Carewise Ltd

Updated 20 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was undertaken by 1 inspector and 1 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.

Service and service type

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

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 7 November 2022 and ended on 16 December 2022. We visited the location’s office on 28 November and 15 December 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people who used the service and 7 relatives about their experience of the care provided. We spoke with 7 members of staff including the registered manager, nominated individual and care support staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed the care and medicine records for 9 people. We looked at a range of records. This included information about staffing and information relating to the management and governance of the service.

Updated 20 April 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Carewise Limited is a domiciliary care agency that provides personal care to people in their own homes. At the time of inspection 53 people received the regulated activity of personal care. People had various health needs, including dementia. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Right Support: The model of care maximised people’s choice, control and independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not supported this practice. We have recommended that the provider considers current guidance on the Mental Capacity Act (MCA) and updates their practice.

Right Care: There was a failure to assess risks people might face. People’s care and support did not consistently follow best practice. Care records lacked important detail to guide staff on how to make people safe. People told us they were happy with the care they received and had developed positive relationships with the staff who were providing their direct care and support.

Right Culture: There was not an adequate process for assessing and monitoring the quality of the services provided and ensuring that records were accurate and complete. There was a lack of provider oversight and governance of the service. People were happy with the care they received and felt safe with the staff that were supporting them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 November 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

The last rating for this service was requires improvement (published 24 November 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 June 2021. Breaches of legal requirements were found, and conditions were placed on the providers registration in relation to the following regulations of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014; Regulation 12 (Safe care and treatment) and Regulation 17(Good governance).The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and support and good governance.

The provider was required to send CQC a monthly report of actions to demonstrate how they were meeting the conditions placed on their registration. We undertook this focused inspection to check they were meeting the conditions and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carewise Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, protecting people from abuse and harm and the governance of the service.

We have taken enforcement action against the provider. We have imposed additional conditions on the providers registration for Regulation 12 (Safe care and treatment) and Regulation 17(Good governance).

A requirement notice has been issued for Regulation 13 (Protecting service users from abuse and harm)

You can see the enforcement action we have taken at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.