Inspection Report - Care Quality Commission · | Inspection Report | Carewatch (Southend) | September 2013 1 Inspection Report We are the regulator: Our job is to check whether hospitals,

| Inspection Report | Carewatch (Southend) | September 2013 www.cqc.org.uk 1

Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Carewatch (Southend)

10 Hadleigh Business Centre, 351 London Road, Hadleigh, SS7 2BT

Tel: 01702557007

Date of Inspections: 21 August 201313 August 201312 August 2013

Date of Publication: September 2013

We inspected the following standards as part of a routine inspection. This is what we found:

Respecting and involving people who use services

Met this standard

Care and welfare of people who use services Action needed

Safeguarding people who use services from abuse

Action needed

Management of medicines Action needed

Requirements relating to workers Met this standard

Staffing Action needed

Supporting workers Action needed

Assessing and monitoring the quality of service provision

Action needed

Complaints Action needed


Details about this location

Registered Provider Carewatch Southend

Registered Managers Mrs. Carol Fleming

Mrs. Cathrine Lawrence

Overview of the service

Carewatch Southend is a domiciliary care agency, providing service for people who live in the community. care is provided for adults with physical disabilities, learning disabilities, mental health problems and the elderly.

Type of service Domiciliary care service

Regulated activity Personal care


Contents

When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

What we have told the provider to do 4

More information about the provider 5

Our judgements for each standard inspected:

Respecting and involving people who use services 6

Care and welfare of people who use services 8

Safeguarding people who use services from abuse 10

Management of medicines 12

Requirements relating to workers 14

Staffing 15

Supporting workers 17

Assessing and monitoring the quality of service provision 19

Complaints 21

Information primarily for the provider:

Action we have told the provider to take 23

About CQC Inspections 26

How we define our judgements 27

Glossary of terms we use in this report 29

Contact us 31


Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 12 August 2013, 13 August 2013 and 21 August 2013, checked how people were cared for at each stage of their treatment and care and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and took advice from our pharmacist.

What people told us and what we found

Over the last two months the CQC had received a number of complaints and safeguarding's about this provider. A visit took place by two inspectors on the 12 and 13 August 2013. A total of 10 people were visited in their own homes and two experts by experience completed telephone interviews to gain people's views. An expert by experience is a person who has had experience in using this form of service and assists the compliance inspectors in their visits and gaining information. Comments from the visits and interviews have been added to this report where possible.

There was a mixed response from people we spoke with. Those who had regular carers and had been with the service for a number of years were receiving a good reliable serviceand had very positive comments. Those who did not have regular carers had experienced missed visits, late calls and not always receiving the care they required. We also found that people's experience of the service depended on the geographical area they lived in.

Other areas of concern raised during this visit included the supervision of staff, medication and quality auditing. The provider had been pro-active since our visit and has submitted a number of action plans on how they intend to rectify the concerns raised around non-compliance. They have also set themselves timespans to ensure these issues are sorted as soon as possible.

You can see our judgements on the front page of this report.

What we have told the provider to do

We have asked the provider to send us a report by 04 October 2013, setting out the actionthey will take to meet the standards. We will check to make sure that this action is taken.

Where providers are not meeting essential standards, we have a range of enforcement


powers we can use to protect the health, safety and welfare of people who use this service(and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.


Our judgements for each standard inspected

Respecting and involving people who use services Met this standard

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run

Our judgement

The provider was meeting this standard.

People's privacy, dignity and independence were respected. People's views and experiences had been taken into account in the way the service was to be provided and delivered in relation to their care.

Reasons for our judgement

We looked at the arrangements in place for ensuring that people using the service were treated with respect and involved in planning their care. We also looked at whether people's views and experiences were taken into account in the way their service was provided.

It was confirmed that a welcome pack would be provided at the start of a service and this would have details of the services Carewatch Southend offers and the people they provideservices to. This document is provided to people during the assessment process and can be produced in other languages and formats upon request. This document was in the process of being reviewed and updated.

