Carewise Ltd

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.

Carewise Ltd is a service that provides care to people living in their own homes. It is based in Lancing, West Sussex. It is the only service owned by the providers, one of whom is also the registered manager. Not everyone who used the service received the regulated activity of personal care. CQC only inspect 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. At the time of the inspection there were 71 people receiving personal care. Care was provided to people with a range of health care conditions which included those living with Dementia, Diabetes, Parkinson’s Disease and Motor Neurons Disease.

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

People had not always been protected from risk. Three people had been provided with high-risk and inappropriate food to meet their assessed needs. This increased their risk of choking. One person had not always been supported to have their time-specific medicines administered at the prescribed times. This increased the risk of their health condition not being well-managed.

The quality of the service had deteriorated since the last inspection. There was a lack of oversight or effective systems to ensure all people consistently received safe care and treatment. Lessons had not always been learned. Similar concerns found at the previous inspection were also found at this inspection, yet had not been identified by the registered manager or provider. Records to document and provide assurances about people’s care were not always well-maintained or stored securely.

There were not always enough trained, skilled and competent staff to meet people's specific health needs and this increased people's exposure to harm.

All people and relatives told us they felt safe and were happy with the care they received. People told us they liked the staff who supported them and felt comfortable in their presence. One person told us, “The best thing is the lovely care staff working there.”

Most people received safe care and treatment and were protected from the risk and spread of infection. People were supported to maintain their nutrition and hydration. People were supported to maintain their health and staff worked with external professionals to help ensure people received timely care and treatment if they were unwell.

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 supported this practice.

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 8 August 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was in breach of three regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 17 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment, gaining relevant people's consent, the governance of the service and informing CQC of any concerns about people’s care.

We undertook this focused inspection to check they had followed their action plan 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. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-led sections of this full report. The service has now been rated as Requires Improvement at the last two consecutive inspections.

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

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 will continue to monitor the service and we will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified continued breaches at this inspection in relation to safe care and treatment and the leadership and management of the service. A further breach relating to staff's skills and competence has also been found. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Carewise Limited is a domiciliary care service providing personal care to people in their own homes. At the time of the inspection there were 111 people using the service, living across four areas in Coastal West Sussex.

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

The service was not consistently well led. Quality assurance systems and processes were not effective in identifying and improving issues in care delivery. When issues were identified these were not always learned from to improve people’s care.

The service was not always safe. Medicines were not always managed safely and gaps in people’s records were not consistently investigated to see if people had missed medicines or if these were recording issues. Risks to people were not consistently assessed and there was a lack of individualised guidance for staff to keep people safe.

People were not always supported to have maximum choice and control of their lives and it was unclear if staff were supporting them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff had a poor knowledge of the Mental Capacity Act (2005) and the management team were not complying with the principles of the Act. Best interest decisions were made for people without assessing their capacity to make these decisions for themselves. Restrictions were implemented for people without first assessing their capacity. There were no best interest decisions to ensure restrictions were the least restraining option.

People received support from kind and caring staff. People spoke positively about the care staff. Staff understood the importance of respecting people’s privacy and dignity. Staff supported people’s independence by involving them in daily tasks. People were involved in their care planning.

People received person centred care by staff who knew them well. Complaints were managed in a timely way and in line with the provider’s policy. Staff received regular support and supervision. People had good access to health care professionals and felt staff would seek medical help should they need it.

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 good. (The last report was published on 16 August 2016)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to people’s safety, need for consent, governance of the service and the registered manager’s failure to notify us of notifiable incidents at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Forty eight hours’ notice of the inspection was given to ensure that the people we needed to speak to were available in the office. At this inspection we found that the breaches of regulation had been met. However there remained some practice in relation to MCA that needed improvement.

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Carewise Ltd is a domiciliary care service which provides personal care and support services for a range of people living in their own homes. These included older people, people living with dementia and people with a physical disability. At the time of our inspection 138 people were receiving a care service.

The service had a registered manager. The registered manager was also the owner of the business. 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.

Improvements had been made in seeking and recording consent in line with the Mental Capacity Act (MCA). At this inspection we found that staff had received training in MCA and were knowledgeable about the principles of the legislation. People’s consent was being sought and where people had a lasting power of attorney in place a copy of this was in people’s care records. However some assessments regarding people who lacked capacity were not decision specific so it wasn’t clear in which areas they lacked capacity to make decisions. We have therefore identified that this remains an area that needs ongoing improvement.

Improvements had been made in the completion of accurate records which meant that the registered manager could be assured that people were receiving the correct care. This was because the registered manager had introduced audit systems that ensured reviews took place and that any shortfalls in practice were identified and then addressed.

People told us they felt safe. One person said “I’m very pleased with them, they look after me very well.” People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. There were systems in place that ensured this knowledge was checked and updated. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

Staff were appropriately trained holding a Diploma in Health and Social Care and had received all essential training. Staff told us they felt supported to carry out their roles and received supervision and attended staff meetings. New members of the management team were in place that provided support with co-ordination and staff supervision.

People were cared for by kind and compassionate staff. People told us how well the staff knew them. One person said “Staff are nice, cheerful and caring, they really are good, we have a lovely rapport”. Another person said “I think they’re excellent, lovely girls”. People also told us they were treated with respect and dignity and that staff were always willing to help. One person said “Anything I want done, they do it”.

People were encouraged to eat and drink. If needed food and fluid intake was monitored to ensure that people maintained a healthy weight. People were supported to access healthcare professionals when needed. One person told us “They would get a doctor if I needed it”.

People told us that staff knew them well. Staff knew people well and were aware of their individual needs. One staff member said “The person is at the centre, it’s their life, their choices, their likes and dislikes”. Care records reflected people’s individuality and were reviewed regularly to ensure that they were accurate. There was a complaints policy in place and a procedure that ensured people’s complaints were acknowledged and investigated promptly. People and relatives were confident that if they had any concerns these would be responded to. One person said “If you have a problem they’re good and get back to you quickly”.

The home was well-led by the registered manager and supported by a management team. They were committed to providing a person centred service. There was a range of audit tools and processes in place to monitor the care that was delivered and the registered manager worked in partnership with other organisations to improve the quality of the service provided.

We visited four people in their homes and spoke with 16 people who used the service, or their relatives; all but one said they were very happy with the service being provided. One person said ' we are very happy with the staff, they are respectful and ensure our privacy'.

All the people we spoke with said that staff acted with their consent. One person said

'they always ask before doing'. Another told us 'the staff are very nice and always respects our wishes'.

People told us the service met their care needs. One person told us 'the staff have been very supportive and very quick to respond to any issues we raise'.

People using the service told us they felt safe with staff. People were happy with the skill and experience of staff. One person told us 'all the staff seem to know what they are doing'. Another told us 'we have a good relationship with all the workers who are respectful of our ways and wishes'. However one person said they felt that staff were better experienced with older people rather than those that were younger.

The manager was regularly seeking the views of people to ensure they were satisfied with the service. People told us if they were unhappy about anything they could tell the staff and something would be done.