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Archived: Carewatch (Thames Valley)

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We have not inspected this service yet

Inspection summaries and ratings from previous provider

Overall summary & rating

Requires improvement

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.

Inspection areas


Requires improvement

Updated 14 March 2019

The service was not always safe.

Medicines management did not always ensure people�s safety.

Risk assessments were not updated when events occurred.

Spot checks were not used as a way to identify trends.

However, spot checks enabled the provider to support staff and identified further training required.


Requires improvement

Updated 14 March 2019


Requires improvement

Updated 14 March 2019


Requires improvement

Updated 14 March 2019


Requires improvement

Updated 14 March 2019

The service was not always well-led.

Records were not always up to date to reflect people�s current care needs.

Quality assurance systems were not always robust in identifying shortfalls and taking the required actions in a timely manner. Staff were more involved in the service and regular staff meetings were held to enable clear communication.