Archived: Carewatch (Poole)

Carewatch Poole provides personal care and support to people who live in their own homes. At the time of our inspection they were providing personal care to approximately 100 people.

Carewatch Poole has a registered manager in post. 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 last inspection in September 2016 the service was not meeting the requirements of the regulations and CQC took enforcement action for the repeated breaches of the regulation we found. The service received an overall rating of Inadequate and the provider was placed into special measures by CQC.

At this inspection action had been taken by both the registered manager and provider, there were significant improvements and the breaches in the regulations had been met. We were not able to tell at the time of the inspection whether the improvements we found could be successfully embedded and sustained. We will review the impact of these improvements further at our next inspection.

People told us they did not always have a consistent staff team and that the communication between themselves and the office still needed to improve further. These were areas for improvement.

Some people received care and support in a personalised way. Staff knew people well and understood their needs. There were care plans in place so that staff knew what care and support to provide to people. We found that people received the health, personal and social care support they needed and any risks were managed.

Staff were caring and treated people with dignity and respect. People and staff had good relationships. People told us they liked all of their care workers.

People told us they felt safe and relatives said their family members were safe with staff and they had confidence in staff.

There were systems in place to safely manage and administer medicines for people. Staff had been trained in the safe administration of medicines.

Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

People and their relatives knew how to raise concerns or complaints. People and relatives were regularly consulted by the service.

Staff received an induction and core training so they had the skills and knowledge to meet people’s needs. There were enough staff employed and staff were safely recruited.

The culture within the service was personalised and open. There was a clear management structure and staff, relatives and people felt comfortable talking to the managers about any issues and were sure that overall any concerns would be addressed. There were systems in place to monitor the safety and quality of the service provided and share any learning both in the branch and across the organisation.

Carewatch West Dorset provides personal care and support to people who live in their own homes. At the time of our inspection they were providing personal care to more than 100 people.

Carewatch West Dorset has a registered manager in post. 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.

This inspection was brought forward from the planned date due to a number of notifications from the service that calls to people had not been completed and safeguarding enquiries from the local authority about missed visits and concerns with medicines administration and concerns about one person who had had a serious accident whilst staff were present. At our last inspection in November 2015 we found breaches in the regulations relating the provision of person centred care and to the management of medicines. The provider submitted an action plan which stated that the service would meet these regulations by July 2016. This inspection was also carried out to check that the provider had taken the required action.

At this inspection we found that the registered manager had been temporarily seconded to another branch for over eight weeks with one day a week at the Poole branch, in addition to regular communication with staff in Poole. The deputy manager told us that they had spent a number of days at the same branch and also spent time supporting the branch from the office in Poole. We found that there were repeated breaches in the regulations relating the provision of person centred care and to the management of medicines. We also found additional breaches in three other regulations.

People we spoke with gave us positive feedback about the staff. They said the staff were kind and caring and they felt confident that the staff were knowledgeable about their role. Staff understood how to maintain people's dignity and treated people with respect. However, people's rights were not always protected because the service was not acting in accordance with the Mental Capacity Act 2005. This shortfall was a new breach of the regulations.

Some people were still not always protected against the risks associated with the unsafe management and use of medicines. Medicine records for four people were checked. Errors and omissions were identified in each record and these had not been identified through the audit process that was in place. This was a repeated breach of the regulations.

Areas of risk in relation to matters such as leaving out medicines for one person and the use of equipment had not been identified by staff for three people and therefore suitable plans had not been put in place to reduce and manage possible risks. Other risks had been identified but the assessments had not been reviewed and updated following significant events or changes in people's needs. This shortfall was a new breach within this regulation.

Staff were recruited safely but the service had experienced a period of staff shortages and existing staff were working long hours to try to ensure that they provided a service to the people the service worked for. Some staff were not receiving regular supervision and support. Seven staff files were reviewed. One staff member had left and another was on long term absence. One staff member had not had any form of supervision since 20 January 2016, another since 5 August 2016. One person had received a number of spot checks and supervisions during their probation. None of the issues that were raised in these meetings were discussed at the probation review where they were taken on as permanent staff. Two further staff members had not received further supervision following disciplinary action being taken. Three other staff supervision records were picked at random. The most recent dates for either an appraisal, office supervision or spot check were December 2015, January 2016 and May 2016. Therefore staff were not receiving regular and effective supervision and support. This shortfall was a new breach of the regulations.

All of the people whose care records we examined were at risk of their needs not being fully met, because care plans and assessments were not up to date and lacked specific information about people's needs and how they should be met. This was a repeated breach of the regulations.

Quality monitoring systems were not effective and had not identified any of the issues found during this inspection. Some records contained errors and omissions and some were illegible: two care plans were not dated or signed, hand written records for the investigation of a complaint were illegible, 15 entries in daily records for one person were checked and there were no entries for three visits, 13 entries in daily records for another person were checked and two entries were illegible, 18 entries daily records for another person were checked and there were not records for two visits. This meant that staff may not always have important information available to them. This shortfall was a new breach of the regulations.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. 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 no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.