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

Archived: Carewatch (Bristol)

Overall: Inadequate read more about inspection ratings

2 Russell Grove, Westbury Park, Bristol, BS6 7UE (0117) 942 4848

Provided and run by:
Morris Social Care Limited

Important: The provider of this service changed. See new profile

All Inspections

14 and 17 November 2014

During a routine inspection

The inspection took place on 14 and 17 November 2014 and was unannounced. At our inspection in August 2013 we identified breaches of regulations relating to care and welfare, how staff were supported and how the quality of the service was managed.

During this inspection we looked at whether improvements had been made. We found that improvements still needed to be made in relation to care and welfare, supporting staff and how the quality of the service was managed.

Carewatch (Bristol) provides personal care to people in their own homes and support with household tasks such as cleaning and shopping. At the time of our visit there were around 70 people using the service.

The inspection took place on 14 and 17 November 2014 and was unannounced. At our inspection in August 2013 we identified breaches of regulations relating to care and welfare, how staff were supported and how the quality of the service was managed.

During this inspection we looked at whether improvements had been made. We found that improvements still needed to be made in relation to care and welfare, supporting staff and how the quality of the service was managed.

Carewatch (Bristol) provides personal care to people in their own homes and support with household tasks such as cleaning and shopping. At the time of our visit there were around 70 people using the service.

There was no registered manager and there had not been one for over 18 months. 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. There was an acting manager who was appointed to the post in August 2014.

The registered provider, who is also the nominated individual, was unable to fulfil the requirements of their role for personal reasons.

Although people said they felt safe we found that the agency was not providing consistently safe care. People regularly did not receive their planned visits from care staff at the required times and on some occasions not receiving visits at all. This directly impacted on the safety and welfare of a number of people who used the service.

People had an individual plan setting out the support they needed and how this was to be provided. Some people’s support was not provided as detailed in their care plans. Some people’s needs had not been regularly reviewed. This meant people did not always receive support in a way that met their needs. For example one person told us their morning visits frequently took place so late their relative had to stay in bed and could not get up at the time of their choosing.

People told us the care workers treated them with kindness and respect. Staff had got to know many of the people they supported well. They also demonstrated an understanding of the needs of people they regularly visited. However staff and people who used the service told us there were often times when they had to assist people who they did not know or only knew slightly. This impacted on the ability of staff to provide a personalised service to people.

The provider had a system in place to ensure safe and suitable staff were recruited. New staff completed training before working unsupervised for the agency. The staff understood their responsibility to protect people from potential harm or abuse. They knew what action to take if they were concerned about the safety of a person using the service.

There had been an increase in late visits and missed visits to people by care workers over the previous six months for a significant number of people. The online monitoring system known as CM2000, which is a system put in place by the Local Authority recorded there were recent and regular occasions when some people were not receiving a safe service.

The lack of reliability of the service people received meant it was not fully effective as people’s personal care needs were not always met.

People reported a lack of effective communications from the office and the staff there. People told us they were often not given the information they asked for if a care worker was running late for a visit. Some people also told us they were rarely contacted with an explanation for why a visit was late or missed. The majority of people said they were given unhelpful responses, such as being asked to remember there were people who were much sicker than they were. One person also reported how they were often called “love” or “darling” when they rang the office, and they found this patronising.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the number of staff, a lack of staff supervision and monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of this report.

5 August 2014

During a routine inspection

The inspection team who carried out this inspection consisted of two adult social care inspectors. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People were safeguarded from abuse because the agency had systems to minimise risks to protect them from harm. All of the people we spoke with told us they felt safe with the care workers who visited them in their home.

The feedback from the people we met and spoke to by telephone was mixed in relation to how safe the service they received was. There was a consistent theme in the feedback we were given. People told us that care staff were able to provide safe care when they visited. However a significant number of people repeatedly told us there had recently been an increase in late calls and missed visits.

Examples of comments made included 'my carer is absolutely brilliant, knows what he is doing and knows all about the feed pumps'. Further comments included, 'no one came today it should be 7.30 no one came back by 8.30 so I rang and said don't bother there is continual inconsistent timing' ,'the carers I have are brilliant', and 'they rarely tell us if they are going to be late they promised a call back when they are late we don't get one'.

