Archived: Carewatch (Windsor)

We previously inspected the service in August 2016. The service was not meeting all the requirements of the regulations at that time. Following that inspection, we asked the provider to make improvements to how complaints were handled, monitoring of the service, staff support including training and supervision and informing us about notifiable occurrences. The provider sent us an action plan which outlined the improvements they would make. We also recommended improvements be made to medicines practice, accident and incident reporting, best interest decision making and use of mobile phones whilst staff were supporting people.

Carewatch Windsor provides support to mainly older people in their own homes. Two hundred and forty eight people were receiving a service at the time of the inspection.

The service had 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.

We received positive feedback about the service. Comments from people included “I’m extremely happy with the help that I get from Carewatch.” A relative said “They’ve made a lot of difference to mum especially with her confidence.” Other people said “Nothing is too much trouble for them at all,” “It’s nice to know that they’re here for me” and “I’m pleased to open the door for them, they’re all very nice staff.”

People we spoke with told us they felt safe. Comments included “Mum feels very safe with them and if she’s happy, I’m happy,” “I feel very safe with them. It’s good to know that they’re here for me,” “I definitely feel safe when they’re here” and “I always feel safe with them.”

We found improvement had been made to recording of when medicines had been given to people. Improvement had also been made to best interest decision making processes where people lacked mental capacity. The service had obtained copies of power of attorney documentation, where appropriate, so it was clear to see who had authority to make decisions on behalf of service users. No one raised concerns with us on this occasion about staff using their mobile phones whilst they supported people.

There were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. People spoke positively of their regular care workers. For example, “The carers are very nice, very kind to me,” “All that come seem quite pleasant,” “The carers are lovely” and “The girls are very good, very kind to me.” People told us they did not always know who would coming to support them. We have made a recommendation for the service to follow good practice by providing people with staffing rotas.

Some people told us they received a different standard of care at weekends. Comments included

“The weekend staff don’t wash me properly, bit slap dash and they rush through things. They just do the minimum required. One girl kept her coat on whilst she was washing me which is not the best when you’re naked.”

There were systems for inducting, training and supervising staff. However, some care workers did not feel they received the support they needed whilst out in the community.

Accidents had not always been properly recorded at the service. For example, injuries were not always noted and information had not consistently been provided about actions to prevent recurrence.

People told us they had mixed responses to how their complaints were handled. Some people were satisfied with the responses they received. For example “Carewatch have a new complaints officer. She is wonderful. She is so prompt, dealt with my concern within two hours. This has never happened before. We are so happy that now we have someone in Carewatch Windsor that listens.” Another person told us “I’ve had a moan and they’ve dealt with it.” Other people were less pleased and said “I ring the office but nothing happens, I spoke with a lady who deals with complaints and it got better for a while then it deteriorated again” and “My daughter has tried to complain but never got anywhere.”

The service had been managed by a different registered manager since our last inspection. A social care professional said they had made “Huge improvements” at the service in that time. Staff we spoke with felt positive changes had been made to the culture of the service. Improvement had been made to notifying us about reportable occurrences. However, we were not promptly provided with additional information we asked for, to tell us what had happened and actions taken by the service.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to good governance of the service, handling of complaints and safe care and treatment.

You can see what action we told the provider to take at the back of the full version of this report.

This was the service’s first inspection since registration.

Carewatch (East Berks and South Bucks) & Carewatch (Woking) provides care to mainly older people in their own homes. Approximately 250 people were receiving support in the East Berks and South Bucks area and 72 in the Woking area. The office is located in Windsor.

The service did not have 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. An application had been submitted to the Care Quality Commission to register a manager.

We found people overall were satisfied with the level of care they received. Comments included “I wouldn’t change any of what they do, I couldn’t do without them,” “On the whole they’re very good, very trustworthy,” “I’m quite satisfied with the service” and “Everything is going well and I’ve no complaints.” One person told us “Most of the carers are 120 per cent.” They added their regular care worker “Does little things without you noticing. She’s very professional but so caring.”

People told us the support they received helped them remain independent in the community. We received positive feedback on the caring nature of staff. One person said care workers were “Always kind, considerate and respectful, they treat me very well.” Another told us “They’re very pleasant, patient, kind and caring.”

People said they were treated with dignity and respect. We heard that some staff used their personal mobile phones whilst they supported people. We have made a recommendation about use of personal phones during the provision of care.

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. We found a very low rate of accident and incident reporting, which was out of line with the number of people supported by the service. We have made a recommendation for action to be taken to ensure staff know what they need to report to the office. The accident records we checked showed appropriate follow up had been made by the service.

Staff were recruited using robust procedures to make sure people were supported by workers with the right skills and attributes.

The induction process for new staff was detailed and led to the Care Certificate. This includes an identified set of standards that health and social care workers need to demonstrate in their work. However, most staff who contacted us said they did not feel supported in their roles and were not able to obtain guidance and advice out in the community when they needed it. Staff and people who used the service told us it was difficult to get through to the office by telephone. They said calls often went unanswered and if they did get through, messages were not always returned or responded to. The service had appointed additional staff to improve the response to phone calls and to provide more support for care workers.

We found the service did not make appropriate checks to make sure relatives had the legal authority to make decisions on behalf of people who lacked capacity. We have made a recommendation about checking who can legally make decisions on people’s behalf. People who did have capacity told us staff asked for their permission before they carried out tasks.

Care workers supported people with their nutritional and healthcare needs. They maintained a log of the care they had provided for people and any concerns they had. We have made a recommendation about the recording of medicines administration.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs.

There was inconsistency in the handling of complaints. People told us their complaints were not always listened to or responded to by the service.

Some of the staff said they would not be confident in reporting any concerns because the culture of the service was not open and they felt there would be negative consequences for them.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to handling of complaints, notifying of serious incidents, seeking and acting on feedback and staff support. We also found a breach of the Care Quality Commission (Registration) Regulations 2009, as the service had not notified us of a safeguarding concern. You can see what action we told the provider to take at the back of the full version of this report.