Archived: Carewatch (Heathview)

Updated 27 November 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.

The inspection was carried out on 22 and 23 October 2018 and was unannounced. On day one the inspection team consisted of one adult social care inspector, one assistant inspector and one expert-by-experience. Day two was carried out by one adult social care inspector and was announced. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before the inspection we looked at any notifications received and any information we held about the provider. A notification is information about important events which the provider is required to tell us about by law. We contacted the local authority contract and quality assurance team and they shared their current knowledge of the service. The manager had not received a Provider Information Return before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. However, we gathered this information during our inspection.

We used a number of different methods to help us understand the experience of people who used the service. During the inspection we spoke with ten people who used the service. We also spoke with the interim manager, quality officer, a quality support improvement manager (QSIM) and four support staff.

We looked at care planning documentation for four people and other records associated with the operation of the service. These included three staff recruitment records; supervision and training records; accident and incident records; quality assurance audits; meeting minutes; complaint records and call schedules.

Updated 27 November 2018

We carried out this comprehensive inspection on 22 and 23 October 2018. This was the first inspection of the service since Carewatch (Heathview) registered with the Care Quality Commission (CQC) on 2 February 2017.

Carewatch (Heathview) provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

There are 49 apartments at Heathview, shared facilities include a bistro, well-being centre and hairdressing salon. Carewatch (Heathview) have an office based on the ground floor. At the time of the inspection we were informed that 22 people received personal care and support.

A registered manager was employed but was absent on a period of extended leave during 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. Day to day managerial responsibilities were being overseen on an interim basis by a registered manager from another of the registered provider’s locations who was generally present at Heathview for one day per week.

We identified that the registered provider was in breach of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to governance, records and staffing.

An internal quality audit carried out in February 2018 identified a compliance score of only 28%. A follow up review noted that compliance had increased to 78% and that the interim manager had made improvements. However, we found that the routine audit procedures were not sufficiently robust and had not identified the issues highlighted within the full version of this report.

People using the service commented about management arrangements at Heathview. Six of the people we spoke with commented that they either did not know who the manager was, they wanted to see them more often or voiced frustration that there was no-one to discuss things with as the interim manager was not present that often. The interim manager agreed that their presence only one day per week was insufficient and advised they would be liaising with their regional director with a view to increasing this.

There was a policy and procedure in place for reporting and recording accidents and incidents. However, we found shortfalls in recording procedures as records were not completed for all accidents and incidents and significant events had not been escalated to the manager. Although staff demonstrated an understanding of how to protect people from abuse, we found that improvement was needed in relation to following local safeguarding protocols.

Staff received training and their competency to administer medicines was regularly checked. However, we found shortfalls in the completion of Medicine Administration Records (MAR) and a medicine was being administered in food without confirmation that it was safe to do so.

Most people we spoke with felt that there were insufficient staff available. Staff felt that the morning period was exceptionally busy. In addition, one person told us how they had to wait in the shower as their carers had been called away to respond to another call, leaving them waiting in the shower until the staff member returned as they were unable to get out independently. We discussed this with the interim manager who accepted there was a shortfall.

There was a business continuity policy and plan in place which contained clear steps to take in the event of disruptions to service, for example loss of significant number of staff.

Most people spoke positively about the care they received. Staff were supported to develop their skills, knowledge and competencies by completing induction and developmental training. Regular supervision and team meetings took place and staff said they felt supported by the management team.

Staff understood the need to protect people’s right to privacy, dignity and independence when providing care. Staff knocked on doors, announced their arrival and sought permission before entering people’s apartments.

There was a clear policy in place with regard to equality and diversity, providing guidance to staff about protected characteristics such as age, disability, religion and sexual orientation.

People’s needs were assessed to ensure they could be met.

There was a policy and procedure in place to handle and respond to complaints. Although we saw that concerns raised had been dealt with, we found that they had not always been recorded.

Care records contained a good level of person-centred information which helped staff to get to know people’s needs. However, we saw in one file that information was not always accurately recorded or was conflicting.

We saw that people’s views about their care were regularly sought and that their choices were respected. Staff were responsive to people’s health needs and contacted medical professionals or emergency services when appropriate.

The service did not provide specialist end of life care although staff received training on this subject during induction. The quality officer informed us that they were seeking additional learning in this area and following the inspection we were advised that this was available.