Archived: Carewatch (Horsham & Crawley)

Carewatch (Horsham and Crawley) is a domiciliary care service providing personal care and support to people in their own home. At the time of the inspection 76 people were being supported. 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 and their relatives told us they were happy with the service they received. They described the care workers as kind, caring, patient and said the service was reliable.

The registered manager had addressed the areas identified for improvement following the last inspection. For example, systems for safeguarding people from abuse had been reviewed and were now robust. Incidents were consistently monitored and safeguarding concerns had been appropriately identified and escalated in line with the provider’s policy.

Systems for monitoring quality and managing risks had been reviewed and improved. There were robust arrangements to support governance and to provide management oversight. This meant that the registered manager could be assured that risks were consistently identified and managed.

Appropriate infection control procedures for the Covid 19 pandemic were in place to keep people safe. Staff had received additional training and used appropriate Personal Protective Equipment.

Risks to people were assessed, managed and reviewed consistently. Detailed care plans provided staff with the information they needed to provide care safely and in the way people preferred.

People were receiving their medicines safely and there were enough staff to provide the care visits that people needed.

People and staff described the service as being well managed. Staff spoke highly of the registered manager and said they were well supported in their roles. A staff member told us they were “proud of the good job” they were doing.

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 23 September 2019) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 8 and 11 July 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 Safe and Well led. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain 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 changed from Requires Improvement to Good. 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 (Horsham and Crawley) on our website at www.cqc.org.uk.

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.

Carewatch (Horsham and Crawley) is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection 82 people were being supported. 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 avoidable harm and abuse. Safeguarding policies and procedures were not embedded within practice and were not consistently followed. Staff had recognised signs of abuse and had recorded their concerns, however appropriate referrals had not always been made. Governance systems had not identified this shortfall and this meant that one person had not been safeguarded from abuse. Following the inspection, we raised a safeguarding alert with the local authority to ensure that any continued risks of abuse for this person were addressed.

People told us they were happy with the care they received and that staff helped them to feel safe.

Risk assessments and care plans were comprehensive and guided staff in how to provide care safely and in the way the person preferred. There were enough suitable staff employed to cover all the care visits. People said they received their calls on time and for the duration that they expected. Staff supported people to have their prescribed medicines safely.

People spoke highly of the staff and consistently described them as “Well trained” and “Professional.” Staff told us they were well supported in their roles. Records showed that staff had received training in subjects relevant to the needs of the people they were supporting. Assessments of people’s needs and choices were thorough and supported people’s diverse needs. Staff supported people to have enough to eat and drink and to access the health care services they needed.

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.

Staff knew people well and had developed positive relationships with them. People spoke highly of the staff and described them as reliable, respectful and caring.

People described how they had been involved in planning their care. Staff had the information they needed to provide a personalised service to people. Staff supported people to maintain contacts and to reduce risks of isolation. There was a robust complaints system in place and people told us that any concerns they raised were addressed quickly. Staff were knowledgeable about end of life care.

All the people were spoke with and their relatives spoke highly of the management of the service.

Staff were clear about their roles and responsibilities and described being well supported. People and staff told us their views on the service were sought. Comments included, “There’s nothing that they could improve on,” and, “I would recommend them to anyone.”

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 12 July 2018) and there was one breach 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 improvements had been made to address this breach, however another breach of regulation was identified. The service remains rated as requires improvement. This service has been rated requires improvement for the last two inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection took place on 13 March 2018 and was announced. We gave the provider 48 hours’ notice of the inspection visit because the location provides a domiciliary care service and we needed to be sure that the registered manager and other staff were available to speak to us on the day of the inspection. At the time of the inspection there were 96 people receiving a home care service. The registered manager was present on the day of the inspection.

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 on 8 December 2015 the service was rated Good overall. At this inspection we found some areas of practice that required improvement.

Risks associated with people’s mobility were not always assessed and there were not always clear plans to guide staff in how to support people safely. Staff had received training in how to administer medicines. There were systems in place to check and monitor that medicines were being administered safely. Some people were being supported with administration of medicines that were prescribed to be given PRN (as and when needed). There were no clear guidelines for staff in how to administer PRN medicines safely. Risks to people were not consistently assessed and managed to ensure that people were supported to be safe.This was identified as a breach of the regulations.

Management systems and processes were not always effective in identifying shortfalls and making improvements. People were not always informed of who was coming or changes to visit times. This had been noted through the provider’s quality assurance feedback system. However, people told us communication about their visits remained inconsistent. Some auditing processes had failed to identify omissions in records. These areas of practice were identified as needing improvement.

People told us that they felt safe with staff supporting them to live as independently as possible. Staff knew how to recognise signs of possible abuse and understood their responsibilities with regard to reporting suspected abuse. Recruitment systems ensured that staff were suitable to work with people. There were enough staff to cover all the care visits.

Staff had received the training and support they needed. People and their relatives told us they had confidence that staff would recognise if people were unwell and would help them to access the health care services they needed. One relative told us about how staff had recognised when their relation became unwell, saying, “I was impressed that they had called me.”

People’s needs had been assessed in a holistic way. Staff understood their responsibilities with regard to the Mental Capacity Act 2005. People told us that staff checked with them before providing care. People were supported to have enough to eat and drink.

People and their relatives told us that staff treated them kindly and were respectful. People said that staff respected their views. One person said, “They are all kind and lovely. I look forward to them coming.” Staff knew people well and told us they had time to get to know people and understand their needs. One staff member said, “If I don’t have enough time I tell the office and they arrange a longer call. It’s important that people don’t feel like we are rushing them.”

Care records reflected people’s views and preferences. Staff were providing care in a personalised way. One staff member said, “We follow the care plans but it’s also about knowing people well and listening to their instructions about the small things.” People and their relatives knew how to make complaints and the provider had a system to address any concerns.

People and their relatives were complimentary about the support they received from the office based staff and the registered manager. Staff were positive about the leadership of the service and described the registered manager as open and approachable. One staff member said, “She is very kind and easy to talk to and always happy to help or guide us.”

The registered manager had a clear vision for the service and described their intention to remain as a small, personable service.

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