The staff told us they were guided in their work by risk assessments and care records that set out how to provide people with safe support. We saw that care records and risk assessments set out what safe practices to follow when they assisted people with their mobility needs. Care plans and risk assessments demonstrated that risks had been identified and preventative actions were put in place.

The procedures in place for recruiting new staff were sufficiently thorough to minimise the risk of unsuitable employees being recruited to work with people who used the service.

The provider had systems in place to ensure there was learning from events such as accidents and incidents, complaints, concerns, and investigations. However the analysis of accidents and incidents was not being carried out on a consistent basis. This lack of analysis meant there was a risk people may not always receive care that was safe and suitable.

Is the service effective?

When people received visits from care staff they told us they felt that they received an effective service and their needs were met. Examples of comments about the service they received included, "I can't complain about the carers', "they are very good with my relative " and "my regulars are all wonderful".

However due to staff shortages, there had been a recent increase in the number of missed visits and late visits. This was a theme in the feedback from the majority of the people we spoke with and met. The online monitoring system known as CM 2000 had also recorded an increase in late visits and missed visits over the last six months. This meant there were recent and regular occasions when some people were not receiving an effective service.

Staff were supported to be able to go on training courses and to obtain further relevant qualifications. There was a training programme on a range of subjects relevant to the needs of people who used the service.

People were assisted by some staff who had been supervised in their work. This was to ensure they provided a safe suitable service. However this was sporadic and was not being kept up to date. This put people at risk of receiving unsafe care because the staff who supported them were not being properly monitored and supported.

Is the service caring?

Everyone we spoke with told us how kind and caring the staff were who visited them. Comments made included 'my carers are wonderful' and 'they are so understanding and they can't do enough for me'.

Is the service responsive?

The management of the agency told us there had been problems over the last twelve months in being able to recruit and retain enough staff. Our findings at the inspection demonstrated this had impacted on the reliability and consistency of service people were receiving. The acting manager told us there was a recruitment plan in place, and more staff had just been employed who were due to start soon.

People's feedback was sought in relation to the way the agency was run. We saw that responses in the feedback forms included people's views of the service provided, the attitude and approach of the staff, and any other issues people wanted to bring up about the service. However people had not received responses to the issues that they had raised in the survey in March of this year. This meant the agency did not directly respond in a timely way to the views of people who used the service.

Is the service well-led?

The acting manager demonstrated during the inspection that they were committed to improving standards in the way the agency was run. They also demonstrated that they were open and transparent in their approach to the running of the agency. They were assisted in running the agency by a deputy manager.

The provider had systems for monitoring the service to check it was safe and suitable. However these were not always effective because they were not being kept up to date or fully implemented. Where actions were needed to improve the service these were sometimes identified. However they were not always being put in place promptly. For example a medication audit had been carried out but there were no follow up actions taken to remedy the shortfalls that were identified.

29, 30 October 2013

During a routine inspection

At the time of our inspection the agency provided support to 75 people in their own homes. We spoke with five people and one relative of a person who received a service from the agency. Comments we received included: 'the service is very good and the carer's are marvellous' and 'the service has improved over the last few months and I would say it was exceptional now'.

People told us that they were involved in the planning of their care and support. It was clear from the records that people were fully involved in the meetings. Their comments and opinions were taken into account when care plans were reviewed.

People's needs were assessed and care was planned and delivered in line with their individual care plan.

The provider had systems in place to ensure that visits to people were not missed. People told us that they were contacted if the time of their visit needed to be changed.

Staff told us that they received appropriate training in relation to supporting people with their medication. We found the provider had systems in place to ensure that people's medication was administered safely.

The provider had put effective plans in place to deal with a temporary shortage in staff which ensured that the effect on people's service was limited.

The service had effective processes in place to monitor the quality of the service provided.

