Archived: Carewatch (Tyne & Wear)

At the last unannounced, comprehensive inspection completed on 12 November 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to staffing, safe care and treatment, need for consent, receiving and acting on complaints and good governance. We asked the registered provider to take action to make improvements. The registered provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. We undertook this comprehensive inspection to check that the registered provider had followed their plan and to confirm that they now met legal requirements.

The service is registered to provide personal care to people in their own homes. At the time of our inspection the registered provider had 316 people using its 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 there was a registered manager in post.

We found that all the breaches of regulation found in our visit in November 2015 had now been met.

We found all care plans had not been reviewed. There was a risk therefore that people’s needs had changed. We did see the service had consulted with people about their care via telephone calls and quality visits.

Staff told us they were supported by their management and could get help and support if they needed it. Staff did receive supervision through observations and discussions but these were not always recorded.

People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated. The registered provider had in place clear guidance to staff regarding gifts and gratuities to prevent people from being placed at risk of financial abuse.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support package met their needs. People who used the service told us that they had a team of staff, who were generally reliable and arrived when expected.

The service had systems to ensure staff were appropriately recruited and trained. The service had introduced the Care Certificate for new staff and staff were being supported to achieve National Vocational Qualifications in health and social care.

The staff undertook the management of medicines safely and in line with people’s care plans. The service had health and safety related procedures, including systems for reporting and recording accidents and incidents. The care records we looked at included risk assessments, which had been completed to identify any risks associated with the person’s environment and delivering the person’s care.

People’s consent had been obtained by the service to deliver care and people and their relatives and carers told us the service was caring.

The service had considered people’s food and fluid intake and put in place specific plans to meet individual people’s needs.

The registered provider had in place a statement of confidentiality and staff we spoke to understood the statement.

The service had in place arrangements to gather information about people before they visited people to assess their needs before delivering care. Care plans were person centred.

There were quality assurance systems in place to gain the views of people using the service and to check on the safety and quality of the service.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We asked for, and received from the provider a written plan of the actions that were to be taken to become compliant with this outcome.

In this desk-based review we have reviewed documentation submitted by the provider to demonstrate compliance.

We found the provider had taken appropriate steps to improve the assessment, planning, documentation, recording, auditing, and safe handling of people's medicines.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

There were enough care workers employed to meet the needs of the people using the service, and a member of the management team was available on call in case of emergencies. Every person we spoke with told us they felt quite safe with their care workers. Risks to people and care workers were assessed and managed. People's safety was monitored by spot checks of their care workers' work. Improved systems had been put in place to record the safe administration of people's prescribed medicines, and care workers had been given training in the safe handling of medicines. However, there was a lack of clarity in some people's medicines support plans. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. They told us they were treated with dignity and respect by their care workers. Care workers we spoke with had a good understanding of the people's care and support needs and knew them well. People told us they had never had a missed call, and said their care workers were usually on time and stayed the full time allotted to them. One person told us, 'I am sure my carers know what they are doing. I have never had a mishap and I know they do training.' Staff had received training to meet the needs of the people using the service.

Is the service caring?

People told us their care workers were kind and attentive and showed patience and gave encouragement when giving their care. People told us they were delighted that they had, for the most part, stable care workers with whom they had forged good working and caring relationships. One person said, 'I have always been treated with respect and my dignity is as important to them as to me, they are more like friends than workers.' Another person commented, 'You would not be able to find a better carer than the one that comes to me, she is like a daughter to me, nothing is too much for her to do.'

Is the service responsive?

We saw the service had improved significantly since the previous inspection, and had responded appropriately to address areas of non-compliance. People's needs were assessed before a service was offered to them, to make sure all their needs could be met by the service. Records confirmed people's preferences, interests, wishes and needs had been recorded and care and support had been provided in accordance with their wishes. One person told us, 'They will do anything I ask of them.' Another person told us she could say anything she liked to the staff and they would always listen to her and try to help her. Only two people told us they had ever needed to complain, but both said their complaints had been taken seriously and responded to immediately. Care workers told us they were encouraged to tell the office of any concerns about a person using the service, and that there was always a positive response.

Is the service well-led?

The service had a registered manager who had been in post for one year. The service had a wide range of systems in place for assessing and monitoring the quality of the service provided. This enabled the manager to identify parts of the service that needed improvement, and take the necessary actions. Most of the people who used the service told us they had been asked for their views about their care in surveys. Staff spoke highly of the manager, saying she was 'very good and very fair.' They told us she always took their views into consideration. One care worker told us, 'Eighteen months ago I was looking for another job, but now I'm glad I stayed, because the management is so much better, now.' Another staff member said, 'The manager is excellent. She is passionate about the service and a good leader.'

People had their care needs assessed before any care was given. People told us they were generally very happy with their care, especially from their regular care workers. One person told us, 'I have no complaints ' my carers are perfection personified.' Another person said, 'We are very pleased. We have a very good carer.'

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were not being fully protected against the risks associated with the unsafe use and management of medicines. The registered person had not made appropriate arrangements for the recording, handling, using, and safe administration of medicines.

Good systems were in place to make sure unsafe people were not employed as care workers.

Although systems had recently been introduced to check the quality of care given, these had not had time to be effective.

Records held regarding people's care and treatment and about the management of the service were not easily accessible, were not stored securely, and were not accurate and kept up to date.