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Inspection carried out on 13 November 2018

During a routine inspection

We inspected Carewatch (Swindon) on 13 November 2018 and the inspection was announced. This service is a domiciliary care agency (DCA). It provides personal care to people living in the community. People include older adults, some living with dementia, disabilities and sensory impairments. Not everyone using the service receives regulated activity; Care Quality Commission 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. On the day of the inspection the service was supporting 57 people.

At the last inspection, the service was rated Requires Improvement. We found the provider did not always maintain an accurate, complete and contemporaneous record. We also found the provider’s quality assurances processes and systems to assess, monitor and mitigate risks were effective and fit for purpose. These issues were a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a requirement notice and asked the provider to send us an action plan on how they were going to address these concerns. We received an action plan promptly that stated the provider was going to be compliant by June 2018.

At this inspection we found the service improved to Good, however their quality assurance processes around monitoring people’s visits needed to be more proactive.

There was 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.

People told us they felt safe receiving care from the team. Staff were trained in safeguarding and understood their responsibilities to report any concerns. Medicines were managed safely. There were sufficient staff deployed to keep people safe and the provider followed safe recruitment processes. The registered manager worked to improve the risks assessments and risks to people's well-being, individual conditions and environment were recorded and reviewed regularly.

The registered manager and the team promoted a positive and transparent culture. The service worked with a number of external professionals including local social and health professionals. Staff told us they were well supported by the registered manager.

People’s needs were assessed to ensure the team were able to care for them effectively. People’s rights to make their own decisions were respected. Staff received training relevant to their roles and told us they were supported by their managers. People were supported to access health services and maintain their dietary needs.

The team provided support in a caring way. People told us they built caring relationships with staff. Staff treated people with dignity and respect. People were involved in their care and encouraged to be independent as much as possible. There were processes in place to ensure people’s confidentiality.

The registered manager worked to improve the care planning documentation and planned further improvement to make the records more user friendly. People told us they were supported by staff that knew them and the support provided met their needs. People knew how to make a complain and complaints received were recorded and dealt with in line with the provider’s policy. Where people received palliative support, the service worked with external professionals and people’s relatives to ensure appropriate care was provided.

Inspection carried out on 19 October 2017

During a routine inspection

We inspected this service on 19 and 24 October 2017. Carewatch (Swindon) is a Domiciliary Care Agency (DCA) registered to provide personal care in people’s own homes. At the time of our inspection 85 people were being supported by this service under the registered regulated activity of personal care. A further 37 people were receiving other support from the service such as help with shopping or housekeeping and this was not included in our inspection.

At our last inspection on 1 June 2016 we found the provider did not always ensure risks to people were identified and risk assessments and care plans that had been in place lacked detail and guidance for staff. As a result of this the service was rated as Requiring Improvement in Safe and Responsive and overall service was rated Requires Improvement.

At this inspection we found the above issues had not been fully addressed. People’s care records were still in the process of being updated. Records around medicine management did not always contain full details. The provider’s quality assurance systems were not always effective. We also found where issues had been identified by audits there was lack of prompt response to address the concerns identified.

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.

People told us they felt the service was not well run but they praised the caring nature of staff. People did not always experience continuity of care and commented on last minute changes to the schedules. The provider followed safe systems when recruiting and appointing staff and ensured relevant checks and references were carried out.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. Staff knew the principles of the MCA and told us they respected people’s rights to make own decisions. We found the records surrounding assessments of people’s capacity were not always in place however people told us their decisions were respected.

We have made a recommendation about referring to MCA Code of Practice when formulating people’s care plans surrounding their decision making ability and capacity issues.

People received support from staff who received ongoing training. Staff told us they were well supported in their roles. Staff understood how to protect people from potential abuse and they were aware about the whistle blowing policy.

The service continued to provide support in a caring way. People were very complimentary about staff and told us staff were kind. People’s dignity and privacy were promoted. People were supported to access health professionals when needed and meet their nutritional needs. People were encouraged to give their opinions through reviews and spot checks.

