Archived: Carewatch (Windsor)

Updated 14 March 2019

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 inspection took place on 9, 10 and 11 January 2019 and was announced.

This was a focused inspection to check the service's compliance with our previously issued warning notices about safe care and treatment and good governance. The inspection team comprised of two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed all the information we held about the service since our last inspection. For this inspection a Provider Information Return (PIR) was not requested. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

In order to gain further information about the service, we spoke with six people who used the service in their homes and telephoned 10 relatives and friends. We also spoke with the person managing the service, the quality officer and four care workers.

We gave the service 48 hours’ notice of the inspection visit as the manager was often out of the office supporting staff or providing care. We needed to be sure that they would be in.

Updated 14 March 2019

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults and younger disabled adults. At the time of our inspection the service was supporting 140 people.

At the time of the inspection, a registered manager was not registered with us to manage the service. However, we were told the member of staff currently managing the service had applied to become the registered manager and was still waiting for the outcome of their application. 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 last inspection was conducted on 13 June 2018. At that inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. To ensure people's safety and quality of care, we issued civil enforcement against the provider. Warning notices were served for safe care and treatment and good governance. We required the service to be compliant with the applicable regulation within 14 days following the warning notice.

The purpose of this inspection was to focus on the regulatory breach and enforcement we issued related to what we found at our previous inspection. This inspection looked at only two key questions; "Is the service safe?" and “Is the service well led?”

We found improvements had been made relating to good governance. However, we found people were still at risk relating to safe care and treatment. We found two people had been without their medicine for two days and the medicine charts we viewed were not always clear to identify what medicines people had received. One person’s warfarin dosage was not clear and a dose had not been signed for on 7 December 2018; we could not confirm if the medicine had been given at that time. In addition, staff were required to complete the back page of medicine charts when issues occurred. For example, if someone refused their medicine or it is not available. We found back pages of the medicine charts were either missing or not completed when issues with medicines arose. We spoke with the quality officer about this and they said they would look into this. We requested further information following our inspection. We had not received this information at the time of writing this report.

We also found that one person had taken all their medicines for the entire day at once. The person self-medicates. However, we saw that they had cognitive impairment due to a brain injury. The service had not completed an incident form or reported this incident as a safeguarding concern to us or the local authority. Following this incident, we did not see a review of the person’s risk assessment relating to the management of their medicines. However, the service had arranged for a review of the person’s mental health and had installed a lockable container in the person’s home to lock their medicines away to reduce the risk of this happening again.

The provider was using less agency staff since our last inspection. We saw documents that confirmed a reduction in agency hours in the previous two months. This had been positive in terms of consistency with people’s support and we saw less incidents were occurring. Spot checks were being carried out regularly including those of agency staff and when issues were identified, actions were in place to address this. In addition, new staff had been recruited to strengthen and improve the service. We visited six people in their homes as part of this inspection and they told us they had seen an overall improvement.

However, we saw that spot checks, telephone checks with people who used the service and agency spot checks were not audited or collated to identify trends. Managers carried out audits of documentation, including risk assessments and reviews of care. We found that these did not highlight that care plans did not always include a comprehensive life history, or detailed notes on religious or cultural needs. In addition, audits had not identified that some risk assessments required updating or reviewing to ensure people’s safety.

We made recommendations relating to the quality assurance system the service currently used.