Archived: Carewatch (Norfolk)

We inspected the service again on 13 and 15 December 2017. We identified the same breaches of regulation as the previous inspection. These were breaches for staffing levels, safe care and treatment, person centred planning, management of complaints and good governance. We rated the service as requires improvement overall, inadequate in well- led and placed the service in special measures. We do this when services have been rated as Inadequate in any key question over two consecutive comprehensive inspections. The Inadequate rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection it was providing care to 260 people. The service provides both 15-minute welfare checks or calls to support with medication administration only. Longer calls were scheduled according to people’s assessed needs. The service also supported people over a limited amount of time to prevent hospital admission or readmission to hospital.

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.

During the first day of our inspection on 9 August 2018 we identified four continued breaches of regulation. We have rated this service as requires improvement in four key questions and inadequate in well- led. This means the service will stay in special measures.

Improvements had been made but were not firmly embedded across the whole service which meant people received different outcomes of care. Some recent changes within the service compromised the continuity of care. For example, office staff, including coordinators. The registered manager said to make improvements to the service some of the staff employed had needed to leave to develop a new and more positive care culture. However, changes in the staff team meant that not all the care visits were planned sufficiently ahead or around the needs and wishes of people using the service. Staff said they did not always have regular care visits or adequate travel time. This meant they did not always arrive on time for the care visit, or stay the correct amount of time. This evidence supported a repeated breach of regulation 18: staffing.

Recruitment of new staff was not always carried out in line with the organisation’s policies and procedures which meant people were not fully protected against the potential employment of unsuitable staff.

There were processes in place to help ensure people received their medicines as intended but audits were not always completed in a timely way and we found improvements were required in recording. This supports a breach of regulation 12: Safe care and treatment.

Risk assessments regarding people’s care were documented. However, the individuals’ care plans and records were not always adequate in informing actions staff should take to keep the person safe.

Infection control measures were in place but not all staff were adhering to them placing people at an increased risk of cross- infection. We found through discussion with people that not all staff were wearing personal, protective clothing.

Safeguarding people from abuse was effective because the service provided staff with adequate training and had systems in place for dealing with any allegation of abuse. The agency worked closely with the local authority to ensure all allegations were reviewed.

The service had systems in place to review all accidents and incidents within the service. This enabled the service to evaluate what had gone well or what they could learn to help ensure that the risk was reduced in the future.

The service kept up to date with changes to legislation and best practice but this was not always communicated to care staff. Several staff said they had not had recent face to face supervision, or direct observation of their practice which they felt was due to recent changes to the management team. We were unable to see from the information provided that all supervision was up to date in line with the organisations policy. This meant some staff were working in line with their own values and not necessarily the values of the company. Communication was disjointed across the different teams. This supported a breach of Regulation 18: staffing.

Staff received regular training and the quality of training provided through induction was said to be good. However, some staff said they did not have the time to attend specific training around the needs of people using the service.

People mostly had their health care needs met and this was reflected by what staff told us. However, we were concerned that staff were rushing in and out of people’s houses which increased the risk of them missing something important or not noticing a change in the person’s needs. We considered this in line with poor record keeping which could increase the risk of the person receiving poor care.

Staff had received training in the Mental Capacity Act 2005 (MCA.) The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. Care plans recorded people consent, (or their legal representatives consent) to care and treatment.

We saw examples of where people’s choice was diminished in relation to their choice of carer and their preferred timing of care call. People also stated they were rushed or their call was cut short which affected the person’s experience of their care.

People were consulted about their care plan and this was reviewed although people felt contact with the office was not always regular. Care plans were not sufficiently robust or person centred. Records were not always up to date, or legible.

People knew how to complain and staff understood the process and how they should support people if they had concerns. The paper records reviewed showed the outcome of complaints received were not always fully documented to show if it had been upheld or how it had been resolved. However, complaints were also logged electronically and could not be closed until all necessary actions had been taken. This was not viewed as part of the inspection and would have provided a fuller audit trail.

