Carewatch ( Horsham and Crawley) is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, and younger disabled adults. Not everyone using Carewatch (Horsham and Crawley) receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

This inspection took place on 13 March 2018 and was announced. We gave the provider 48 hours’ notice of the inspection visit because the location provides a domiciliary care service and we needed to be sure that the registered manager and other staff were available to speak to us on the day of the inspection. At the time of the inspection there were 96 people receiving a home care service. The registered manager was present on the day of the inspection.

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.

At the last inspection on 8 December 2015 the service was rated Good overall. At this inspection we found some areas of practice that required improvement.

Risks associated with people’s mobility were not always assessed and there were not always clear plans to guide staff in how to support people safely. Staff had received training in how to administer medicines. There were systems in place to check and monitor that medicines were being administered safely. Some people were being supported with administration of medicines that were prescribed to be given PRN (as and when needed). There were no clear guidelines for staff in how to administer PRN medicines safely. Risks to people were not consistently assessed and managed to ensure that people were supported to be safe.This was identified as a breach of the regulations.

Management systems and processes were not always effective in identifying shortfalls and making improvements. People were not always informed of who was coming or changes to visit times. This had been noted through the provider’s quality assurance feedback system. However, people told us communication about their visits remained inconsistent. Some auditing processes had failed to identify omissions in records. These areas of practice were identified as needing improvement.

People told us that they felt safe with staff supporting them to live as independently as possible. Staff knew how to recognise signs of possible abuse and understood their responsibilities with regard to reporting suspected abuse. Recruitment systems ensured that staff were suitable to work with people. There were enough staff to cover all the care visits.

Staff had received the training and support they needed. People and their relatives told us they had confidence that staff would recognise if people were unwell and would help them to access the health care services they needed. One relative told us about how staff had recognised when their relation became unwell, saying, “I was impressed that they had called me.”

People’s needs had been assessed in a holistic way. Staff understood their responsibilities with regard to the Mental Capacity Act 2005. People told us that staff checked with them before providing care. People were supported to have enough to eat and drink.

People and their relatives told us that staff treated them kindly and were respectful. People said that staff respected their views. One person said, “They are all kind and lovely. I look forward to them coming.” Staff knew people well and told us they had time to get to know people and understand their needs. One staff member said, “If I don’t have enough time I tell the office and th

We inspected Carewatch (Horsham and Crawley) on the 8 December 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service. We wanted to be sure that people would be in whom we needed to speak with.

Carewatch (Horsham and Crawley) provides personal care and support to people who wish to retain their independence and continue living in their own home. Personal care and support is provided for older people and people living with early stages of dementia. At the time of our inspection 100 people were receiving a care service.

The service had a registered manager. 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.

The experiences of people were positive. People told us they felt safe and staff were kind and the care they received was good. One person told us “Absolutely safe, very good. It’s not a problem to raise a concern”.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff at all times to meet people’s needs. When the provider employed new staff at the service they followed safe recruitment practices.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and supported to access health care services if required.

The service considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

People confirmed staff respected their privacy and dignity. Staff had a firm understanding of respecting people within their own home and providing them with choice and control.

People were supported at mealtimes to access food and drink of their choice and were supported to undertake activities away from their home. One person told us “They cut up carrots and onions and peel fruit for me. I still do the cooking”.

There were clear lines of accountability. The service had good leadership and direction from the registered manager. Staff felt supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. Staff had the skills and knowledge to meet people’s needs. Staff received regular training to ensure they had up to date information to undertake their roles and responsibilities. One member of staff told us “I do all the training every year. It keeps you refreshed and up to date with rules and regulations”.

Feedback was sought by the registered manager via surveys which were sent to people and staff. Survey results were positive and any issues identified acted upon. People and relatives we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues. The provider responded to complaints with details of any action taken. One person told us “Not complained for a long time, I wouldn’t worry about that. If I’m not getting value, I would say so”.