Archived: Carewatch (Colebrook House)

Carewatch (Colebrook House) is an extra care housing scheme providing support to people living in their own flats and houses across two schemes. Carewatch (Colebrook House) provides care and support to 57 flats at Colebrook House and 43 flats and two bungalows at Richard Neve. At the time of this inspection, 68 people were using the service.

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.

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

Records were not always complete, consistent, updated when required and personalised to individual needs. There were systems and processes in place for assessing and monitoring the quality and safety of the service. The improvements made had not been fully embedded across both schemes and sustained over a period of time to consistently achieve best outcomes for people.

We have made a recommendation about the infection prevention and control and supporting people with their communication needs.

People and their relatives told us they felt safe using the service and that improvements were being made to the quality of care and support received. Risk to people were identified and assessed but risk management plans were not always personalised to meet individual needs. Despite this staff knew people well and the management team was in the process of reviewing and updating all care and risk management plans to be in line with their current standards. People received care and support from staff that were supported through training, supervision and appraisal.

People were supported by staff that were kind and caring towards them. Staff supported people with activities, however, this was limited due to COVID19 restrictions.

Staff understood their responsibility to protect people from the risk of abuse and to report any concerns of abuse. There were enough staff available to support people’s needs and appropriate recruitment procedures were followed before staff started working at the service. People were supported to manage their medicines safely. Lessons were learnt from accidents and incidents.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Before people began using the service their needs were assessed to ensure they could be met. People were supported to maintain good health; eat healthily and access healthcare services when required. Staff respected people’s privacy, dignity and promoted their independence. Staff understood people's diverse needs and supported them in a caring way. People were involved in making decisions about their care and support needs and knew how to complain if they were unhappy about the service.

Care and support was planned and delivered to meet people’s needs and people were encouraged to build relationships with those that were important to them.

The manager understood their responsibility for meeting regulatory requirements. We received mixed views from staff about the culture and the way the service was managed. The provider gathered the views of people, their relatives and staff to improve on the quality of service. The service worked in partnership with key organisations to deliver an effective service.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 10 December 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was carried out to monitor for improvements following our last inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led key question sections of this full report. We found no evidence during this inspection that people were at risk of harm from this concern.

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.

About the service

Carewatch (Colebrook House) is an extra care housing scheme providing support to people living in their own flats and houses across two schemes. Carewatch (Colebrook House) provides care and support to 57 flats at Colebrook House and 43 flats and two bungalows at Richard Neve. At the time of this inspection, 81 people were being supported with personal care.

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.

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

People were not always protected from the risk of avoidable harm. Appropriate risk assessments and management plans were not always in place as required. The systems and processes in place for assessing and monitoring the quality of the service was not robust enough to identify shortfalls.

People’s medicines were not always acquired in time to ensure they had sufficient stock in place.

There were procedures in place to minimise the spread of infection. Appropriate staffing levels were in place to ensure people’s needs were met. Also, the organisational culture had not improved, and all these areas required improvement.

People were protected from the risk of abuse. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Care and support was planned and delivered to meet individual needs. People and their relatives’ views were gathered through telephone monitoring to improve on the quality of the service

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

Rating at last inspection (and update) - The last rating for this service was requires improvement (published 05 March 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found that improvements had been made person-centred care and the need for consent; therefore, the provider was no longer in breach of these regulations. However not enough improvement had not been made or sustained and the provider was still in breach of regulations 12 and 17.

The service remains rated requires improvement. This service has been rated requires improvement for the second time since they changed their legal entity.

Why we inspected

The inspection was prompted in part due to concerns received about medicines management, infection control, staffing, safeguarding adults, risk management, quality assurance and the overall management of the service. Also, we carried out an announced comprehensive inspection of this service on 14, 15 and 27 January 2020 where breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care, need for consent, safe care and treatment, good governance and notifications of other incidents.

We made a decision and undertook this focused inspection to examine those risks and to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the whole Key Questions of Safe and Well-led. We also followed on specific breaches of legal requirement under Key Question Effective and Responsive which all contained those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carewatch (Colebrook House) on our website at www.cqc.org.uk.

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 will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, good governance at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Carewatch (Colebrook House) is an extra care housing scheme providing support to people living in their own flats and houses across two schemes. Carewatch (Colebrook House) provides care and support to 57 flats at Colebrook House and 43 flats and two bungalows at Richard Neve. At the time of this inspection, 63 people were being supported with personal care.

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.

People’s experience of using this service

People were not protected from the risk of avoidable harm. Risk to people was not always identified, assessed and had appropriate management plans in place to manage risks safely. Accidents and incidents were reported and recorded but these were not always analysed to drive improvements. Medicines were not always managed safely, and medicines records were not always consistent with the care and support people received. Care and support were not always planned to ensure people’s individual needs were met. Records were not always accurate, complete and consistent. The systems in place for assessing and monitoring the quality of the service was not always effective. The provider failed to notify the commission of incidents that had occurred at the service as required by law.

People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. However, the service did not seek people’s consent for photography and records were not consistently clear whether people had given their consent to the care and support they received.

We have made two recommendations in relation to supporting staff and presenting information in formats that meet people’s needs.

People and their relatives were complimentary of the care and support they or their loved ones received. They said the service had improved since our last inspection and they received care and support from staff that were kind, compassionate and treated them respectfully. People said their privacy and dignity was respected and their independence promoted. People and their relatives were involved in making decisions about their care and support needs and their views were respected.

Enough staff were available and effectively deployed to ensure people’s needs were met. The service followed appropriate recruitment checks. Staff followed infection control procedures to minimise the spread of diseases. Before people started using the service their needs were assessed to ensure it could be met. People were supported with food and drink for their health and well-being. People were supported to maintain good health and staff engaged with healthcare professionals to provide care and treatment where required. People and their relatives said they knew how to make a complaint and were confident their complaints would be addressed. People’s views were sought through surveys and tenants’ meeting to improve the quality of the service. The service worked in partnership with key organisations to ensure people’s needs were met.

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 April 2019). Since this rating was awarded the provider has altered its legal entity.

Why we inspected

We carried out an announced comprehensive inspection of this service on 20 and 21 February 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve, person-centred care, dignity and respect, safe care and treatment and good governance.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

Enforcement

We have identified breaches in relation to person-centred care, need for consent, safe care and treatment, good governance and notification of other incidents at this inspection.

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

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.