Archived: Carewatch (Luton)

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.

During our inspection in February 2015, the provider required to make improvements in how they managed staff rotas so that people’s care was not adversely affected by late or missed visits. People had told us that they did not always know who would be supporting them because they either did not receive a rota or this was inaccurate. There were mixed views about the response people received when they raised these issues with the office staff and the majority of people found the office staff not helpful. Some people were not confident that all staff had the right skills to support them appropriately and we noted that some staff had not received regular supervision. In addition, some people said that following a review of their care plans, the agreed changes had not always been made in a timely manner. We had found changes in managers did not promote stability within the service. Also, there was not always evidence of how the findings from the audits had been used to drive improvements. Following the inspection, we had also received concerns that some missed visits had resulted in people being left without appropriate care and support. During this inspection, we found the provider had made significant improvements in all areas.

The service did not have a registered manager in post. The current manager had been in post for nearly five months and they had started the process to register with the Care Quality Commission. 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.

People felt safe and there were systems in place to safeguard them from risk of possible harm.

People had individual risk assessments so that staff had the information they needed to support them safely and minimise the identified risks. People’s medicines were being managed safely and administered by trained staff.

The provider had safe staff recruitment processes in place and there were sufficient numbers of staff to support people safely. Staff’s training was up to date and there had improvements in how often they received supervision. Improved staff deployment had resulted in a reduction in late or missed visits.

Staff understood their roles and responsibilities to seek people’s consent prior to any care or support being provided. Where people did not have capacity to give informed consent or make decisions about their care, appropriate action had been taken so that their care was provided in line with the requirements of the Mental Capacity Act 2005 (MCA).

People said that staff were caring and respectful, and they were supported to maintain their health, wellbeing and independence.

People’s needs had been assessed and there were care plans in place that took account of their individual needs, preferences, and choices. The provider had had an effective system to manage complaints. They had also improved how office staff dealt with people’s concerns so that they felt listened to and supported.

The provider regularly sought people’s feedback about the quality of the service provided. There had been improvements in how the service used information from audits to assess and monitor the quality of the service they provided. However, changes in managers meant that there had not been a long enough period for these to be fully embedded within the service.

During our inspection on 30 September 2013, we found that improvements had been made to people's records and that staff had improved the accuracy of the records they kept on a daily basis. The provider was monitoring both people's care records and medication records on a monthly basis, to ensure that the improvements continued.

We noted from the eight care files we looked at, that people were offered support at a level which encouraged independence and ensured their individual needs were met.

Although records showed people were encouraged to express their views and were involved in planning their care, they were insufficient to ensure people were protected from the risks of unsafe care.

People told us the staff were friendly and courteous in their approach, and were knowledgeable and confident in their roles. Staff records showed that appropriate training and recruitment checks were conducted before staff were actively employed.

The provider welcomed suggestions from people to improve the service they provided, and people said they felt able to approach the staff or manager to discuss anything. They were confident that swift action would be taken to resolve any issues they had.