Archived: Carewatch (St Helens)

Updated 28 July 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was carried out by one adult social care inspector. The inspection took place over three days and was announced on the first two days then unannounced on the third day. On the fourth day the inspector undertook telephone calls to people using the service, relatives and staff. The registered provider was given 24-hour’s notice on the first day as we needed to be sure that someone would be available at the office.

During our inspection we visited five people who used the service in their homes. We spoke with 16 people by telephone and with seven relatives. We observed staff working in people’s homes when we visited. We spoke with 10 support staff, one member of office staff, and the registered manager. We looked at 12 people’s care records, 13 staff records and records relating to the management of the service.

We also reviewed information we held about the service. This included any notifications received from the registered manager, safeguarding referrals, concerns about the service and other information from members of the public. We contacted the local authority quality monitoring and safeguarding teams and they highlighted some concerns regarding the service.

Updated 28 July 2017

This was an announced inspection, carried out on 20 and 23 March 2017. '24 hours' notice of the inspection was given because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be available in the office. Following the receipt of additional information of concern we also undertook an unannounced inspection on 16 June 2017 and contacted people using the service by telephone on 20 June 2017.

Carewatch is a domiciliary care agency based in St Helens. It offers care and support to 300 people in their own homes including personal care. The agency is registered as a supplier of services to St Helens, Halton and Warrington local authorities. They employ 130 support and office staff.

This was the first comprehensive inspection of this service since it was registered by the Care Quality Commission in June 2016.

The service had a registered manager who had been in post since June 2016. We were advised during our inspection that the registered manager had resigned and at the time was working their notice period. They have since left their position on 9 May 2017. 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

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 registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The systems in place to protect people from abuse and the risk of harm were not effective. We found multiple missed visits to people had occurred in the Warrington area leaving them without personal care, medication, food and nutrition. This meant vulnerable people were at risk of neglect.

The registered provider did not have safe recruitment practices in place which were robust. Checks to ensure staff suitability to work with vulnerable adults were not consistently undertaken.

The management of medication was not always undertaken safely. Staff had failed to fully and consistently complete all areas of the medication administration records (MARS). This meant that there was a risk to people and that staff would not identify where safety was compromised and be able to respond appropriately to concerns.

The registered provider had audit systems in place for monitoring the quality of the service. These were not fully effective as they had identified areas for development and improvement however; had not addressed the areas of concern in a timely manner. Two of the local authorities contracting with the registered provider had identified areas for development and improvement that had not yet been addressed.

Staff had not received regular supervision. This meant the monitoring of staff performance was not effective and development opportunities were not considered.

People had access to information about how to complain. The registered provider had a complaints policy and procedure in place, however recent complaints had not been responded to in a timely manner. We have made a recommendation about the management of complaints.

Risk assessments were in place and people's needs were fully assessed. These records were not all up to date or regularly reviewed in line with the registered provider’s policy. This meant people may not receive the care and support which they required in line with their wishes. Daily records were documented with the care tasks undertaken and were signed by the member of staff. These records were not always fully completed and the time of the call not consistently recorded.

The registered provider had not notified the Care Quality Commission of all significant events that had occurred at the service in line with their legal obligations. This meant that the registered provider was not complying with the law.

All new staff undertook an induction process which included a period of shadowing an experienced member of staff. All staff received regular training to ensure they kept up to date with the knowledge and skills required for their role.

Staff were polite and respected people’s privacy and dignity. People told us staff were kind and caring.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw that the registered provider had policies and guidance available to staff in relation to the MCA. Staff had undertaken training and had a basic understanding of this.

The registered provider had up to date policies and procedures in place to support the running of the service that were regularly reviewed.