Archived: Carewatch (Morpeth)

We undertook this comprehensive inspection as we had received information of concern about the safety of people using the service, including missed planned visits and lack of staff.

At the last inspection in May 2017 were we found breaches of Regulation 12 and 17, relating to safe care and treatment and good governance. As medicines were not well managed and governance systems were not robust, with incomplete record keeping. We asked the provider to complete an action plan to show how they planned to improve the key questions: Is the service; safe, effective, responsive and well led to at least good, and to comply with all legal regulations.

This inspection took place on 20 and 28 November 2017. The first day of the inspection was unannounced with the following day being announced.

There was no registered manager in post. The last registered manager had left the organisation at the beginning of September 2017 and deregistered in October 2017. A new manager had been appointed and had taken up the role at the new location. 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 reviewed records of people’s administered medicines at the service and were concerned with the findings. We found gaps, missing names and dates of when staff had been responsible for medicine administration. There was not always full or detailed information. Staff told us they had prepared their own records to help support people with their medicines as management had not provided them with medicines administration records. This meant we could not be assured that people were receiving their medicines as prescribed.

Risk assessments were not always in place, or lacked detail. Staff therefore did not have the correct level of information to keep people and themselves as safe as possible.

Accidents had been historically reported, the provider confirmed they conducted quarterly analysis on any accidents reported.

Initial assessments and care plans were not always in place. Those that were, lacked detail or had elements missing or names were misspelt. At the last inspection, the registered manager said there was a backlog of incomplete care records. This was still the case.

Staff were aware of their obligation to report any safeguarding concerns and protect people from harm. Staff raised concerns with us during the inspection. They had previously received training in this topic and procedures were in place to support them.

Recruitment was ongoing with many of the office staff new in post, including the manager. The manager felt that there was enough staff in post to support people, although missed calls and rota issues made this difficult to confirm.

Although staff indicated they had an awareness of infection control and its procedures, people told us staff did not always follow safe practice. Gloves and aprons were not always available to staff to support this.

We could not confirm if people were always supported to have maximum choice and control of their lives or that staff always supported them in the least restrictive way possible. This was because information was missing. The policies and systems in the service did not fully support this practice as they were not robust.

Records relating to capacity and consent continued to not be fully completed or in place at all. This meant that we could not always evidence that the service was operating within the principles of the Mental Capacity Act 2005.

Staff had not always received suitable induction, training, supervision or appraisal with the provider to ensure they were suitably trained and supported to work with the people they helped. Evidence was missing and staff confirmed this area to need improvement. At the last inspection we recommended that dementia training be incorporated. The provider sent us evidence to confirm this was now part of the induction process.

The provider confirmed that quality officers who would have normally completed spot checks on staff working in people’s homes had been precluded from doing this because of covering shortages in other areas of the service, including trying to get behind the backlog of care records which needed to be in place. We found spot checks had not taken place for all of the staff records we checked.

Records regarding the level of support people required were not always sufficiently detailed. This meant crucial detail could have been missing to support staff ensure that people received the correct levels of nutrition and hydration.

Comments about the service and its staff were mixed. People were positive about the care staff, but more negative about office and management staff. Comments made about one particular member of management were passed on to the operations director.

We were concerned about the lack of care plan documentation in place. The provider, in some cases only had information they had been supplied with by the local authority and had not completed their own assessment and care plan documentation. This meant there was a risk to people when unfamiliar staff visited as they would not necessarily know what level of care to provide.

The service was not reliable, with missed calls and timings of care calls were erratic. People we contacted were concerned about the number of missed, late and not fully timed calls they received. The local authority was extremely concerned and placed a member of their own care team at the service to support them cover calls.

The provider had a complaints procedure in place, but this had not always been followed or complaints recorded and responded to as they should have. People told us they had found it difficult to contact the provider to make a complaint and some told us they had given up trying.

Quality assurance checks to monitor the robustness of the service were in place. However, these had not always identified the issues we had during the inspection or when they had they had not been followed up to ensure they had been addressed.

During service reviews, feedback from people and their relatives would normally be sought. However, as reviews had not always taken place this had not always occurred. The provider had contacted a number of people though to listen to their concerns in recent weeks but we were not given any evidence what action had been taken as a result of this.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, staffing, receiving and acting on complaints and good governance.

We also made two recommendations in connection with infection control and accessibility.

We sent a letter of ongoing serious concern to the provider stating our initial findings.

