Carewatch (Lancashire West & Central) was rated Good across all five key questions at its January 2019 inspection, having successfully addressed two regulatory breaches found in March 2018 relating to medication management and governance. The service demonstrated personalised, person-centred care, safe staffing and effective quality assurance systems, with only minor residual issues identified around missing bed rail risk assessments and occasional rota uncertainty.
Concerns (5)
moderateMedication management: “At the last inspection carried out in March 2018 we found the registered manager had failed to manage medicines in line with their policies and procedures.”
moderateCare planning: “At the last inspection carried out in March 2018 we identified care plans were inconsistent and did not always have enough detail, considering the complex needs of the individual.”
minorRecord keeping: “people who used bed rails and bed levers did not have risk assessments. By the end of the inspection, assessments to manage risk had been completed.”
minorMissed or late visits: “Sometimes as the rota says unallocated you don't know who if anyone is going to turn up and they don't always arrive on time.”
minorConsent / capacity: “At the last inspection in March 2018 we made a recommendation regarding the signing of consent forms and recommended that any discussions and outcomes regarding consent were documented appropriately.”
Strengths
· Staff were trained and competent in safeguarding, able to describe good practice and knew how to raise concerns.
· Registered manager implemented a ten-question medicines quiz and additional training following previous inspection breach, with ongoing competency assessments and audits.
· Safe recruitment procedures in place with DBS checks completed before staff delivered care.
· People reported positive, trusting relationships with consistent regular carers.
· Care plans were personalised, containing social history, likes, communication needs and end of life wishes.
Carewatch (Lancashire West & Central) was rated Requires Improvement overall following its March 2018 inspection, with breaches of Regulation 12 (safe care and treatment) relating to medicines management and risk assessment, and Regulation 17 (good governance) due to ineffective audit systems failing to identify regulatory breaches. Caring was rated Good, with positive feedback about staff relationships and dignity, but significant shortfalls remained in care planning, consent/MCA compliance, and record-keeping.
Concerns (7)
criticalMedication management: “We found people did not always have medicine support plans in place which contained an up to date medicines list. We found one person had no record of the medication they were prescribed.”
criticalMedication management: “Medicines audits we checked had not picked up on issues we found such as missed signatures and signatures that had been scribbled out.”
criticalCare planning: “Risk assessments we looked at did not always contain information to adequately lessen the risks to individuals. One example was for a person who had diabetes type 2. The risks and plans to manage the risk were not recorded.”
criticalGovernance: “The audit system had not identified the breaches of regulation and areas of improvement we had noted during this inspection.”
moderateCare planning: “We found care plans were inconsistent and did not always have enough detail, considering the complex needs of the individual cared for.”
moderateConsent / capacity: “We found people's capacity to consent to care had not always been assessed and information was, at times, conflicting.”
moderateRecord keeping: “Daily notes for the person did not document where the patch was applied to ensure this was done safely.”
Strengths
· Staff understood how to identify and report abuse; a central safeguarding register was maintained with lessons learned recorded.
· Recruitment was safe, including DBS checks and written references from previous employers.
· Staff received regular supervision and appraisals and reported feeling well supported in their roles.
· Consistently positive feedback from people and relatives about the quality and reliability of care staff.
· People were supported with activities to reduce social isolation and cultural needs were respected.
Carewatch (Lancashire West & Central) was rated Good overall at its October 2015 inspection, with Safe rated Requires Improvement due to omissions and incomplete entries on Medication Administration Records, prompting a recommendation to follow NICE guidance. All other key questions were rated Good, reflecting a well-trained, caring staff team, person-centred care planning, and effective governance and leadership.
Concerns (6)
moderateMedication management: “the MAR chart for this person did not identify the type of medication patch, the strength of the medication or how often it needed to be replaced and some signatures were missing.”
moderateRecord keeping: “The MAR charts contained hand written entries, but these had not been signed, witnessed or countersigned, in order to reduce the possibility of medications being transcribed incorrectly.”
minorStaffing levels: “two relatives told us they thought there had been a staff shortage for a few weeks recently, which had resulted in unfamiliar care staff arriving and more than the usual number of late calls.”
minorPerson-centred care: “two males...told us they preferred male care staff to deliver their personal care, but due to a shortage of male care staff this was not always possible.”
minorCommunication with families: “three people told us they did not think the communication with the office staff was good. For example, messages were not always passed on.”
minorStaff training: “the training matrix we saw showed that some training modules were slightly overdue, but this had been recognised by the registered manager and efforts were being made to ensure all training was brought up to date.”
Strengths
· Robust recruitment practices including DBS checks, written references and annual declaration of convictions forms
· Staff were confident in safeguarding procedures and reporting concerns, with clear policies and whistle-blowing procedures in place
· Comprehensive induction programme spanning twelve weeks including at least 20 hours shadowing an experienced care worker
· Regular supervision meetings, annual appraisals and observed practice for all staff
· Well-written, person-centred care plans developed from thorough pre-admission assessments with involvement of people and relatives