Archived: Carewatch (Morpeth)

Updated 30 January 2018

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 the 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.

We had received concerns from a number of different sources regarding the service and a decision was taken to complete an unannounced comprehensive inspection.

This inspection took place on 20 November 2017 and was unannounced. The provider was unaware that we would be visiting the service on that date. We continued with the inspection on 28 November and the provider was aware of this. The inspection team consisted of two inspectors on day one with a further two inspectors and one expert by experience supporting on other days to make calls to people and staff. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed information we held about the service, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us. We had already been contacted by the local authority commissioning and safeguarding teams before the inspection, as they wanted to share their concerns and views they had gathered from people using the service.

We contacted 29 people and their relatives by telephone. We spoke with the head of compliance, an operations director, the quality service improvement manager, an executive director, the manager, the deputy manager, two coordinators, two quality officers and a number of administration staff. We also spoke with five care staff at the provider’s offices and a further five were contacted by telephone.

We reviewed a range of 22 care records, including records associated with medicines management. We reviewed information regarding the management of the service, including reviewing the information on 15 staff personnel files, service audits and other management information regarding the service.

Updated 30 January 2018

Carewatch Morpeth is a domically care service which provides personal care and support to people in their own homes. At the time of the inspection the service supported 362 people across Northumberland, Gateshead, Newcastle and North Tyneside. However, the majority of people lived in Northumberland. Carewatch Morpeth had recently moved their offices to a purpose built building in Ashington at the end of September.

We undertook this comprehensive inspection as we had received information of concern about the safety of people using the service, including missed planned visits and lack of staff.

At the last inspection in May 2017 were we found breaches of Regulation 12 and 17, relating to safe care and treatment and good governance. As medicines were not well managed and governance systems were not robust, with incomplete record keeping. We asked the provider to complete an action plan to show how they planned to improve the key questions: Is the service; safe, effective, responsive and well led to at least good, and to comply with all legal regulations.

This inspection took place on 20 and 28 November 2017. The first day of the inspection was unannounced with the following day being announced.

There was no registered manager in post. The last registered manager had left the organisation at the beginning of September 2017 and deregistered in October 2017. A new manager had been appointed and had taken up the role at the new location. 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.

We reviewed records of people’s administered medicines at the service and were concerned with the findings. We found gaps, missing names and dates of when staff had been responsible for medicine administration. There was not always full or detailed information. Staff told us they had prepared their own records to help support people with their medicines as management had not provided them with medicines administration records. This meant we could not be assured that people were receiving their medicines as prescribed.

Risk assessments were not always in place, or lacked detail. Staff therefore did not have the correct level of information to keep people and themselves as safe as possible.

Accidents had been historically reported, the provider confirmed they conducted quarterly analysis on any accidents reported.

Initial assessments and care plans were not always in place. Those that were, lacked detail or had elements missing or names were misspelt. At the last inspection, the registered manager said there was a backlog of incomplete care records. This was still the case.

Staff were aware of their obligation to report any safeguarding concerns and protect people from harm. Staff raised concerns with us during the inspection. They had previously received training in this topic and procedures were in place to support them.

Recruitment was ongoing with many of the office staff new in post, including the manager. The manager felt that there was enough staff in post to support people, although missed calls and rota issues made this difficult to confirm.

Although staff indicated they had an awareness of infection control and its procedures, people told us staff did not always follow safe practice. Gloves and aprons were not always available to staff to support this.

We could not confirm if people were always supported to have maximum choice and control of their lives or that staff always supported them in the least restrictive way possible. This was because information was missing. The policies and systems in the service did not fully support this practice as they were not robust.

Records relating to capacity and consent continued to not be fully completed or in place at all. This meant that we could not always evidence that the service was operating within the principles of the Mental Capacity Act 2005.

Staff had not always received suitable induction, training, supervision or appraisal with the provider to ensure they were suitably trained and supported to work with the people they helped. Evidence was missing and staff confirmed this area to need improvement. At the last inspection we recommended that dementia training be incorporated. The provider sent us evidence to confirm this was now part of the induction process.

The provider confirmed that quality officers who would have normally completed spot checks on staff working in people’s homes had been precluded from doing this because of covering shortages in other areas of the service, including trying to get behind the backlog of care records which needed to be in place. We found spot checks had not taken place for all of the staff records we checked.

Records regarding the level of support people required were not always sufficiently detailed. This meant crucial detail could have been missing to support staff ensure that people received the correct levels of nutrition and hydration.

Comments about the service and its staff were mixed. People were positive about the care staff, but more negative about office and management staff. Comments made about one particular member of management were passed on to the operations director.

We were concerned about the lack of care plan documentation in place. The provider, in some cases only had information they had been supplied with by the local authority and had not completed their own assessment and care plan documentation. This meant there was a risk to people when unfamiliar staff visited as they would not necessarily know what level of care to provide.

The service was not reliable, with missed calls and timings of care calls were erratic. People we contacted were concerned about the number of missed, late and not fully timed calls they received. The local authority was extremely concerned and placed a member of their own care team at the service to support them cover calls.

The provider had a complaints procedure in place, but this had not always been followed or complaints recorded and responded to as they should have. People told us they had found it difficult to contact the provider to make a complaint and some told us they had given up trying.

Quality assurance checks to monitor the robustness of the service were in place. However, these had not always identified the issues we had during the inspection or when they had they had not been followed up to ensure they had been addressed.

During service reviews, feedback from people and their relatives would normally be sought. However, as reviews had not always taken place this had not always occurred. The provider had contacted a number of people though to listen to their concerns in recent weeks but we were not given any evidence what action had been taken as a result of this.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, staffing, receiving and acting on complaints and good governance.

We also made two recommendations in connection with infection control and accessibility.

We sent a letter of ongoing serious concern to the provider stating our initial findings.

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

During the inspection we were contacted by the provider and informed that they intended to remove the location. This meant that the service in Morpeth would close down and people receiving care would transfer to another provider along with the majority of staff. Before this report was published, the provider closed this service on 18 December 2017.