Archived: Carewatch (Central London)

Our previous comprehensive inspection was conducted on 27 and 28 September and 3 October 2017. At this inspection we found that some improvements had been made in a number of areas in relation to breaches found previously. At that time, we found the provider had not had sufficient time to implement its action plan and issues remained with providing care in accordance with people’s valid consent, responding to people’s complaints in a timely manner and conducting effective quality monitoring to identify and remedy issues. At this inspection we found improvements had been made in all areas inspected and the provider had implemented its action plan.

This service is a domiciliary care agency. It provides personal care for people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection they were supporting approximately 140 people. Not everyone using Carewatch (Central London) receives a regulated activity; CQC 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.

There was a registered manager 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 provider had a procedure in place for investigating and responding to allegations of abuse. Care workers knew how to recognise abuse and were aware of their responsibility to report allegations. The provider appropriately reported safeguarding incidents to the local authority for investigation.

The provider had appropriate systems in place to ensure there were enough, suitably qualified care staff scheduled to work with people. Recruitment processes ensured care staff were safe to work with people.

We saw there were appropriate risk assessments and care plans in place to mitigate known risks. Care workers had a good understanding of how to support people safely to manage risks associated with their care.

Medicines were managed safely. Records indicated that medicines were administered to people as required and care records contained full details of their needs.

The provider operated safer recruitment procedures to help ensure appropriate candidates were appointed to safely care for people.

The provider met the requirements of the Mental Capacity Act 2005 and care workers had a good understanding of their responsibilities.

Care workers were given appropriate training, regular supervision and appraisals of their performance.

The provider ensured that people received appropriate nutrition where this formed part of their package of care. People’s healthcare needs were understood and met by care workers.

There were effective systems in place to monitor the quality of the service and complaints were investigated and managed effectively.

Our previous comprehensive inspection was conducted on 19, 20, 21 and 23 December 2016 and 5 January 2017. At this inspection breaches of regulations were found in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, staffing and submitting notifications to the Care Quality Commission. We issued warning notices in respect of the breaches relating to person centred care and safe care and treatment. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these areas. We undertook a focused inspection on 8 and 9 June 2017 to check that they had followed their plan in relation to the warning notices and other breaches of regulations. We found the provider had made some improvements in a number of areas, but had not had sufficient time to meet their action plan.

Carewatch (Central London) provides care and support to people living in their own homes. There were 302 people using the service when we visited.

There was a registered manager 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.

Risk assessments and care plans contained a good level of information for care staff.

Medicines were accurately recorded when care workers prompted people to take their medicines. Senior staff audited medicine administration records (MARs) on a monthly basis and retrained care workers where errors were made.

Safeguarding adults from abuse procedures were robust and staff understood how to safeguard people they supported. Staff had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However, we found two examples of care records being signed by people’s next of kin where they did not have the legal authority to do so.

People gave good feedback about care workers, but we received some complaints that they were often seen by different care workers. At the time of our inspection, the provider had taken action to address these complaints.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision and appraisal of their performance.

People were supported to maintain a balanced, nutritious diet where this formed part of their package of care. People’s care records contained sufficient information for staff about how to meet people’s needs in relation to their health and nutrition.

The organisation did not have effective systems in place to monitor the quality of the service. Audits were conducted of care records and MAR charts. We saw evidence that feedback was obtained from people using the service. However, the provider’s monitoring did not identify the issues we found in relation to complaints and obtaining valid consent.

We have made two recommendations, one about obtaining valid consent for people to receive care and support and another about the management of feedback and informal complaints.

Carewatch (Central London) provides care and support to people living in their own homes. There were 300 people using the service when we visited.

At the time of our inspection there was no registered manager at the service. The previous manager had left the service approximately two weeks prior to our inspection and a new manager had been recently appointed and was working at the service when we visited. They were in the process of submitting their application to be the registered manager to the CQC.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.

At our previous inspection we found care workers understood how to safeguard the people they supported. However, we identified three examples of safeguarding concerns that had either not been investigated or reported to the relevant local authority in a timely manner. At this inspection we found care workers still had a good understanding of how to safeguard people. We did not identify any safeguarding concerns that had not been investigated or reported.

