Archived: Carewatch (Windsor)

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.

The inspection visits took place on 13, 14 and 15 June 2018 and were announced. Subsequent to the inspection, we received concerns from three separate sources. We have incorporated evidence arising from these concerns in this report.

We gave the provider 5 days’ notice as we wanted to make sure someone would be there to assist with locating documents and to arrange visits to people’s homes. This is the first inspection since the service moved to this location.

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 196 people.

The service requires a registered manager to manage 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. At the time of our inspection a registered manager was managing the service.

We received information following our inspection that the registered manager and deputy manager left the service on 23rd August 2018. The interim arrangements were that the area manager would be responsible for managing the service.

Medicines were not always managed safely. For example, we saw that staff had not always signed for medicines they had given and incorrect codes were used on some medicine records. We saw that staff were signing medicine records for one person’s insulin which would indicate that they had administered the insulin. However, the person administered their own insulin and only required prompting. We discussed this with the management team during feedback. We were told this would be addressed. We received concerns about the poor management of medicines following our inspection.

During our inspection we visited one person in their home and found a risk assessment was not in place for the person’s bedrails and their overhead hoist.

The provider did not have robust systems to monitor the quality and safety of the service. Systems did not enable the provider to identify that safety of people using the service was compromised. Spot checks were carried out by senior staff but did not highlight the concerns we found. Systems for identifying risks and issues were ineffective.

Safe recruitment procedures were carried out. Files we saw contained relevant documentation required to ensure only suitable staff were appointed. Staff received appropriate induction, training and support. Mandatory training was completed by new staff before they could support people. Following completing of training senior staff carried out spot checks to ensure staff were competent in their role. However, spot checks did not identify issues we found following our inspection. Following our inspection, we received a whistle blowing concern raised to the local authority about a member of staff not having a Disclosure and Barring Service check completed prior to them joining the service. We were aware the provider agreed to complete an investigation into the concern raised.

At our inspection we found that complaints were responded to and used as a way of improving the quality of the service. However, following our inspection we received additional information that concerns and complaints had not been responded to or acknowledged.

We received mixed views about the service from relatives and people we spoke with. Relatives told us, “I think [my family member] is safer with them now, it was quite bad before, but I still check on everything”, “Well the regular carers are very good it’s when we get random others that it is not so good”, “I am sure [family member] is safe with them, “I suppose I have to say it has got better in the last few weeks”, “The regular girls in the week are alright but at the weekend it’s all strange faces and [family member] doesn’t like it, well who would.” People told us, “Well its usually the same carers but sometimes they are different, they do my medicines fine”, “They just come once a week to take me shopping, it’s the same lady, I do feel very safe with her”, “I am happy with the staff.”

Professionals we spoke with told us they had seen improvements in the service provided.

Staff received training in safeguarding. They told us they would not hesitate to report any concerns they had. Staff could contact the office or the on-call system if they wanted to discuss anything.

Staff told us they felt supported and they had regular supervisions. Records confirmed supervisions took place. One member of staff told us, “Yes definitely supported, you couldn’t want for more.”

People had access to healthcare services to maintain good health. People were supported to attend healthcare appointments when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Information we received following our inspection showed this was not always the case. We were aware one person specifically stated their preference to have female staff only supporting them. However, the service did not respect the person’s wishes which led to care and support being rejected by the person.

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