Archived: Carewatch (Cranbrook Court)

The people supported by the service had a wide range of needs including decreased mobility, general frailty, dementia, care needs related to age and people who live with a learning disability. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 32 people being supported with personal care by Carewatch (Cranbrook Court) at this time.

People’s experience of using this service and what we found

Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, not all were effective at this inspection. For example, medicine audits were undertaken but were lacking detail, for example, had the medicine been missed and of possible impact on people of not receiving their essential medicines. There were shortfalls in the care plans and risk assessments that had not been identified through the audits of care plans. Feedback from people and staff had not always been acted on.

Not everyone’s specific health needs were identified and planned for to promote responsive care to ensure their safety and well-being, for example, risk assessments for risk of choking were not consistently completed. People who lived with a mental health disorder did not have person specific care plans and risk assessments to enable staff to ensure their health and well-being. COVID-19, person-specific risk assessments were not seen in files at the time of inspection so there was no guidance or information to guide staff. The Manager rectified this.

The service were not following their medicine policy in the management of medicines, which meant there was an element of potential risk to people and staff. The risk of harm to people had not always been mitigated as incidents and accidents were not consistently reported, recorded and investigated.

People received care and support by staff who had been appropriately trained to recognise signs of abuse or risk and understood what to do to safely support people. One person told us they “Totally trust the staff here, I feel safe with the care staff.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with their personal care and mobility.

There was minimal evidence that learning from incidents and accidents took place. Specific details and follow up actions by staff to prevent a re-occurrence were not clearly documented. Action from incidents and accidents were not shared with all staff or analysed by the management team to look for any trends or patterns.

Staff received essential training to meet people’s needs. All new staff completed an induction programme where they got to know people and their needs well. One staff member said, “We do receive regular training, and refreshers.” Where there was an assessed need, people were supported to eat and drink enough to maintain a balanced diet. Referrals and advice were 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.

The management team actively looked for and took up opportunities to work in partnership with local health care and community services to improve people's health and wellbeing.

Staff had a good relationship with the community nurses and other health care professionals and contacted them for advice when needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 20 April 2020). There were no breaches of regulation but we asked for improvements to be made. The provider completed an action plan after the last inspection to show what they would do to improve. The service remains requires improvement.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to review the previous ratings.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The people supported by the service had a wide range of needs including decreased mobility, general frailty, dementia, care needs related to age and people who live with a learning disability. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. There were 31 people being supported by Carewatch at this time.

People’s experience of using this service and what we found

Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, there were areas of peoples’ documentation that needed to be improved to ensure staff had the necessary up to date information to provide consistent, safe care. Some care plans contained information that the staff told us was not current and changes to care needs were not clearly defined. The care plans were immediately updated with the necessary changes to ensure that all staff had up to date information. Quality assurance systems were not fully effective as they had not identified shortfalls to safe recruitment processes and whilst issues with medicines had been identified, improvements were not consistent.

People received care and support by sufficient numbers of staff who had been appropriately trained to recognise signs of abuse or risk and understood what to do to safely support people. One person told us they “Totally trust the staff here, I feel safe with the care staff.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with their personal care and mobility.

Staff received essential training to meet people’s needs. All new staff completed an induction programme where they got to know people and their needs well. One staff member said, “We do receive regular training, and refreshers.” Where there was an assessed need, 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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One person said, “Best staff I’ve ever had.” People’s independence was considered important by all staff and their privacy and dignity was promoted.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. There was a stable staff team who were knowledgeable about the people they supported and had built trusting and meaningful relationships with them. People were supported to go out and form relationships with family and members of the community.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

People that were supported by Carewatch, their relatives and members of staff were actively engaged in developing the service. The registered manager and the staff team actively worked in partnership with other agencies to support the development of joined-up care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 24 September 2018). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

This service was registered with us on 17/04/2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on our inspection programme.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.