Archived: Carewatch (Morecambe)

Updated 30 August 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.

This inspection took place on 01 and 02 August 2018. We gave the service 24 hours’ notice of the inspection visit because we needed to be sure they would be in. We visited the office location to see the registered manager and office staff; and to review care records and policies and procedures. We telephoned people who received support, their relatives and staff to gain their views on the service provided over both days.

One adult social care inspector visited the office and met with the management team. Along with a second inspector they made four prearranged visits each to people who received support on the second day. A third Inspector and an expert by experience telephoned people and staff for their views on the service.

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.

Carewatch Morecambe is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. We gave the service 24 hours' notice of the inspection visit because we needed to be sure that they would be in.

Before our inspection, we checked the information we held about Carewatch Morecambe. This included notifications the registered provider 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. We also gathered information on the service being delivered in Cumbria by Carewatch Morecambe. This helped us to gain a balanced overview of what people experienced when they received support from Carewatch Morecambe.

We looked at information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. 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 eight people in their own homes. We spoke with a further 25 people who used the service and five relatives. We also spoke with the registered manager, area manager, quality officer, two administrators and 17 members of staff. We looked at the care records of 21 people, training and recruitment records of 10 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 provider 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 provider 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.

We used all the information gathered to inform our judgements about the fundamental standards of quality and safety of the service delivered by Carewatch Morecambe.

Updated 30 August 2018

This inspection visit took place on 01 and 02 August 2018 and was announced. The registered provider 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.

Carewatch Morecambe is a domiciliary care agency. It provides personal care to 172 older adults living in their own houses and flats.

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 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 in May and June 2017, we found four breaches of regulation. We found breaches in the regulations related to Safe care and treatment, Good governance, Staffing and Fit and proper persons employed. We issued requirement notices for these breaches in regulation.

We also noted improvement were required around the use of language that promotes respect and protects people's dignity and positive communication and leadership. We made recommendations in relation to these.

Following the inspection in May and June 2017 we asked the registered provider to act to make improvements in the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements.

At this inspection, we found the service met the required fundamental standards and would be rated 'Good' in all areas.

During this inspection, we noted the registered provider planned visits to allow staff enough time to reach people and complete all tasks required. We did see occasions when staff left before the allocated time was complete. The registered manager told us sometimes this was at the request of the client. We have made a recommendation about this.

The registered provider had regularly completed a range of audits to maintain people's safety and welfare. We noted some documentation took time to travel from people’s homes to the office. This impacted on the timeliness of audits taking place. We have made a recommendation about this.

We found staff had received training to safeguard people from abuse. They understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of adults who may be vulnerable. Staff we spoke with told us they were aware of the safeguarding procedure.

Staff members received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

There was an appropriate skill mix of staff to ensure the needs of people who used the service were met. New staff worked alongside experienced staff members whilst they learnt their role.

People told us staff respected their privacy and dignity during their visits. One person commented, “They always close the bathroom doors, they wear gloves and aprons and they are very respectful to me.”

Care plans identified the care and support people required. We found they were personalised and informative about the care people received. They had been kept under review and updated when necessary. They reflected any risks and people's changing needs.

Staff responsible for assisting people with their medicines had received training to ensure they were competent and had the skills required. The registered provider completed spot checks on staff to observe their work practices were appropriate and people were safe.

Staff were provided with personal protective equipment to protect people and themselves from the spread of infection.

The registered provider had procedures around recruitment and selection to minimise the risk of unsuitable employees working with people who may be vulnerable. Required checks had been completed before any staff started work at the service. This was confirmed during discussions with staff.

People and their representatives told us they were involved in their care and had discussed and consented to their care packages. We found staff had an understanding of the Mental Capacity Act 2005 (MCA). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

When appropriate, meals and drinks were prepared for people. This ensured people received adequate nutrition and hydration.

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

People said they had a team of regular carers with whom they and had built up good relationships. For example, one person told us, "They are very compassionate and caring and involve me in all decisions.”

Staff we spoke with understood the support needs of people they visited. They knew how individuals wanted their care to be delivered. One person stated, “They come and do what they should, but its more than that, they are interested in me. They ask how I am, what I’ve been doing, that sort of thing.”

A complaints procedure was available and people we spoke with said they knew how to complain. We noted the registered manager addressed all concerns in a structured and timely manner.

The registered manager had sought feedback from people receiving support and staff for input on how the service could continually improve.

The service demonstrated good management and leadership with clear lines of responsibility and

accountability within the management team.