All inspections: Carewatch (Harrow, Hillingdon & Ealing)

We undertook an announced inspection on 12 January 2016 of Carewatch (Harrow, Hillingdon and Ealing). The service is registered to provide the regulated activity personal care. Carewatch (Harrow, Hillingdon & Ealing) is a domiciliary care service for people living in their own homes and run by Graham Home Care Limited. The service has around 280 people who use the service and 176 care workers working for them.

The service did not have a registered manager in post. 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 was a branch manager in place however he also told us that he would be leaving the service and the provider would be looking to recruit another manager who would apply to be registered with us.

At our last inspection on 27 August 2014, the services met the regulations inspected.

During this inspection, we found people experienced a lack of consistency in the care they received. Some people did not have regular care workers and were also not aware of which care worker was coming to support them.

Although there were some positive aspects to the service such as people were being cared for and supported to have access to healthcare services, we found failings in four of the five domains resulting in people who used the service receiving lower standards of care than they should.

Individual risk assessments were completed for each person. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments

Care plans were not person centred and did not reflect the appropriate support people would need in relation to sometimes complex health and mobility needs.

Training records showed staff did not receive regular and appropriate training for them to gain the necessary knowledge and skills they needed to carry out their roles and responsibilities effectively.

People using the service and relatives told us they felt the care workers were not sufficiently trained to provide the care and support people needed.

There were some arrangements in place to obtain, and act in accordance with the consent of people using the service. However care plans did not contain any information about a person’s mental capacity and levels of comprehension especially for those people who may have dementia and are unable to verbally communicate.

The current systems in place were not robust enough to monitor and improve the quality of the service being provided to people using the service. Although the provider had conducted audits to assess the quality of the service and identified areas of improvement, there were no effective measures put in place by the provider to address the areas that needed improving and the service continued to provide a poor service.

There were suitable arrangements in place to manage medicines safely and appropriately.

Feedback from people and their relatives indicated that people were being treated with dignity and respect. Care workers had a good understanding and were aware of the importance of treating people with respect and dignity and respecting their privacy. People were supported to maintain good health and have access to healthcare services and received on going healthcare support.

Appropriate checks were carried out when staff were recruited.

People using the service were encouraged and supported with their independence.

We found five 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.

During our previous inspection of 19 February 2014, we found people's needs were assessed but care and treatment were not always planned and delivered in line with their individual care plan. We carried out an inspection on the 7 August 2014 and 19 August 2014 to see whether improvements had been made.

During this inspection we found the manager had taken prompt action and had undertaken an audit of care workers and their call times. The service had also sent out written surveys and we saw positive feedback had been received.

We spoke with 21 people who used the service, their friends/relatives and four members of staff including the registered manager, care workers and supervisors.

Although there were some concerns from people who used the service about how they were communicated with, most people were happy with how they were involved in their care. Although records showed people felt they were not always introduced to their care worker, the provider had appropriate processes in place to obtain and review people's consent to care and treatment.

Some people who use the service and their friends/relatives were not happy with the punctuality and continuity of their care workers. Although there were appropriate arrangements in place to ensure care could be provided safely, this was not always delivered.

We were told most concerns regarding people's care were dealt with appropriately by the service. The provider dealt appropriately with safeguarding concerns for vulnerable adults and had appropriate arrangements in place to protect vulnerable people from abuse.

Members of staff were recruited, inducted and checked appropriately.

Although there were a few concerns regarding the accuracy and legibility of people's records, records for the service were fit for purpose.

We spoke with four people who use the service, the relative of one person who uses the service and three members of staff.

All the people we spoke with said they were involved in their care and that the staff ensured that their privacy and dignity was maintained. The relative we spoke with said staff were flexible enough to work around their circumstances such as if the relative was at work.

People told us that they were well cared for and their wellbeing was maintained. One person said they received "fantastic care" and "would not dream of changing".

All the people who needed support with their meals said staff prepared and supported appropriately with their meals. One person said their care worker prepared the meals according to his choices and he was very happy with these.

None of the people we spoke with had any concerns with the service. They all said the central office would answer any queries and make different arrangements such as a different care worker if requested.

All the people we spoke with were happy with the staff and felt they were well trained. They all said staff were generally on time and it was usually the same members of staff that cared for them. One person said they had to explain the care and support they needed to the substitute care worker when their usual care workers could not visit them. However everyone said this was rare and the service did everything it could to ensure the same members of staff visited each person.

All the people we spoke with were very positive about the way in which care was

delivered. People told us that staff were professional, capable and efficient. People felt that the carers were reliable and supportive of their needs and wishes.

Everyone we spoke with said they felt comfortable contacting the provider to make

comments or requests and that these were acted upon quickly and satisfactorily.

Archived: Carewatch (Harrow, Hillingdon & Ealing)

All Inspections

12 January 2016

During a routine inspection

7, 19 August 2014

During an inspection looking at part of the service

19 February 2014

During a routine inspection

19 November 2012

During a routine inspection

1 December 2011

During a routine inspection