At our previous inspection we found risk assessments and support plans contained some information for staff, but there were many examples of incomplete or inconsistent record keeping and therefore we could not be assured that people were protected from avoidable harm. At this inspection we found some progress had been made to ensure that care records contained enough information for care staff. However, there were still some examples of care records not containing enough detail about the risks to people’s care.

At our previous inspection we found medicines were not accurately recorded when care workers administered them, so it was not possible to determine what medicines people had taken and when. At this inspection we found progress had been made to ensure accurate records were kept and senior staff were in the process of reviewing all MAR charts to ensure this was happening.

At our previous inspection we found care records contained limited information about people’s healthcare needs and very little recorded information from healthcare professionals. At this inspection we found some progress had been made to ensure that care records contained appropriate information about people’s health needs. However, there were still some examples of care records not containing enough detail about people’s health needs.

At our previous inspection we found that staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However, records did not always contain details of people’s capacity and records were often not signed by the person using the service. Senior staff did not ascertain whether signatories to documentation had the legal authority to make decisions on people’s behalf and therefore we could not be assured that people’s rights were being protected. At this inspection we found some progress had been made to ensure that care was provided in accordance with people’s valid consent. However, there were still some examples of care records not being signed by people using the service or of records not containing details about people’s capacity.

At our previous inspection we found that appropriate numbers of staff were not always deployed to provide people with care. People requiring two care workers to attend to them did not always receive this support. People with moving and handling needs were sometimes hoisted by one person despite needing to be hoisted by two people for their safety and the safety of staff. At this inspection we found people who required two care workers were provided with this support.

At our previous inspection we found complaints were not investigated and responded to in a timely manner. At this inspection we found complaints were investigated and responded to in a timely manner.

At our previous inspection we found information was not reported to the Care Quality Commission (CQC) as required. We found evidence of five safeguarding incidents that were not reported in line with requirements. At this inspection we found that incidents were reported to the CQC as required.

There had been concerns about the high number of safeguarding alerts since the registration of this service. At the time of the inspection the local authorities that commissioned the provider’s services were working with the provider to support them to make improvements.

At the time of our inspection there was no registered manager 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 previous manager had left the service on 28 November 2016 and a new manager had been recently appointed and was working at the service when we visited. They had submitted their application to be the registered manager to the CQC.

Risk assessments and support plans contained some information for staff, but we saw many examples of incomplete or inconsistent record keeping and therefore could not be assured that people were protected from avoidable harm.

Medicines were not accurately recorded when care workers administered them, so it was not possible to determine what medicines people had taken and when.

Safeguarding adults from abuse procedures were in place and care workers understood how to safeguard people they supported. Care workers had received safeguarding adults training and were able to explain the possible signs of abuse as well as the correct procedure to follow if they had concerns. However, we identified three examples of safeguarding concerns that had either not been investigated or reported to the relevant local authority in a timely manner.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However, records did not always contain details of people’s capacity and records were often not signed by the person using the service. Senior staff did not ascertain whether signatories to documentation had the legal authority to make decisions on people’s behalf and therefore we could not be assured that people’s rights were being protected.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way. However, care records contained very limited details about people’s individual needs or preferences.

People we spoke with and their relatives told us they were involved in decisions about their care and how their needs were met.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role.

People requiring two care workers to attend to them did not always receive this support. People with moving and handling needs were sometimes hoisted by one person despite needing to be hoisted by two people for their safety and the safety of staff. Care workers were provided with appropriate training to help them carry out their duties. Care workers received regular supervision of their performance, but appraisals had not been conducted for over one year for some staff.

People were supported with their nutritional needs where this formed part of their package of care. However, care records contained very limited information about people’s dietary needs.

Complaints were not investigated and responded to in a timely manner.

The provider’s systems for monitoring the quality of the service were not always effective. Information was not reported to the Care Quality Commission (CQC) as required. We found evidence of five safeguarding incidents that were not reported in line with requirements. An action plan was in place which mirrored the findings in our inspection, but the service needed more time to implement this. We saw evidence that feedback was obtained by people using the service and the results of this was positive.

During this inspection we found breaches of regulations in relation to person centred care, dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaint handling, good governance and submitting notifications to the CQC. You can see what action we told the provider to take at the back of the full version of the report. We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.