20 March 2017
During a routine inspection
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.