Background to this inspection
Updated
15 July 2021
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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of three inspectors.
The service type
This domiciliary care service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
The service had a manager who was in the process of registering with the CQC. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed the information we held about the service and the service provider, including the previous inspection report. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.
We looked at notifications and any safeguarding alerts we had received for this service. Notifications are information about important events the service is required to send us by law.
During the inspection
We visited Cranbrook Court and the Carewatch office and met with people who lived there and the staff that supported them. We met or spoke with 10 people to understand their views and experiences of the service and we observed how staff supported people. We spoke with the manager, deputy managers and five members of staff.
We reviewed the care records of seven people and a range of other documents. For example, medicine records, four staff recruitment files; staff training records and records relating to the management of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We spoke with six relatives who visited the service and one professional who regularly visit the service.
Updated
15 July 2021
Carewatch (Cranbrook Court)) is a domiciliary care service situated in Langley, Eastbourne, East Sussex. They provide personal care for people living in extra care housing in a purpose-built block of flats that could accommodate up to 62 people. Extra care housing is designed for people who need some help to look after themselves, but not at the level provided by a residential care home. People living in extra care housing have their own accommodation and have care staff that are available when required either contracted or in an emergency.
The people supported by the service had a wide range of needs including decreased mobility, general frailty, dementia, care needs related to age and people who live with a learning disability. 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. There were 32 people being supported with personal care by Carewatch (Cranbrook Court) at this time.
People’s experience of using this service and what we found
Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. However, not all were effective at this inspection. For example, medicine audits were undertaken but were lacking detail, for example, had the medicine been missed and of possible impact on people of not receiving their essential medicines. There were shortfalls in the care plans and risk assessments that had not been identified through the audits of care plans. Feedback from people and staff had not always been acted on.
Not everyone’s specific health needs were identified and planned for to promote responsive care to ensure their safety and well-being, for example, risk assessments for risk of choking were not consistently completed. People who lived with a mental health disorder did not have person specific care plans and risk assessments to enable staff to ensure their health and well-being. COVID-19, person-specific risk assessments were not seen in files at the time of inspection so there was no guidance or information to guide staff. The Manager rectified this.
The service were not following their medicine policy in the management of medicines, which meant there was an element of potential risk to people and staff. The risk of harm to people had not always been mitigated as incidents and accidents were not consistently reported, recorded and investigated.
People received care and support by staff who had been appropriately trained to recognise signs of abuse or risk and understood what to do to safely support people. One person told us they “Totally trust the staff here, I feel safe with the care staff.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We saw that people were supported to be as independent as possible with their personal care and mobility.
There was minimal evidence that learning from incidents and accidents took place. Specific details and follow up actions by staff to prevent a re-occurrence were not clearly documented. Action from incidents and accidents were not shared with all staff or analysed by the management team to look for any trends or patterns.
Staff received essential training to meet people’s needs. All new staff completed an induction programme where they got to know people and their needs well. One staff member said, “We do receive regular training, and refreshers.” Where there was an assessed need, people were supported to eat and drink enough to maintain a balanced diet. Referrals and advice were sought from relevant health care professionals to ensure people remained as healthy as possible. 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 systems in the service supported this practice. People were asked for their consent prior to any care or support tasks being completed. The registered manager had taken the necessary steps to ensure that people only received lawful care that was in line with legislation.
The management team actively looked for and took up opportunities to work in partnership with local health care and community services to improve people's health and wellbeing.
Staff had a good relationship with the community nurses and other health care professionals and contacted them for advice when needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 20 April 2020). There were no breaches of regulation but we asked for improvements to be made. The provider completed an action plan after the last inspection to show what they would do to improve. The service remains requires improvement.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Why we inspected
This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to review the previous ratings.
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.