About the service:

Carewatch (Mid Bucks) is registered to provide personal care to people living in their own homes. At the time of the inspection 92 people were being supported with personal care. The main office is located in the market town of Wendover.

People’s experience of using this service:

¿People and their relatives gave us positive feedback about how they had been supported. Comments included “They’re very nice ladies. It helps me a lot really,” “The carers themselves are brilliant. They’re fantastic girls. They know straight away how I am, even if I tell them otherwise” and “I’ve got a regular one and got to know her. She’s very good.” Another person told us “All carers (staff) are kind and friendly, it is not just a job of work.”

¿People were not always supported to have maximum choice and control of their lives and staff did not always support in the least restrictive way possible; the policies and systems in the service did not always support this. We found some people were subjected to restrictive practice, for instance had bed rails in place. We checked if the service had followed the code of practice for the Mental Capacity Act 2005, we found they had not ensured this was followed for all the people who had equipment in place which restricted their movement. We have made a recommendation about this in the report.

¿Prior to people receiving care and support, an environmental risk assessment was carried out. Risks associated with people’s medical conditions were assessed and staff had access to additional guidance on how to minimise the likelihood of harm. However, records showed that additional risk assessments were required for the use of bed rails and the risk of pressure damage to skin. We found these were not routinely in place. We have made a recommendation about this in the report.

¿People were supported by staff who had been employed following a robust recruitment process to check their suitability and safety.

¿People were cared for by staff who were assisted to keep their skills and knowledge up to date and received support from a line manager.

¿Where required people were supported with maintaining their hydration and nutritional needs.

¿People told us they felt involved in decisions about their care and support. People told us “The supervisor comes every so often, putting new papers in the book and checking on the carers. They ring me up and go through a questionnaire with relevant questions,” “There’s a questionnaire over the phone normally. A supervisor takes certain papers out of the folder, we have a chat” and “They visit and ring me up as well.”

¿Staff were aware of people’s communication needs. Where required picture cards were used to support people to express how they were feeling.

¿Systems were in place to monitor the service provided. Feedback provided by people, relatives and staff was used to drive improvement to the service.

Rating at last inspection:

The previous inspection was carried out on 28 September 2016 (Published on 4 November 2016). The service was rated Good at the time.

Why we inspected:

The inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Inspections will be carried out to enable us to have an overview of the service, we will use information we receive to inform future inspections.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 28 and 29 September 2016. It was an announced visit to the service.

Carewatch is registered to provide personal care. It supports people in their own homes in Buckinghamshire. The Head Office is located in the town centre of Wendover. At the time of our inspection the service was supporting approximately 100 people.

We previously inspected the service on 24 February 2014. We found the provider was not meeting two of the five standards checked at the time. We found breaches of Regulation 10 and 20 of the Health and Social Care Act 2008. There were ineffective systems in place to monitor and assess the quality of service provision and we found records did not always reflect people’s needs. This meant there was a danger for people to receive inappropriate care. The provider sent us an action plan to tell us what action they were taking to ensure it improved. At this inspection we found that the provider had changed its working practice to ensure care plans reflected what support was required and effective systems were in place to monitor the quality of the service.

The service had 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.

People told us they were happy with the service provided, comments included, “Whatever you want doing they always ask and get me to do things for myself if I can,” “Person centred. Promote independence they really do. I've got animals and they look after them too.”

People were protected from abuse and avoidable harm as care workers were aware of how to recognise abuse and what to do if a concern was raised. One person told us “They'd never send a carer out unless they've been police checked.”

People told us care workers were respectful when providing care. Care workers were aware of how to provide a dignified service. People were supported by staff who provided a dignified service and understood people’s likes and dislikes.

People were supported by care workers that had been recruited in a safe way. Care workers had support through a robust induction process. The service supported their staff to achieve ‘The Care Certificate’, a nationally recognised set of standards expected for care staff.

Care workers had a good understanding of the Mental Capacity Act 20005 (MCA), and we saw that people were encouraged to be involved in decisions about their care.

There were good systems in place to ensure that people were supported with the right level of care. Care plans were reviewed when required. Care plans provided detailed information about how someone wished to be supported.

The service was well-led, many office staff and care workers had worked for the service for a long time and there were opportunities for staff to develop within the service. The service communicated its values to staff and staff understood them.

We spoke with twenty eight people who used the service. People were very complimentary about the care they received. One person told us “Usually a young male carer visits me who is very good. This is what I like about Carewatch as they send a male carer to me.” Another comment included “They genuinely care for you and care about little things which is very good.”

We saw initial assessments were completed and signed when people first started using the service. Care plans provided details of how staff members should support people. Risk assessments were completed when people first started using the service; however we found risk assessments in eight files were not updated and did not reflect people’s current needs. Regular reviews were undertaken to gain feedback from people, however, these were sometimes sporadic.

We reviewed twelve recruitment files and found the provider had an effective system in place to ensure the suitability of staff to work with people. The service received an annual audit review of the service, however, internal audits were not undertaken to check care plans and risk assessments were reflective of people’s current needs.

The agency had policies and procedures in place that ensured people’s needs and wishes were assessed and recorded prior to them receiving care.

People’s needs and wishes were recorded in a plan of care and these incorporated an assessment of risks to people’s safety. We saw evidence that these were reviewed regularly.

People we spoke to were satisfied with the service they received. Two people said “we receive an excellent service” and another said that they were lucky to receive such a good service.

In order to protect the people using the service, there was a robust safeguarding policy in place. All new staff received safeguarding training during induction. Regular refreshers were in place for all staff.

Staff received ongoing training and support, which provided them with the skills and knowledge to meet the needs of the people they were supporting. Observational techniques and mentoring were used, to ensure staff carried out their roles appropriately.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and spot checks. We saw that the service made changes in response to questionnaires and one person we spoke to said that they had been happy with the changes that had been made following an issue they had raised with the provider.