15 January 2013

During an inspection looking at part of the service

We undertook an inspection on the 28 and 29 August 2012. We found that the provider was not meeting one of the ‘Essential Standards of Quality and Safety’. This was because the provider had not ensured that the care plans in people’s homes reflected their current needs. This meant that people were at risk of receiving inappropriate care and support.

Following the inspection we asked the provider to take action to ensure that they became compliant with outcome 4 ‘Care and Welfare of people who use services’.

The provider sent us a copy of their action plan in September 2012. The purpose of this inspection was to review the action the provider had taken, to check that the necessary improvements had been made.

During our visit we found that systems had been put in place which ensured that people’s care and treatment was planned and delivered in line with their individual care plans.

We saw that the provider had a business contingency plan put in place. This ensured that people were protected from the risk of missed visits when the service experienced high levels of staff absence.

29 August 2012

During an inspection looking at part of the service

People told us that they were happy with the service that they received from the care workers who visited them. People said that the care workers treated them with dignity and respect and assisted them in a sensitive and caring way. One person said 'the regular care workers who visit me are excellent and you can't fault them'

People told us that the carers always turned up for appointments. However, people did tell us that care workers were often a little late. Two people told us that sometimes they have had to call Carewatch(Bristol) to make sure that someone was coming. People told us that staff had reassured them that someone was on their way and the carers had always turned up.

People told us that they knew how to raise concerns with Carewatch(Bristol) management and felt confident that these would be dealt with appropriately. They also said that when they require two staff for a visit to perform certain tasks there were always two care workers in attendance.

Staff we spoke with confirmed that they attended regular training and that the training helped them in their work. We spoke to eight members of staff about the support they received from the senior staff. Six people told us that they received regular supervision meetings. However, two staff told us that they had not had a supervision meeting for several months. The registered manager told us that due to changes in the senior staffing some staff had not received all of their supervisions meetings. However, they were working hard to ensure that all staff were up to date. Staff we spoke with also told us that they felt confident about raising any issues with senior staff when they arose and wouldn't have to wait for their next supervision.

26 March 2012

During an inspection looking at part of the service

We carried out this inspection of Morris Social Care Limited to check compliance with a warning notice issued concerning breaches of Regulation 9 ' Care and Welfare. The notice set a compliance date of 15 March 2012.

13 January 2012

During an inspection looking at part of the service

The purpose of this visit was to follow up the way compliance with regulations was achieved following our previous review. For this reason we did not speak to people using the agency

We have written to the registered provider to seek an immediate undertaking from Morris Social Care Ltd that they will not agree to any further care packages for people from Carewatch agency. This is to ensure that people already using the personal care services of Carewatch are not placed at increased potential risk of harm and to also ensure that any new care packages are not placed at any potential risk of harm, whilst improvements are being addressed by Morris Social Care Ltd.

We have already asked the registered provider to send us a report setting out the immediate action they will take to improve. We have asked the provider to send us an update of their actions on a weekly basis. We will check to make sure that the improvements have been made.

We have asked the provider to send us a report within 7 days of them receiving this report, setting out the action they will take to improve. We will check to make sure that the improvements have been made.

We will continue to monitor the safeguarding concerns with Bristol City Council. We will check to make sure that improvements have been made

Where we have concerns we have a range of enforcement powers we can use to protect the safety and welfare of people who use this service. Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeals processes. We will publish a further report on any actions we have taken.

2, 10 June 2011

During an inspection in response to concerns

We visited people that use the agency and asked them and their relatives about the way they experienced the delivery of care from the staff at the agency. We were told about their problems with staffing levels, they said that the staff often arrived late and left early. We were also told that visits were often missed and 2 staff didn't always visit, although it was in their contracted packages of care.

Poor medication management was raised by relatives, they told us there was confusion on the times and dates that medication was to be administered. They then said that because visits were missed people were not receiving their medications at the correct intervals.

Another area that concerned people we visited was confidentiality; they said that staff would openly discuss their healthcare needs in the presence of others.

While we were told that the same staff rarely visited, 1 person said they had the same staff. 2 people and 3 relatives made positive remarks about individual staff and 1 person said that the staff were ok and they found them to be very nice.