At previous visits to this service it was established that people's views were taken into account when assessing and arranging care. An assessment would be completed before aservice started and people's views would be taken into consideration during this process. This would also reflect any individual preferences and diversity needs the person may have. Feedback from people spoken with included, "Before I came out of hospital my social worker, explained the care I would receive once I was discharged, this has happened just as planned" "Yes I have a folder I haven't read it though, as I'm visually impaired, but do get to input in to it" and "I have a care plan and I have contributed to the plan and it was reviewed a week ago."

Privacy, dignity, diversity and independence would be covered as part of the staff's induction programme and staff spoken with confirmed that they had covered these subjects. Evidence could be found on staff files of a 'dignity challenge questionnaire' wherestaff had to answer questions on what they considered privacy and dignity was. One staff member had written "To treat people the way I would like to be treated." Written guidance on these subjects could also be found in the staff handbook. Carewatch Southend also had a dignity charter that staff signed up for and they had also received training on person-centred care, which covered autonomy and choice.


All the people who received a telephone interview stated that they felt "safe" with their careworker and thought that they were respectful. Other feedback gained included, "The manager rang to enquire if I was satisfied with the service one month after my service began and I thought that they respected my views," "The ladies that come to me are excellent, they respect me and my home" and "I cannot fault my carer she is always on time and rings if she is going to late".

We visited five people who lived within the Southend, Castle Point and Canvey Island area. All stated that they had been able to make decisions about their care and received the support and help they needed. All had been receiving a service from Carewatch Southend for a number of years (four years plus) and confirmed they had regular carers and received the support they required. Comments included "She is so caring," "I am assisted to get ready for bed and they respect my privacy and dignity," "I never feel rushed" and "She is a diamond."

The Expert by Experience who completed telephone interviews with a number of people stated, "All the service users I spoke to felt that the staff were respectful and treat them well and staff treated them with dignity." Comments they received during the interviews included, "They all speak to me really nice and in an appropriate manner," "I have a good relationship with most staff, but I do think some need a bit more training," "I'm quite happy with it overall. I suppose they could do to improve on one thing that is turning of their phones, because they receive a lot of calls while they are here. They can forget to do the odd thing on occasions" and "They always treat me with dignity and respect like my religious beliefs they always knock."


Care and welfare of people who use services Action needed

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement

The provider was not meeting this standard.

Care and treatment was planned and delivered in a way that did not ensure people's safety and welfare.

We have judged that this has a moderate impact on people who use the service, and havetold the provider to take action. Please see the 'Action' section within this report.


We looked at the arrangements in place to ensure care and treatment was planned and delivered in a way that ensured people's safety and welfare.

Prior to our inspection concerns were raised in relation to the care and welfare of some people who received a domiciliary care service through Carewatch Southend. These related to concerns about missed calls/visits, no support plan documentation being completed for some people and care staff not staying for the allocated time.

The support plans for 18 people who received support via the domiciliary care agency were viewed. Records showed that support plans had been developed after an initial assessment with a field supervisor prior to the start of a service. This ensured that the service had considered whether or not it could meet the person's needs and also provided details for the individual's support plan.

The 18 records viewed showed that there were support plans for 16 out of 18 people and these covered all aspects of a person's individual circumstances. This included the level ofsupport required, the number of staff required to provide support at each visit, the length oftime for each visit, call time preferences and additional duties and tasks to be undertaken. Records also showed that assessments relating to health and safety, medication, moving and handling and environment had been completed. The provider's support plan policy stated, "It is required that care/support plans are reviewed at least annually but preferably every six months." Out of 18 support files viewed we found that four people's support plansand risk assessments had not been updated within the preceding 12 months. This could mean that people's care and support needs may be compromised due to the staff providing their care not having the most up to date information about the individual.

