare. On the second visit we looked at the records of other people using the service. We saw that their care needs had been properly assessed by the provider and had been reviewed on a regular basis to ensure that the care plans met the people's needs.

We were not able to see staff files during our first visit and so we returned on the 5 March. The deputy manager was on leave and we met with other representatives of the provider. We were told that the registered manager, who was also the nominated individual, had not been able to carry out their responsibilities for some time due to ill health. We were told that steps had commenced to appoint a new registered manager

We looked at the employment records of the provider's office staff and found insufficient evidence that they had been properly supported by the provider to carry out their responsibilities.

The provider had appropriate systems to regularly monitor and assess the quality of the service.

People using the service were generally very positive about the care and support they received. One person said 'they are very good, very supporting.' Another told us the care workers were 'friendly and kind.' One person said that temporary care workers were sometimes not familiar with their care needs.

We saw that care plans setting out people's support needs were up to date and had been prepared by the provider in agreement with the people themselves and their relatives and carers.

We saw that care workers were subject to appropriate pre-employment checks. They were given suitable induction and were assessed before beginning work. They were encouraged and supported to attain relevant professional qualifications and received on-going training and support.

The provider had effective systems for monitoring and assessing the quality of the service and dealt appropriately with complaints.

People using the service were involved in the regular assessment and review of their care and support needs, which was person-centred and individualised. People were generally happy with the quality of the service provided, stating that workers were familiar with their needs, were polite and treated them with respect. A number said that care workers were occasionally late for appointments or that if two workers provided the care they might not both arrive at the same time. One person said 'Yes, it's a good service. They do what they are supposed to do, but are sometimes a bit rushed.' Another said the workers providing their support were 'Very good.' Some care workers we spoke with said that the time allowed for the visits was sometimes not enough to do all the tasks needed.

We saw that workers were given appropriate induction and assessment before beginning work, as well as them receiving ongoing training and support.

The provider had effective systems for monitoring and assessing the quality of the service and dealt appropriately with complaints.