The service was not sufficiently well managed. There were insufficient resources to ensure people always received good outcomes of care and received support around their needs. Quality audits did not always demonstrate how the service was identifying and making necessary improvements in a timely way.

The service remains non -compliant in a number of areas and will therefore remain in special measures due to its history until we are confident that the service can make and sustain the necessary improvements. This supported a breach of regulation 17: Good Governance.

At our last inspection in April 2017, we found that the quality and safety of the care being provided to people required improvement. We identified that the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because they had not employed enough staff to meet people's needs and preferences, risks to people’s safety had not been sufficiently assessed or managed and people’s care had not been planned or delivered to meet their individual preferences. Furthermore, not all people’s complaints or concerns had been identified and therefore investigated and the provider’s governance systems were not effective at improving the quality of care people received or driving the required improvement.

Following that inspection we sent the provider a warning notice telling them they had to ensure they had adequate governance processes in place to drive the necessary improvements required by 30 June 2017. The provider wrote to us and requested we extend this deadline which we did to the 30 August 2017.

At this inspection, we found that some improvements had been made and that the warning notice had been partially met. However, from the feedback we received from people using the service, staff and the records we looked at we have judged that the provider remains in breach of these five regulations. You can see what action we have told the provider to take at the back of our report.

This is the third consecutive inspection that the service has been rated Requires Improvement. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of the inspection it was providing care to over 280 people.

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.

There continued to be insufficient staff to meet some people’s needs and preferences. Some staff did not always receive sufficient travel time between calls which made them late attending people’s calls. People’s care needs and some of their preferences had been assessed. However, not all care had been planned and delivered to meet these needs and preferences which impacted on their daily lives.

The systems in place to monitor that people received their medicines correctly were not robust and therefore, the provider could not be assured that people received them when they needed them.

Once again, some people's complaints or concerns had not been recorded and therefore not investigated to enable the provider to take action to improve the quality of care they received.

The provider's governance systems to assess and monitor the quality of care provided were not all effective. Although we saw improvements in some areas, the provider had failed to take sufficient action to drive the necessary level of improvement required.

At the start of the inspection visit, we found that some people’s care records and risk assessments did not have sufficient information in them to guide staff on how to provide people with safe care. However, this was corrected during the inspection therefore reducing the risk of people receiving inappropriate care.

Improvements had been made to ensure that most people were visited by the same staff so they could build trusting relationships with them. The staff that visited people were kind, caring and compassionate. They treated people with dignity and respect and tried to help them be as independent as they could. However, the provider had not ensured that people’s care had always been planned and delivered in a caring manner and further improvements are therefore required within this area.

Improvements had also been made to staff training. Staff had received sufficient induction, training and supervision. Where necessary, the service supported people to eat and drink sufficient amounts for their needs although care visits had not always been spaced sufficiently to meet some people’s individual needs.

Staff worked well with other professionals and organisations to support with their healthcare and other needs when required. Staff used appropriate techniques to prevent the spread of infection.

People’s consent was sought in line with the relevant legislation and information was provided to people in a number of different formats when required to help them make decisions about their care. People had been involved in making most decisions about their care. However, not all of these had always been respected or adhered to in line with people’s wishes.

There were systems in place to protect people from the risk of abuse and any incidents, accidents or safeguarding concerns had been thoroughly investigated and learnt from to try to prevent them from re-occurring.

Strategies were being formulated to involve people in the running of the service that included a regular forum that people could attend. Plans were in place to involve people in the recruitment and training of staff and in the development of policies and procedures.

The manager and staff worked well with other services to embed strategies to improve people’s health and wellbeing such as in the areas of oral and foot health and to reduce the number of falls that people had. This work was on-going and the manager was keen to collaborate with further organisations for the benefit of people using the service.

Carewatch (Dereham) is a service that provides personal care to people in their own homes. At the time of the inspection over 300 people were receiving support from the service.

