Carewest Ltd

Updated 8 February 2019

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 on 22,23 and 24 January 2019. We gave the service 24 hours’ notice of the inspection visit because we needed to be sure they would be in.

The inspection team consisted of two adult social care inspectors and one expert 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. The expert by experience had experience of caring for older people who received support within a community setting.

Before our inspection, we checked the information we held about Carewatch (Lancashire West & Central). This included notifications the registered manager sent us about incidents that affect the health, safety and welfare of people who received support.

We also contacted the commissioning, safeguarding and contracts departments at Lancashire County Council. This helped us to gain a balanced overview of what people experienced when they received support from Carewatch (Lancashire West & Central). All the information gathered before our inspection went into completing a planning document that guides the inspection. The planning document allows key lines of enquiry to be investigated focusing on any current concerns, areas of risk and good or outstanding practice.

During this inspection, we visited the office location on 22 January 2019 to see the manager and office staff; and to review care records and policies and procedures. We visited three people in their own homes on 23 January and telephoned staff on 24 January 2019. The registered manager did not select and was unaware who the inspection team contacted by telephone.

We spoke with the registered manager, deputy manager, three members of the management team and five carers. We looked at the care records of eight people, training and recruitment records of four staff members, records relating to the administration of medicines and the management of the service.

We looked at what quality audit tools and data management systems the registered manager had. We reviewed past and present staff rotas, focusing on how staff provided care within a geographical area. We looked at how many visits a staff member had completed per day and if the registered manager ensured staff had enough time to travel between visits. We looked at the continuity of support people received and how long staff stayed on each visit by reviewing the registered managers electronic call monitoring system.

We used all the information gathered to inform our judgements about the fundamental standards of quality and safety of the service delivered by Carewatch (Lancashire West & Central).

Updated 8 February 2019

Carewatch (Lancashire West & Central) was inspected on the 22,23 and 24 January 2019 and the inspection was announced. We visited the office on the first day. We arranged to visit clients on the second day and telephoned randomly selected staff on the third day to gather their views. The registered manager was given 24 hours' notice as we needed to be sure people in the office and people the service supported would be available to speak to us.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. Carewatch (Lancashire West & Central) is registered to provide support with personal care. At the time of our inspection visit there were 87 people who received support.

Not everyone using Carewatch (Lancashire West & Central) receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, 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.

At the last inspection in March 2018, we found two breaches of regulation. We found breaches in the regulations related to safe care and treatment and good governance. We issued requirement notices for these breaches in regulation. In addition to the requirement notices we made a recommendation related to people’s capacity to consent to care.

Following the inspection in March 2018, we asked the registered manager to act to make improvements in the areas we had identified. The registered manager was required to send the CQC an action plan, outlining how they intended to make improvements. We used this inspection process carried out in January 2019 to check the action plan had been followed and improvements made.

At this inspection, we found improvements had been made. Staff had the skills, knowledge and experience required to support people with their care and support needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and documentation in the service supported this practice.

People’s care and support was planned with them. People told us they had been consulted and listened to about how their care would be delivered. Care plans held personalised information that guided staff on peoples support needs and promoted positive relationships.

Care records contained information about the individual's ongoing care and rehabilitation requirements. This showed us the registered manager worked alongside other health care services to meet people's health needs.

The service had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. New staff shadowed experienced staff members while they learnt their role.

The registered manager completed spot checks on staff to observe their work practices were appropriate and people were safe.

The registered manager planned visits to allow carers enough time to reach people and complete all tasks required. People told us they mostly had the same staff visit and relationships had developed.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at the times they needed them.

The service had safe infection control procedures and staff had received infection control training. Staff had been provided with protective clothing such as gloves and aprons as required. This reduced the risk of cross infection.

Staff supported people to have a nutritious dietary and fluid intake. Assistance was provided in preparation of food and drinks as people needed.

People told us staff were caring. Staff we spoke with understood the importance of high standards of care to give people meaningful lives.

The service had information with regards to support from an external advocate should this be required by people they supported.

People told us staff who visited them treated them with respect and dignity. People’s end of life decisions were documented within their care plans.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The service had kept a record of complaints received and these had been responded to appropriately.

The service used a variety of methods to assess and monitor the quality of the service. These included quality monitoring, quality assurance visits and care reviews.

The registered manager and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people in their care.