We reviewed time sheets and the provider's 'care work compliance summary' for several people. Records showed that there were occasions when calls/visits by the care staff werenot recorded. It was difficult to determine if this was as a result of the records not being accurate or whether care staff had not provided the support to individual people. For


example, the support plan for one person recorded that they should receive four calls through out the day. The timesheets for this person were viewed for the period 24 May 2013 to 05 July 2013 inclusive. Records suggested that there were 12 occasions whereby this person received between two to three visits on any given day and not four as required.The timesheets for another person who required four visits each day were also reviewed for the period 26 May 2013 to 03 August 2013 inclusive. Records suggested that there were 17 occasions whereby this person received between two to three visits on any given day and not four. It was also noted that there were occasions whereby the person who used the service was left in bed for long periods, for example, between 15 to 16 hours. Records also showed that some of the lunchtime and teatime calls were close together with only a two hour gap between times.

The feedback received by the Expert by Experience included "Yes I have seen my care plan and I am happy with what is written in it, I have also been consulted about my care, but I don't think I really need care in the evenings" and "I think the care is pretty good, theycome four times a day and am happy with the care. They sometimes put me to bed to early."


Safeguarding people who use services from abuse Action needed

People should be protected from abuse and staff should respect their human rights

Our judgement


People who use the service were not protected from the risk of abuse.



We looked at the arrangements in place for ensuring that people who were using the service were free from risk of abuse and harm. This included the whistle blowing procedure in place, to ensure staff were able to raise concerns without fear or recriminations.

The provider is aware of the correct procedure for referring safeguarding concerns to the local authority. There were systems and procedures in place to help care staff identify concerns and respond appropriately to the signs and allegations of abuse. All staff would complete an induction prior to commencement of work and this included training on safeguarding, the signs of abuse and how to recognise it. They also received a handbook on safeguarding adults from abuse.

Other guidance available to care staff included the grievance, disciplinary and whistle blowing procedures. Staff spoken with confirmed they had received training in safeguarding and that they had an understanding of what signs of abuse to be aware of. Some care staff spoken with had an understanding of the term 'whistle blowing,' but otherswere not able to explain what it was with one adding "I have heard of it, but I am not 100% on what it is." People spoken with who received a service confirmed that they felt safe withtheir care worker and knew who to raise concerns with.

Carewatch Southend had received a number of safeguarding referrals recently and these were in the process of being investigated. The consultant present during our visit provided written evidence where safeguarding's had been investigated and a report produced. On looking at the reports it was not always clear on how the referral had actually been investigated. This was due to evidence not having always been collected from relevant sources and some reports produced did not reflect a response to the actual concerns raised. This was raised with the consultant and confirmation was received that the safeguarding reports which had been recently produced, would be reviewed and redrafted to reflect a more comprehensive and detailed reporting procedure. The target date for completion of this piece of work was set for Friday 23 August.


There were systems in place and written guidance on how care workers should deal with people's finances to keep both them and the people safe.


Management of medicines Action needed

People should be given the medicines they need when they need them, and in a safe way

Our judgement


People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.



We looked at the arrangements in place for ensuring the safe recording, administration and dispensing of people's medication.

Prior to our inspection concerns were raised in relation to the management of medicines. These related to concerns that not all people who used the service received their prescribed medication and that medication was not always provided in a timely manner.

During our inspection on 12 August 2013, 13 August 2013 and 21 August 2013, we lookedat the provider's systems for the safe management of medicines. As part of the inspection process we reviewed people's support plans, looked at people's Medication AdministrationRecords (MAR) and reviewed care worker's visit report sheets. Many of the people who were being cared for in their own home required assistance and/or prompting with taking their medicines. Whilst visiting people's homes we saw that the majority of people used theNOMAD monitored dosage system via blister pack cassettes or medication directly from boxes and bottles. These had been supplied by a selection of local pharmacies and handwritten MAR forms were in use.

The support files for 18 people who used the service were reviewed and these included people living in Southend, Castle Point, Canvey Island and Basildon. The support files for 16 people showed that a support plan had been completed and this recorded information relating to the person's ability to look after and take some or all of their medicines or if carestaff were responsible for giving them.

The MAR forms for seven people were viewed. These showed that there were a significantnumber of unexplained omissions giving no indication of whether people had received theirmedicines or not, and if not, the reason why was not recorded. There was no record to indicate the reason for these omissions. For example, the MAR forms for one person showed that care staff assisted them to take their medication twice daily. Records over a 21 day period showed that out of a possible 42 entries on the MAR form; these had been


signed on only 23 occasions. This is not in line with the provider's medication policy. This states "The MAR must be completed in full each time medication is taken or given, or should indicate why a medication has not been taken or given."

None of the MAR forms viewed listed the person's specific medication and corresponding dose. For example, MAR forms were noted to state, "Contents of blister pack" and "Blister pack am 5 tablets and pm 6 tablets." The latter type of recording is seen to be unsatisfactory as it does not maintain a clear record of what care workers administer to people who use the service. This is not in line with the provider's medication policy. This stated, "The MAR details what medication has been prescribed, when it should be taken, the dose and method by which it should be taken." Where the code 'O' other was recorded, the rationale for its use was not always recorded. The use of an agreed code alerts other care staff that this person has not taken their medication for a valid reason. It could also be useful when the GP reviews the treatment for this person. The provider's medication policy states, "The Medication Administration Record contains codes which must be used when recording medication." This did not concur with our findings.

During our visits to people's homes on 21 August 2013 we found that at one person's home no MAR forms had been completed. It was unclear as to how long care workers hadbeen without these forms. This was a concern as there were no records available to account for all of the medicines administered and/or prompted for this individual. We foundat another person's home that no MAR forms had been completed since 03 August 2013. The care worker visit report sheet advised that this person had not received their prescribed medication since 19 August 2013. Although the records made reference to this and suggested that the person's family had ordered more medication, there was no evidence to show that this had been followed up by the domiciliary care service to ensure that this had happened and why no medication was available. This was actioned at the time of our visit by the agencies co-ordinator.

The same person's support plan made reference to this person receiving two calls per day for a period of 15 minutes to support the person to take their medication. We requested evidence of the provider's 'care work compliance summary' for this person for the period 01 July 2013 to 21 August 2013 inclusive. This provided a summary of the number of visitsconducted to the person's home by the care staff and the actual time that they had attended. Records showed that there was only one missed call where there was no record that a care worker had not visited the person who used the service. However records showed that out of a possible 110 visits, 88 visits recorded that the care workers had only spent between three and five minutes with this person and this included the administration of their medication.

The staff training records showed that the majority of staff required refresher medication training. The provider told us that refresher training for staff was planned throughout August 2013, September 2013, October 2013 and November 2013. We looked at the staff personnel records for seven care workers. There were no records to suggest that staff hadhad their competency assessed.


Requirements relating to workers Met this standard

People should be cared for by staff who are properly qualified and able to do theirjob

Our judgement

The provider was meeting this standard.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.


We looked at the systems in place to ensure staff were appropriately recruited and required checks had taken place.

The service had a recruitment policy and procedure in place to help ensure the correct checks had been completed for all new employees. The files of the last five people recruited were viewed and these contained an application form and documentation to show that relevant checks had been completed. References had also been sought and a criminal record check had been completed. The files were well set out and information waseasy to find.


Staffing Action needed

There should be enough members of staff to keep people safe and meet their health and welfare needs

Our judgement


There were not enough qualified, skilled and experienced staff to meet people's needs.



We looked at the arrangements for ensuring that there were enough qualified, skilled and experienced staff available to meet people's needs.

From the feedback we received from some people we spoke with, records seen and care workers spoken with, it was clear that some people were not receiving the actual care hours allocated to them. Many of the complaints and safeguarding that had been received by the provider were around people not receiving their assessed time or missed visits.

On 21 August 2013 we conducted ten visits to people's home. People spoken with were generally happy with the quality of care and support provided. Comments included, "I cannot fault the staff, they are all very nice", "Oh there is no problem with the staff, if there was something I would say", "You couldn't ask for better staff" and "The staff are lovely, they are very attentive." Many of those spoken with had regular carers and had been receiving a service for a number of years.

Three relatives spoken with confirmed that they were also very happy with the care and support provided. Comments included, "[Name of staff member] is absolutely brilliant, needs as many stars as you can give. Staff spoken with told us that they "loved" working with the people they supported and that they found their role to be very rewarding.

Other people spoken with had not experienced the same quality of service and reported missed visits, late calls and staff not staying the correct time and some did not have a regular carer. The assistant manager confirmed that they were in the process of recruiting new staff to ensure there were sufficient care workers to cover the care needs of all the people who received a service; as there are presently some people who did not have a regular allocated carer. A number of complaints and safeguarding had also been raised regarding carers not providing the full time or the care required.

Feedback from the interviews completed by the expert by experience reported, "Things were settled for some time but this has been a bit chaotic recently although they are


permanent staff they have been swapping and changing who visits and this means I have to keep explaining what my needs are and what I want them to do for me. They seem to be getting things sorted more recently" and "They don't always come late enough to toilet before bed. The care is adequate, some staff are really good and others not so good - the not so good is generally on a weekend."

One care worker spoken with stated that they would "Give the time allocated and won't take on more work unless they can give the full time" They added that they worked weekends and the last person they assisted with personal carein the morning was 9:00 am, which they considered was late enough. Another care worker stated they had a regular work and was not under pressure. They added that at weekends they finished personal care in the mornings at 10:15 am, and would not want to finish any later, but they were aware that other care workers who assisted with personal care did not finish until much later.


Supporting workers Action needed

Staff should be properly trained and supervised, and have the chance to develop and improve their skills

Our judgement


People are not presently cared for by care staff that are supported to deliver care and treatment safely and to an appropriate standard.

We have judged that this has a minor impact on people who use the service, and have toldthe provider to take action. Please see the 'Action' section within this report.


We looked at the arrangements in place for ensuring that there were enough qualified, skilled and experienced staff available to meet people's needs and whether staff were well supported.

The provider ensured that all care workers received an in-depth induction prior to providingcare and support and this was in line with the Skills for Care requirements. As part of the staff induction all new care workers would complete a two week induction and also shadowanother carer until they were confident. Care workers spoken with confirmed that they had completed an induction when they were first employed and this provided them with the information they needed in their role as a care worker. Comments included, "Very good induction" and "I shadowed another staff member and they did a checklist to ensure I had covered all the areas" and "It was a good induction, I had enough information and I shadowed someone for three shifts." All new staff received a handbook as part of their induction and this included information on the office, administration procedures and also information relevant to their role as a carer.

Training available to staff included in house and external training courses. There were systems in place to ensure staff's knowledge was updated and regularly checked. The training manager was able to print off a list of care workers that would require an update intraining within the next month. Nine care worker's files were viewed and these had evidence of training they had completed. It was noted that some care workers required updates in safeguarding, medication and moving and handling training; but updates were in the process of being organised. The training manager advised that they had just started to pay staff to attend mandatory training and one care worker spoken with had made positive remarks regarding this and felt it was a "Good idea." A large number of the staff had achieved a recognised qualification in care.

Staff spoken with confirmed the office staff were very good with training and they would receive a letter advising them when they needed an update and a date when their training would be provided. Comments included, "I am all up to date with my training – I am doing


moving and handling today," and "Training is regularly updated." The provider is also looking to introduce a new system that staff would not be able to be allocated any work if and when their mandatory training expired.

Carewatch Southend had a supervision policy and procedure in place and it stated that thecompany was committed to providing high quality supervision and support to staff to ensure the best possible standards of practice within the organisation and promote high quality services. Thirteen staff files were viewed for evidence of supervision and from the files viewed it was apparent that the frequency and quality of supervision varied and did not reflect the provider's own supervision policy.

Four files viewed contained evidence that the care workers had received one to one supervisions, spot checks and an appraisal each; but of the remaining files some had beenseen once during 2013 and others had not yet received any form of formal supervision. For example, one staff member had evidence of only one formal supervision having been provided in 2013 and this had been recorded as, "Came up to book some holiday and have a chat with everyone." No other information was recorded.

We also looked to see if staff had received an annual appraisal. The purpose of an annual appraisal is to review a member of staff's overall performance, to ensure that the care workers are competent and provide a high standard of care and support to people who usethe service. Records showed that each member of staff had received an appraisal within the preceding 12 months. However there was little evidence to show that objectives had been set for the following year. Where issues had been highlighted, there was no evidenceto show how these were to be addressed and/or actioned. For example, the records for one member of staff recorded that they were concerned that there were "too many calls and getting to clients late." No proactive steps were recorded as to how this was to be addressed.

Evidence of staff meetings or minutes were not available and when the assistant managers were questioned they stated that these had not been routinely arranged for a while. Feedback from care workers regarding supervision was mixed. One reported "I havenot received any" and another stated "I have not attended any staff meetings."

We spoke with 13 members of staff and found that comments about Carewatch Southend were variable. Six out of 13 members of staff were positive about the domiciliary care agency; stating that communication within the office was good and that they felt valued as a member of staff. Others advised that whilst they enjoyed working with the people they supported and team work with other carer workers was positive; they did not feel valued bythe organisation. Staff clarified that they received little positive feedback and praise about what they did well, but that the organisation were quick to feedback negative things. Care workers also stated that they did not always feel listened to and that issues highlighted to some supervisors and the manager were not dealt with. Some care workers also advised that communication within the office was variable. This related specifically to not always passing on messages, not returning calls and that confidentiality could be an issue.



Action needed

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement


The provider had an effective system to regularly assess and monitor the quality of servicethat people receive, but these had not been routinely used.



We looked at the arrangements in place for ensuring that people who use the service, theirrepresentative and staff were asked for their views about their care and these were acted on.

Carewatch Southend had a number of procedures and systems in place that would help tomonitor the quality of their service delivery and ensure people who received a service wereable to give feedback; but from evidence gathered on the day of our visit these had not been routinely completed.

Some quality assurance was in place and there were systems on care worker's files to ensure the correct paperwork had been received. Training could also be monitored to show that the care workers were up to date and when they required further training. The last quality questionnaire had been sent out just before our visit last year and the provider was in the process of arranging the next one to be sent out. Due to Carewatch Southend being contracted with local authorities regular meetings took place to look at quality and compliance of the service. Any areas of concern that were raised at these meetings required an action plan to show how this would be rectified.

There were a number of areas raised during this visit that the provider would have already been aware of if regular audits had taken place. Checks on medication had not been completed and documentation seen during our visit showed that there were areas of concern around the recording and assistance care workers provided for people's medication. The provider has since contacted the CQC to advise they are in the process ofrecruiting someone to the new post of Medication Compliance Officer, who will assist in ensuring the care workers are following correct procedures and keeping people safe.

Quality checks on complaints and safeguarding's had not been completed. This would have highlighted that investigations completed were not satisfactory and records did not contain relevant written documentation.


The service monitoring form used by the provider to record any missed visits or concerns about the service had not routinely been completed since January 2013. This would have helped to highlight areas of concern around their service and assist in improving the quality of the service provided.

Staff supervision records had not been routinely completed and the quality and frequency of this varied from one staff member to another. Regular audits by the provider would haveshown this was an area that needed to be addressed and they could have gained feedback from care workers about their work and being employed by Carewatch Southend.

Checks had also not been completed on people's files to ensure the information was correct and annual reviews had not taken place.

The lack of auditing showed us that the provider had not been routinely monitoring the quality of their service.


Complaints Action needed

People should have their complaints listened to and acted on properly

Our judgement


There was an effective complaints system available but people could not be confident that their comments or complaints will be responded to appropriately.



We looked at the arrangements in place to ensure people were made aware of the complaints system and they could be confident that their complaints would be listened to and acted upon.

Carewatch Southend had systems in place for people to use if they had a concern or were not happy with the service provided to them. Guidance on how to make a complaint could be found in the service user guide, which was provided to people when they first started the service.

The service had systems in place to record complaints. On looking at the complaints received and the investigations that had been carried out it was noted that the quality of the information varied from one complaint to another. Although details of the complaint hadbeen recorded the provider may like to note that the information available did not always include evidence on how these concerns had actually been investigated or contain copies of any correspondence or details of the outcome. The quality of the investigation was discussed with the consultant who was assisting with the inspection, as it was not always clear if and how a satisfactory outcome had been reached.

At previous visits the provider has had a service quality form in place, which recorded details of verbal complaint/concerns regarding missed visits and care issues and how these had been investigated and what if any action had been taken. On looking at the quality forms during this visit it was evident that they had not been routinely used after January 2013. Two records had been made in February, one in March, one in May, one in June and one in August. On speaking to the assistant managers they advised that issues had still been raised by people who used the service or their relatives, but they had not routinely recorded these on the required form. The assistant managers arranged for copiesof the form to be photocopied during our visit so they could be used straight away; as this assisted in monitoring the quality of the service.

When speaking to people who used the service they reported that they all knew how to make a complaint and felt able to do so. Comments included "I have never had to


complain and if I wish to I would telephone the agency manager" and "I have been told how to make a complaint and I will if the occasion arises".

Others spoken with by the expert by experience stated they had not been given any information on who to raise any concerns to, but many stated they would ring the office. Those who had raised issues reported "I did complain about one member of staff they came out and saw me and yes I was happy with the outcome and the way things were handled. I think the staff member needed more time with service users" and "I did have a disagreement with one staff member a number of years ago this was sorted out to my satisfaction and I have had no problems since."

On looking at some of the complaints the agency had actually received it was noted that some people had stated they had contacted the service previously, but they had not received any correspondence or contact in connection to their concerns and had had to raise the issue again. This is an area that the provider needs to monitor and address as although people are made aware of the complaints procedure they cannot have confidence that their concerns will be listened to or acted upon.

This section is primarily information for the provider


Action we have told the provider to take

Compliance actions

The table below shows the essential standards of quality and safety that were not being met. The provider must send CQC a report that says what action they are going to take to meet these essential standards.

Regulated activity Regulation

Personal care Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010

Care and welfare of people who use services

How the regulation was not being met:

Care and treatment was planned and delivered in a way that did not ensure people's safety and welfare. Regulation 9


Personal care Regulation 11 HSCA 2008 (Regulated Activities) Regulations2010

Safeguarding people who use services from abuse


People were not safeguarded against abuse and the provider didnot always respond appropriately. Regulation 11.



Management of medicines


People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.



Regulation 13



Staffing


People could not be sure that there were not sufficient staff numbers employed for the purposes of carrying out the regulatedactivity.Regulation 22.



Supporting workers


Staff were not supported in relation to their responsibilities, to enable them to deliver care to service users safely and to an appropriate standard.Regulation 23.





The provider did not have effective operation systems in place toregularly assess and monitor the quality of the services provided.Regulation 10.





Complaints


People could not be sure that their complaint would be fully investigated, and as far as practicable resolved to a satisfactory outcome.Regulation 19.

This report is requested under regulation 10(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider's report should be sent to us by 04 October 2013.

CQC should be informed when compliance actions are complete.

We will check to make sure that action has been taken to meet the standards and will report on our judgements.


About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.


How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action.We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action taken

If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.


How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.


Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.


Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.


Contact us

Phone: 03000 616161

Email: [email protected]

Write to us at:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

Copyright Copyright © (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with thetitle and date of publication of the document specified.

Documents

Inspection Report - Care Quality Commission · | Inspection Report | Carewatch (Southend) | September 2013 1 Inspection Report We are the regulator: Our job is to check whether hospitals,