There was no registered manager working for 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 and associated Regulations about how the service is run. The last registered manager de-registered with us in January 2017. A new manager who was currently working as the provider’s regional manager had been employed by the provider to run the service. They told us during the inspection they would be applying to register with us.

At our last inspection in August 2016, we found that the quality and safety of the care being provided to people required improvement. We identified that the provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because they had not employed enough staff to meet people’s needs and preferences and that their governance systems were not effective at improving the quality of care people received. At this inspection, we found that the required improvements had not been made. This has resulted in five breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take at the back of our report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There continued to not be enough staff to meet some people needs and preferences. Although some people had regular staff who provided them with good quality care, this was not the case for all people. Some people experienced missed, late or inconsistent calls that impacted on their daily lives. Some also saw a number of different staff which meant they could not build caring or trusting relationships with them.

Where staff were asked to provide care to people they did see regularly, they did not always have the correct information to hand to tell them about the care people needed. Therefore, there was a risk these people could receive unsafe or inappropriate care that didn’t meet their needs.

Some people’s complaints or concerns had not been acknowledged or investigated. Where they had, these had not always been listened to or the quality of care people received had not changed. Incidents that had occurred or that staff had become aware of, had not always been recorded and investigated. This resulted in missed opportunities for the provider to improve the quality of care some people received.

The provider’s governance systems to assess and monitor the quality of care provided were not all effective. Since our last inspection, there had been a lack of impetus from the provider to drive improvement within the service. A new manager had been recruited who had comprehensive plans in place to improve the quality of care people received.

People who required support with eating and drinking and maintaining their healthcare received this. The staff were kind and caring and treated people with dignity and respect. People could make decisions about their care but the facilitation of their involvement in this could be improved. Consent had been obtained from people in line with the relevant legislation.

The staff were happy working for Carewatch (Dereham). They felt supported and knew how to reduce the risk of people experiencing abuse. They felt that the quality of care being provided to people was improving.

Carewatch (Central Norfolk) is a service that provides personal care to people in their own homes. At the time of the inspection, 286 people were receiving care from the service.

There was a registered manager working 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 and associated Regulations about how the service is run.

At this inspection we found three breaches 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 this report.

There were not enough staff working at the service to cover all of the care visits that people required. Therefore, not all people had received individualised care that met their needs and preferences. Existing staff had been utilised to cover the shortfalls but there were not enough of them to do this. This meant that in some geographical areas, care staff had attended people’s visits late or had arrived at inconsistent times. On occasions, some people had not been visited at all and therefore, had not received the care they required which placed them at risk.

Staff were kind and compassionate and treated people with dignity and respect. However, some people had been visited by a number of different staff they did not know well. This made it difficult for them to develop caring and trusting relationships with the staff.

There were a number of different ways that people could express their views about the service received and to make decisions about their care. Although people’s complaints were investigated, not all people’s feedback had been acted on. The necessary improvements had not been made in a timely manner to improve the quality of care that people received.

People’s care needs and risks to their safety had been assessed. However, there was insufficient information within people’s care records to guide staff on how to meet these needs and to reduce risks to their safety. As some staff were visiting people whose care they were not familiar with, sometimes at short notice, this lack of information increased the risk of people receiving poor care.

Staff asked people for their consent before providing them with care. However, not all staff knew how to act within the requirements of the Mental Capacity Act 2005 when providing care to people who were unable to consent to it themselves. Therefore, people’s rights may not have always been respected.

There were systems in place to protect people from the risk of abuse and people received their medicines when they needed them. Where it was part of their care package, people received sufficient food and drink to meet their needs and they were supported to access healthcare services when needed.

The current systems in place to monitor the quality and safety of the service provided and to mitigate risk to people’s safety were not all effective. The provider was aware that the quality of service they were providing to people needed to be improved. Plans were in place to implement these improvements.

We have made a recommendation regarding following the principles of the Mental Capacity Act 2005 when making best interest decisions on behalf of people.