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

During the inspection we were contacted by the provider and informed that they intended to remove the location. This meant that the service in Morpeth would close down and people receiving care would transfer to another provider along with the majority of staff. Before this report was published, the provider closed this service on 18 December 2017.

At the time of the inspection, the service was actively providing care to 311 people in the Morpeth, Alnwick, Rothbury, Heddon and Ponteland areas.

A registered manager was 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.

The registered manager had previously worked between two sites, but changes made in the organisation meant that at the time of the inspection, they were based full time at the Morpeth office.

We checked the management of medicines and found the procedures were not always followed. There were gaps and errors in medicine records. Before we finished our inspection, quality officers reviewed medicines and records in people's homes to ensure information was accurate and up to date. Additional medicines training was arranged for staff.

Risk assessments relating to individual risks to people, were not always completed or did not contain sufficient detail. Hard copies of risk assessments were not always available in people's homes, although staff were sometimes sent this information securely to their work telephone. Some were generic in style and therefore liable to misinterpretation by staff. We did not observe any unsafe practices. Environmental risks in people's homes had been assessed. Records of accidents and incidents were maintained and we observed staff reporting concerns about people's safety to the office.

Care plans were also lacking in in detail and were not always available in people's homes. The registered manager confirmed that they had a backlog of care plans for completion, and in the meantime had increased the amount of information and level of detail they sent electronically to staff.

Systems of audit and quality monitoring had not picked up all of the issues we identified although the manager and deputy had already begun addressing some of the concerns we raised.

Staff had received training in the safeguarding of vulnerable adults. They were aware of how to report concerns, and safeguarding records were clear and detailed. Safe recruitment procedures were followed, which helped to protect people from abuse. The service had experienced some issues with staffing although this had improved. There continued to be some issues with recruitment in more rural areas. Some staff told us they often worked long hours. The registered manager and deputy told us they were in the process of reviewing staff rosters and introducing a shift system to avoid staff working long days and working split shifts.

Staff were aware of infection control procedures and were praised by people and their relatives for their cleanliness and always tidying up after themselves. Staff wore gloves and aprons when necessary, for example while preparing food.

Records relating to capacity and consent were not always fully completed. This meant that we could not always evidence that the service was operating within the principles of the Mental Capacity Act 2005. We did not observe, nor were we made aware of any restrictive practices during our inspection. Staff were observed to seek consent and supported people to make decisions about their care.

Staff received regular training, and attended an in depth induction before starting work. They also shadowed more experienced staff before working unsupervised. Training was provided to staff which was relevant to people's specific health needs or specialist equipment in use, and this was carried out by professionals where necessary. Staff competency was also assessed and recorded. We identified that some staff would benefit from further dementia awareness training, as a number of relatives expressed that they felt some staff appeared to have a better understanding of the condition than others. We have made a recommendation about this.

Quality officers carried out field based observations and 'spot checks', where staff were unaware they would be visiting them. Staff also told us they felt well supported by office staff and could contact them if they had any questions.

We observed people being well supported with eating and drinking. Records regarding the level of support people required were not always sufficiently detailed.

Feedback we received from people and their relatives about the care staff was extremely positive and complimentary. We observed that care staff were kind, patient and courteous. Despite working within tight timescales, people told us, and we observed, that staff didn't rush people and supported them in a calm unhurried manner.

Staff we observed were very responsive to the needs of people and appeared to know them well. We observed habits and routines that staff and people had developed which meant that care was provided in the way the people preferred. A lack of documentation of these meant there was a risk that unfamiliar staff may not know about these if they visited, particularly at short notice to cover absence.

We received mixed feedback about the reliability of the service, and there appeared to be geographical variations in relation to this. Some people and their families told us that staff were very punctual and that they were rarely late. Other people explained that the times of visits could vary greatly, which meant that planning and personal routines or preferences could be impacted upon. We were told however, that there had been improvements in the consistency and reliability of the service and there was acknowledgement that the registered manager was trying to address this. We have made a recommendation that the timeliness of calls and the consistency and numbers of staff involved in each package remains under close review.

A complaints procedure was in place and the complaints log was up to date and contained detailed information including responses, outcomes, and lessons learnt. Responses had been provided to people within the timescales outlined in the policy, and where this wasn't possible, people received a holding letter explaining why there was a delay. We read a number of compliments that had been received in the last 12 months. These had been passed on to individual staff where appropriate and recorded in their personnel file.

Feedback systems were in place where the views of people, relatives and staff were sought.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.