Date of assessment 17 September 2024 to 27 September 2024. The service has improved. People were protected from the risk of harm. Risks to people were now identified and managed safely, with guidance for staff on mitigating risks. Care plans now provided detailed advice and information on how to keep people safe, which staff followed. Medicines care plans were now in place and medicines to be taken as required (PRN) were now recorded appropriately. Systems and processes for protecting people from the risk of abuse had improved, with accidents and incidents documented, together with outcomes and lessons learned. Staff understood how to recognise the signs of potential abuse and described the actions they needed to take. The system for considering people's capacity to make specific decisions had improved. The provider has now implemented robust systems to measure and monitor the service overall and to drive improvement. The service has been in Special Measures since 21 April 2023. The provider demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore this service is no longer in Special Measures. As a result of these improvements, the service is no longer in breach of regulations and is now rated good overall.
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Carewise Ltd, a domiciliary care agency in Shoreham-by-Sea, was rated Requires Improvement overall (with Well-led rated Inadequate) following a focused inspection in November 2022, representing the third consecutive inspection with breaches of Regulations 12 and 17. Enforcement action was taken with additional conditions imposed on the provider's registration due to persistent failures in risk management, medication care planning, safeguarding processes, and governance.
Concerns (11)
criticalCare planning: “Care plans were not in place to ensure safe and consistent care...Information was not available to guide staff to provide safe care or to recognise and act upon changes in people's health and wellbeing.”
criticalMedication management: “Medicine care plans were not in place and there was a failure to provide guidance to staff about people's medicines...lack of information relating to risk management and protocols for administering 'as and when required' (PRN) medicines.”
criticalSafeguarding: “Some staff we spoke with failed to demonstrate an understanding of the signs and types of abuse or their responsibilities within safeguarding processes.”
criticalIncident learning: “The provider did not have a robust system in place to monitor or analyse incident records for trends. Information was not used to mitigate the risk of a repeated incident or accident.”
criticalGovernance: “There was a shortfall in their oversight and governance of the service and a continued failure to implement robust quality assurance processes to improve the quality and safety of the service.”
criticalRecord keeping: “Records and documents were not available on paper or any other electronic device...Information relating to people's care and the running of the business were not held securely.”
criticalLeadership: “The registered manager did not have day to day oversight of, and access to, electronic records relating to people's care or the management and governance of the service.”
moderateSupervision / appraisal: “Staff told us they did not receive formal recorded supervision on a regular basis. Care staff told us they had limited engagement with the registered manager.”
moderateConsent / capacity: “We were not assured by the providers processes to consider people's capacity under the MCA...Some staff we spoke with had limited understanding of MCA.”
moderateInfection control: “Staff and people told us staff rarely wore face coverings when supporting personal care. This placed people and staff at an increased risk of contracting and spreading Covid-19 and other infections.”
moderateStaff competency: “The office manager did not have a background in care and was unable to demonstrate they had undertaken any care-based training including safeguarding and medicines.”
Strengths
· People felt safe and were happy with the care they received, describing staff as 'Absolutely brilliant', 'Very nice', and 'Always make me feel better'.
· Safe recruitment processes were in place including DBS checks and appropriate references.
· Comprehensive range of training opportunities including bespoke training for specific needs such as dementia and eating and drinking safely.
· Staff supported a robust induction including the Care Certificate for those new to care.
· Evidence of working effectively with healthcare professionals including community nursing, occupational therapists and the falls team.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Carewise Ltd remained Requires Improvement overall with Well-led deteriorating to Inadequate, and continued breaches of Regulations 12 and 17 plus a new breach of Regulation 18 due to unsafe food provision for people with swallowing difficulties, untimely medicines and lack of staff training/competence. Governance was weak with insecure records, ineffective oversight and failure to learn from prior inspections, prompting CQC to issue Notices of Decision and three safeguarding referrals.
Concerns (10)
criticalCare planning: “Three people had been provided with high-risk and inappropriate food to meet their assessed needs. This increased their risk of choking.”
criticalMedication management: “The person had consistently been administered their medicines outside of the prescribed times, on two occasions over an hour later.”
criticalStaff training: “Staff had not been trained and lacked understanding about how to support people who required texture-modified diets and this exposed people to a risk of harm.”
criticalStaff competency: “Staff had received on-line training in medicines administration and moving and positioning, yet their practical skills and competence had not been assessed.”
criticalGovernance: “There were a lack of systems to ensure sufficient oversight of people's care. Neither the provider nor the registered manager had a system in place to enable them to oversee people's day to day support.”
criticalLeadership: “there were wide-spread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalSafeguarding: “The provider and staff lacked understanding about their responsibilities to keep people safe from harm and abuse.”
criticalIncident learning: “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.”
moderateRecord keeping: “Records were not always stored securely or well-maintained to demonstrate the care people had received.”
moderateStaffing levels: “There were not enough staff who had appropriate understanding and skills to meet people's specific needs.”
Strengths
· All people and relatives told us they felt safe and were happy with the care they received
· Effective electronic call monitoring system minimising risk of missed visits
· Safe and effective recruitment systems including pre-employment checks and references
· Good infection prevention and control practices with adequate PPE during COVID-19
· Improvement made on consent: provider no longer in breach of Regulation 11 (MCA)
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and management; Using medicines safely; Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement