Archived: Carewatch (Bentley Grange)

Carewatch (Bentley Grange) is a domiciliary care agency (DCA). This service provides care and support to people living in extra care housing in a purpose built block of flats so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Carewatch (Bentley Grange) is situated in Hailsham, East Sussex and has a satellite location, Cranbrook, which is situated in Eastbourne, East Sussex. They provide personal care for people living in extra care housing in a purpose-built block of flats. Extra care housing is designed for people who need some help to look after themselves, but not at the level provided by a residential care home. People living in extra care housing have their own accommodation and have care staff that are available when needed. The people supported by the service had a wide range of needs including dementia, care needs related to age and people who live with a learning disability. There were 69 people being supported at this time.

At our comprehensive inspection in December 2017 and January 2018, the service was rated inadequate and placed into special measures. This was because we found five breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These related to the delivery of safe care, including medicine management, receiving and acting on complaints, consent to care provided, staff deployment and good governance. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Carewatch (Bentley Grange) on our website at www.cqc.org.uk.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following that inspection, the provider sent us an action plan on how they would meet these regulations. At this inspection we found the provider had made the required improvement and now complied with our regulations. The service has now been taken out of special measures. We have rated the service overall as Requires Improvement. This is because of the previous rating of inadequate in the safe and well-led questions. We needed to be sure they were delivering consistent safe care and were well managed before we can change the rating of safe and well-led to Good.

The last inspection report separated the two locations, Cranbrook and Bentley Grange, as the services had very different outcomes for people. As there had been significant improvements made at Cranbrook we have reported as one service.

There was a registered manager in post who was also the registered provider. 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.

People felt safe with their care staff. Staff understood the importance of keeping people safe and knew the action to take if they had any suspicions that someone was at risk of harm. Risks to people within their home environment and out in the community had been assessed and where issues were identified action was taken to mitigate the risk of harm. People were protected by the prevention and control of infection. Staff understood their responsibilities to report safety incidents, and improvements were made when things went wrong. There were enough staff to meet people’s assessed needs. People were provided with consistency and continuity of care, with a small staff team that knew them well. Safe recruitment practices were followed to reduce the risk of unsafe staff working with people. Staff were trained and supported to have the skills and knowledge to meet people’s needs. Staff enjoyed their role and felt valued by the registered manager. People that received support with their medicines did so safely. Staff had been trained in medicine administration and regular checks were made to ensure people were receiving their medicines safely.

People’s needs were assessed before staff began to support them. The assessments took into account peoples protected characteristics such as their ethnicity and religious beliefs. Where staff were responsible, people were supported to eat and drink enough to maintain a balanced diet. Referrals and advice was sought from relevant health care professionals to ensure people remained as healthy as possible. 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. People were asked for their consent prior to any care or support tasks being completed. The registered manager had taken the necessary steps to ensure that people only received lawful care that was in line with legislation.

Staff treated people with kindness and respect, whilst maintaining people’s privacy and dignity. People were regularly asked for their views about the service and be actively involved in their care. Staff understood the importance of maintaining people’s confidential information. The systems in place supported the management of confidential personal information, in line with legislation.

People and their loved ones were encouraged and supported to raise any issues or concerns with the registered manager. There was a formal complaints procedure in place, and details of how to complain were held with the person’s care records at their home. People were supported by staff to attend functions within their community and in the wider community.

The registered manager had made the necessary arrangements to ensure that regulatory requirements were met. People that were supported by the DCA, their relatives and members of staff were actively engaged in developing the service. Systems were in place to monitor and improve the quality of the service that was provided to people. The registered manager and the staff team actively worked in partnership with other agencies to support the development of joined-up care.

Carewatch (Bentley Grange) is a domiciliary care agency. This service provides care and support to people living in extra care housing in a purpose built block of flats so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Carewatch (Bentley Grange) is situated in Hailsham, East Sussex and has a satellite location, Cranbrook, which is situated in Eastbourne East Sussex. They provide personal care for people living in extra care housing in a purpose built block of flats. Extra care housing is designed for people who need some help to look after themselves, but not at the level provided by a residential care home. People living in extra care housing have their own accommodation and have care staff that are available when needed. The people supported by the service had a wide range of needs including dementia, care needs related to age and people who live with a learning disability.

The service had a registered manager. 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 responsibility for both Bentley Grange and Cranbrook.

