Archived: Carewatch (Ipswich)

Updated 20 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection and took place on 17, 21 and 24 May 2018. The inspection was carried out by two adult social care inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. Our experts by experience had experience of receiving care and support at home.

We gave the service 48 hours' notice of the inspection visit because we needed to be sure that the manager would be available.

Before our inspection we reviewed the information we held about the service. We reviewed notifications of incidents that the provider had sent us since their registration. A notification is information about important events, which the service is required to send us by law. We reviewed the information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

On the first day of the inspection we visited the agency office where we spoke with the manager and the providers head of quality. On the second day and third day of the inspection we visited three people in their home. We contacted 24 people and nine relatives of people who used the service and spoke with them on the telephone. We also spoke with two quality officers and six members of care staff.

We looked at three records which related to people's individual care needs. We viewed four staff recruitment files, training records, and records associated with the management of the service. This included policies and procedures, quality assurance processes, people and staff feedback, and the complaints process.

Updated 20 July 2018

This inspection took place on 17, 21 and 24 May 2018. The inspection at the office premises on 17 May 2018 was announced but the subsequent visits to people in their homes on 21 and 24 May were not announced to the service.

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.

The previous registered manager of the service had left. The new manager had applied to register with the Care Quality Commission. 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 were not receiving care and support in a consistently safe manner. This was because risks to people from receiving care and support were not managed effectively. For example risk assessments were not in place for people who required the use of a hoist with moving and handling. This put people at risk of unsafe practise for example if the wrong size sling was used. Where the service was responsible for managing people’s medicines this was not done in a safe manner. We saw examples of where medicines had been missed, or were stored inappropriately.

At the beginning of 2018 the service had missed a high number of visits. For the three weeks prior to our inspection there had been no missed visits. We discussed this with the manager and the provider’s head of quality. They told us that measures had been put in place to recruit additional staff and schedule calls effectively so that visits were not missed. However, feedback we received showed that covering all of the calls was still proving challenging for the service.

People expressed dissatisfaction to us that the service did not always send out a rota detailing the person that would be visiting them to provide their care and support. They also told us that if they did receive a rota it was often incomplete and the times that staff actually arrived varied from that on the rota. People also expressed dissatisfaction that they were not told the time care staff would call with visits being scheduled as ‘am’ call, or tea call. Not receiving an accurate rota meant people felt unsafe and their lives were disrupted when they did not receive support at the appropriate time.

People did not feel encouraged or empowered to raise concerns with the service. Incidents were described to us by people which had caused them concern but they had not felt able to raise these with the service. Where people had made a formal complaint they did not feel that this had been dealt with to their satisfaction.

Staff training was not up to date and one member of staff told us they regularly provided care and support having received no training from the service. This did not assure us that the service ensured staff had the skills and knowledge to deliver safe and effective care and support.

People were not always supported to maintain adequate nutrition. Where people required support with their nutrition effective care plans were not in place and food and fluid intake was not effectively recorded.

People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible. For example people had their medicines locked away in their homes without the appropriate procedures being followed. However, people told us that staff sought their consent before providing care and support.

We received mixed views as to whether care staff delivered care in a caring and supportive manner. Where people received support from a regular member of care staff they were complimentary but where a number of different care staff provided care and support, for example at weekends, the feedback was poor.

Care was not always delivered in the manner which the person requested and that care staff did not always stay for the required amount of time. We found that systems in place to check the duration of staff visits were ineffective. People also told us they were not able to choose the gender of the person providing their care and support.

The service had recognised that there were deficiencies in the care and support being provided when they took on staff and increased care hours from another provider. However, actions put in place to address the concerns had not resulted in an effective and timely improvement in care and support.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We were so concerned about the safety of people being supported by the service that after the inspection visits we contacted the provider. They have responded by putting measures in place which addressed our immediate concerns. You can see what action we told the provider to take at the back of the full version of the report.