Carewest Ltd

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.

Carewatch (Lancashire West & Central) is managed from well-equipped offices located in Preston. Services are provided to support people to live independently in the community. During this inspection there were 68 people who used the service.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing.

Not everyone using Carewatch (Lancashire West & Central) receives a 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 take into account any wider social care provided.

There was a registered manager at the service. 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.

At the last inspection we found Medication Administration Records (MARs) were not always completed in line with the company policy and best practice. We made a recommendation around this. During this inspection we looked at how the service managed people’s medicines. We found people were not being supported in line with the services own policies and procedures. Documentation around medicines management was conflicting at times.

This amounted to a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Risk assessments did not always contain information to adequately lessen the risks to individuals. Behaviour management plans we saw were brief and did not document how individuals were supported in line with best practice.

This amounted to a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We saw evidence that monthly quality monitoring was being undertaken, however the audits were not always effective. We found little information surrounding the details of issues found and how these had been rectified and lessons learned. We also noted the audit system had not identified the breaches of regulation and areas of improvement we had noted during this inspection.

These shortfalls in quality assurance amounted to a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we found the principles of the MCA were not consistently embedded in practice. We found people’s capacity to consent to care had not always been assessed and information was, at times, conflicting. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. We have made a recommendation around this.

Staff understood how to identify abuse and report it. They told us they had received training in keeping people safe from abuse and this was confirmed in staff training records. Staff told us they would have no concern in reporting abuse and were confident the registered manager would act on their concerns.

We found recruitment was safe. We reviewed staffing at the service and did not find any concerns.

We were able to see staff supervision was taking place. Staff we spoke with confirmed they felt supported in their role. Staff training was ongoing and evidence has been seen of staff completing training.

We found people were supported with nutrition and hydration. Holistic assessments had been undertaken to ensure the service could meet the needs of people.

We received consistently positive feedback about staff and about the care people received. People told us positive relationships had been developed. People felt the staff knew them well. Staff had a good understanding of protecting and respecting people's human rights.

People were supported by staff with activities to minimise the risk of becoming socially isolated. An example was seen in one person's care file where the person enjoyed activities such as bingo and staff supported them with this. The provider had taken steps to meet people’s cultural needs by ensuring support was available and that staff respected their needs.

People told us they were encouraged to raise any concerns or complaints. The service had a complaints procedure. We saw evidence of complaints and information was available to show how those complaints had been reviewed, investigated and responded to.

We found a positive staff culture was reported by the staff members we spoke with. The provider and registered manager had clear visions around the registered activities and plans for improvement moving forward. The management and staff team were open and transparent in providing information and worked well with the inspection team.

People said that they were able to influence and determine their care and that they decided on how their care was delivered.

People told us their care arrangements were flexible to support their needs and as a result of support from the agency their lifestyle had improved.

People told us that they were supported to manage their medicines and these arrangements suited their needs and circumstances.

We saw that staff were recruited appropriately and as a result people were protected from unsafe care.

We saw that there was a complaints procedure in place and people knew how to use it and who to speak to if they were dissatisfied with their care.

They told us:

'It's been hard going to be honest, very inflexible in the beginning don't seem to be able to get themselves organised...the office seems to be the problem it's disorganised'. 'I had a girl for the first couple of months; she didn't seem to know what she was doing'.

In relation to safety 'sometimes I feel safe, other times I don't' depends on staff' adding '20% not happy it's down to staff'.

'I like the regular carers'.

'Think they're fine'.

'At the moment they're not very good as they're short of staff' 'why don't they let me know what's happening?'