This was the first inspection for Carewatch (Bentley Grange) since registering under the new provider in August 2017’. Cranbrook was found to be running as an unregistered service in August 2017, it was subsequently attached as a location to the registration of Bentley Grange in December 2017 to ensure it was legally registered.

There was a lack of leadership and oversight of the service. The registered manager of Bentley Grange had taken full responsibility for managing both locations and had not been supported by the provider to do so. At the beginning of the inspection it was clear that the two locations were running separately and that communication between the two was not clear or transparent. There was a registered manager based at Bentley Grange location and a manager based at Cranbrook. The manager at Cranbrook had applied to be registered with CQC.

The registered manager did not have oversight and information of the people who received care and support at Cranbrook.

Communication between the two locations improved considerably during the inspection. However, as discovered during this inspection process the acting manager of Cranbrook left the organisation in January 2018.

Cranbrook

Audits had been undertaken in September 2017 by senior managers of Carewatch where considerable shortfalls had been found in care documentation, care delivery and in management of medicines. Support had been given by the local authority and senior management of Carewatch. However the necessary improvements had not been taken forward and actioned in a timely manner.

People’s safety was put at risk, because risk assessments and risk management practices at the service were not consistent. Although the acting manager had considered some risks to people’s safety they did not ensure all risks had been properly assessed. The management of medicines were not always safe. Storage of medicines in peoples’ flats for those that lived with dementia were not always locked, placing people at risk of taking medicine without the required supervision. The provider had not made sure that people who required PRN medicines had their needs assessed. PRN guidance had not been completed. PRN guidance is needed to enable staff to understand when someone may need their PRN medicines. There were not enough staff to manage people’s care calls properly, particularly when people needed the support of two staff. There had been a number of missed and late calls which meant that people did not get the call they wanted at the time they preferred. Recruitment processes needed to be improved to ensure that staff were suitable to be working with vulnerable people.

Not all staff had received the necessary training and supervision that ensured they were skilled and competent to care for the people they supported. Whilst staff received training in respect of the Mental Capacity Act (MCA) we found contradictory information in people’s documentation and a lack of person specific capacity assessments.

Whilst there was a complaint procedure made available to people, family and visitors, complaints were not always recorded and responded to appropriately. We received examples and information throughout the inspection process that evidenced the complaint procedures had not been followed. The manager had not reported relevant safeguarding concerns to the local authority when they should have, and not all of the relevant incidents had been notified to CQC.

We did receive some positive feedback about the staff and people felt they were a good bunch, just not enough of them and not enough support for them.

One person told us “Very good staff, seem to know what they are doing.” Staff demonstrated an awareness of people’s needs and were kind in their approach.

Bentley Grange

People were very positive about the care they received. One person told us, “The staff are lovely, I wouldn’t say a word against them. They come on time without fail.”

There were systems in place to regularly monitor the service and make continuous improvements. These included audits, home checks (where staff are observed supporting a person) and satisfaction visits to people. Where results identified areas for improvement these were analysed and acted upon to ensure accountability. People told us the service was well run.

People told us they felt safe. They said they received a punctual, consistent and reliable service. People were protected from abuse and harm because staff had completed training in safeguarding adults, and knew how to recognise and report safeguarding concerns. Risks to people’s health and safety were well managed. Before people began receiving a service an in depth assessment was carried out to assess any risks to the person using the service and to the staff supporting them. Where people needed assistance with medicines, staff had received training and knew how to support people safely.

Staff had the skills and knowledge to meet people’s needs effectively. Recruitment and induction checks were thorough. Reflective practice was encouraged to enhance staff skills and people’s care. People’s health needs were monitored and prompt action was taken to address any concerns or changes. The service had good links with local health and social care professionals and supported people to seek advice and treatment promptly when necessary.

People’s needs were assessed and reviewed regularly to ensure people’s choices, aspirations and preferences were met. Individualised care plans were drawn up with each person before the service started. The care plans contained easy to read and clear information about each task the person wanted support with but also the individual ways people liked their support and care delivered. The care plans explained how to support and encourage people to remain independent, support them to socialise and improve their health. People were confident they could raise any complaints or concerns with the provider and these would be dealt with promptly and satisfactorily. There were enough staff employed to ensure that people’s needs were met. Staff received on-going training and support, which included a mixture of online training and attendance at internal training courses. There were safe recruitment systems to ensure that new staff were checked before starting to work in the home.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is