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

Inspection carried out on 1 June 2016

During a routine inspection

Carewatch provides domiciliary care and support services to people with individual needs in their own homes. At the time of our inspection 65 people were being supported by this service under the registered regulated activity of personal care. A further 35 people were receiving domestic visits from the service including support with shopping and cleaning, which was not included in the inspection. This inspection took place on 1 June 2016. This was an announced inspection which meant the provider had prior knowledge that we would be visiting the service. This was because the location provides a domiciliary care service, and we wanted to make sure the manager would be available to support our inspection, or someone who could act on their behalf.

At the time of our inspection a registered manager was in place 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. The registered manager and the managing director were accessible and approachable throughout the inspection.

Risks to people had not always been identified and risk assessments that were in place lacked detail to support a person. Care plans relating to a person’s life history or a specific health condition also lacked detail and guidance for staff. This had been identified and was on an action plan to be addressed.

People were protected from unsafe care by staff who demonstrated a good understanding of safeguarding and whistle-blowing procedures. They knew how to report concerns and had confidence in the registered manager that these would be fully investigated to ensure people were protected.

Staff were appropriately trained and skilled. They received a thorough induction when they started working for the service. Staff received support through regular supervisions with their line manager.

People and relatives were very complimentary about the caring nature of staff. Staff were knowledgeable about people’s needs and people’s privacy and dignity was always respected.

People had the opportunity to provide feedback on the service; this took place through an annual survey and telephone monitoring calls. People’s needs were regularly reviewed and updated accordingly.

People, their relatives and staff felt the service was managed well and could approach the management team if they needed too. The quality of the service was regularly monitored and effective systems were in place which identified shortfalls and took appropriate action.

Inspection carried out on 26 September 2013

During a routine inspection

The people who used the service and relatives told us that the carers were always polite and respectful, one person said that their care workers were "kind", another stated that the staff were "always on time" and one person said "my carer is excellent. One relative said that there were "bright, cheerful staff".

People were supported to make decisions about their care and their day-to-day lives. They were also supported to be as independent as possible.

There were safeguarding procedures and staff had received training so that people were protected from abuse. Staff had also received a range of training and qualifications and they were supervised and supported so that they could meet people's needs.

There were medication procedures and staff had received training so that they could support people safely with their medicines.

The people and their relatives told us that the carers were always polite and respected their dignity. The relative of a person who had been receiving care for approximately 7 years stated that they were " personally satisfied� and the care staff �knows the routine�. People were supported to make decisions about their care and their day-to-day lives. They were also supported to be as independent as possible.

People and their representatives were asked their views about the service and these were listened to and acted upon. There was a system to monitor the quality of the service that people received and to make improvements when needed.

Inspection carried out on 8 March 2013

During a routine inspection

We spoke with two relatives and three people who used the service. They told us that they, or their relative, had been involved in developing their care plans, for example by saying what support they needed and when. The three people also said that they had been given information about the service and they each had a copy of their care plan in their home.

The people and their relatives told us that the carers were always polite and respected their dignity. One relative said that �they are a nice bunch.� People were supported to make decisions about their care and their day-to-day lives. They were also supported to be as independent as possible.

There were medication procedures and staff had received training so that they could support people safely with their medicines. Staff had also received all the right recruitment checks. They also had a range of training and qualifications so that they had the right skills to meet people's needs.

People and their representatives were asked their views about the service and these were listened to and acted upon. There was a system to monitor the quality of the service that people received and to make improvements when needed.

Inspection carried out on 5 January 2012

During a routine inspection

We spoke to three people who used the service. Feedback was positive. They told us that they trusted the staff that provided their care and support. One person told us �I have no complaints whatsoever. X (care worker) is quite an angel�. Another told us �they are all very nice; they treat me very well�. People told us that they thought the agency was well run.