Archived: Carewatch (Luton)

Updated 11 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 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.

This inspection took place between 12 April 2017 and 9 May 2017, and was announced. We gave 48 hours’ notice of the inspection because we needed to be sure that there would be someone in the office. The inspection was carried out by one inspector and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We planned this inspection in response to information of concern we received from one of the local authorities who commissioned the service. They had a number of concerns about how people’s care was being managed by the service.

Before the inspection, we reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we held about the service, including the notifications they had sent us. A notification is information about important events which the provider is required to send to us.

During the visit to the provider’s office, we spoke with the registered manager and one of the senior staff (quality officers and coordinators). We looked at the care records for 15 people who used the service to check how their care was planned and delivered. We also looked at six staff files for staff employed in 2017 in order to review the provider’s staff recruitment processes. We reviewed the training and supervision records for all staff employed by the service. We also reviewed information on how the provider assessed and monitored the quality of the service, and how people’s medicines and complaints were being managed.

The experts by experience spoke with 16 people who used the service and eight relatives, and the inspector spoke with 10 care staff by telephone including two senior staff. We also spoke with the commissioners of the service during the two meetings we attended to discuss the concerns one of the commissioning local authorities had raised about the service. We contacted Healthwatch Luton to check if they had any information about concerns raised by people who used the service in that area and they had none recorded.

Updated 11 July 2017

This announced inspection was carried out between 12 April 2017 and 9 May 2017 in response to concerns about the quality of the service raised by one of the local authorities that commissioned the service.

The service provides care and support to people in their own homes, some of whom may be living with dementia, chronic conditions and physical disabilities. At the time of the inspection, 93 people were being supported by the service within a geographical area that covered Central Bedfordshire, Luton, North and West Hertfordshire.

The service had a registered manager. 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. The registered manager was supported by a team of senior staff (quality officers and coordinators) to manage people's care on a day to day basis.

People told us they were safe because they were supported well by care staff. Staff had been trained on how to safeguard people. However, some people said that inconsistent visit times put them at risk of unsafe care because of the subsequent delays in providing the care and support they required. Although people had risk assessments in place, these had not always been updated in a timely way to reflect people's current needs so that staff knew how risks to people could be minimised. Senior staff had not been appropriately trained to complete the new risk ratings and this meant the quality of risk assessments varied depending on who completed them. Apart from a few occasions when there had been missed visits, people’s medicines were mainly managed safely and administered in a timely manner by trained staff. The provider had effective recruitment processes in place and there was an on-going recruitment programme to ensure that they had sufficient numbers of staff to support people safely.

People told us they were supported effectively by their regular staff, who knew their needs well. Although the record of staff training (training matrix) was not up to date, we saw that training had been provided to staff whose refresher training was overdue. Staff were complimentary about the quality of the training and they told us that they received regular supervision. However, there were mixed views about whether they were well supported by the senior staff and the manager. The requirements of the MCA were being met, but the quality of the records needed to be improved. People were happy with how they were supported with food and drinks. Where required, the service had ensured that people had been supported to access healthcare services and equipment they needed to maintain their health and wellbeing.

People told us that their regular staff were kind and caring, but they were not so positive about staff who supported them occasionally. They also said that staff treated them with respect, and supported them to maintain their independence as much as possible. People made choices about how their care was provided and they valued staff’s support, particularly when they helped them with tasks or issues that were not part of their care plans. People were happy with the amount of information they had been given by the service, although some would have liked to receive their rotas regularly so that they knew who would be supporting them. We saw that the manager had taken appropriate action to ensure that rotas were sent to people on a weekly basis.

People’s needs were assessed prior to them using the service, but some staff said that thorough assessments were not always completed resulting in people not receiving appropriate care. Some staff also said that there were sometimes delays in developing people's care plans or updating them when their needs had changed. People told us that their individual needs were being met and they were happy with how their care was being provided by staff. The provider had a system to manage people’s complaints, but they needed to review how they dealt with concerns and suggestions that would not normally be recorded as complaints, so that they could assure themselves that they dealt with these in a timely way.

Although people told us the service was good and they would recommend it to others, they were not so positive about the responses they received when they contacted the office. Some people found the staff at the office were sometimes rude, not always helpful and did not pass on messages they would have left for others to contact them and this was echoed by the feedback we received from staff. We found concerns about poor performance by some of the senior staff were not managed in a timely way and this had an impact on the quality of care provided to people in one of the geographical areas covered by the service. Although we found regular audits had been completed by senior staff and the manager, these had not always been used effectively to drive continuous improvements.

The provider was not meeting some of the fundamental standards. You can see what action we told the provider to take at the back of the full version of this report.