Archived: Unique In Care Ltd

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People's care and support had been planned and delivered in a way which ensured people's safety and welfare. Risk assessments had been completed with guidelines in place for staff to follow. We saw evidence that the environment had been assessed for any risks to both the staff and person receiving care and support. This was to ensure their safety and welfare. Risks had been assessed in relation to the delivery of care and support which included pressure area care and moving and handling. These ensured staff managed any risks in a way which reduced the likelihood of injury or harm and promoted people's safety and comfort.

We found examples of poor recording of medications, gaps in the medication administration records and an example of medication being prompted from a dossett box which had not been filled by a pharmacist. This meant people were not protected against the risks associated with medicines because the registered manager did not have appropriate arrangements in place to manage medicines safely.

These findings demonstrated to us the service was not safe.

Is the service caring?

Generally people said they were happy with their care and support and the staff met their needs well. Comments included ''They (the staff) do everything that's in the care plan....I have a good relationship with them, I look upon them as friends.'' ''The girls are doing a fantastic job.''

People's care plans were individualised and centred on each person's specific needs. People and their family members were involved in the planning of the care and support. This enabled them to be have a say in how they wished their care and support to be provided taking into account their wishes and preferences. Where people's needs had changed the registered manager acted upon them to ensure staff had up to date guidelines in place to meet those needs whilst supporting people safely.

The findings throughout our inspection showed on the whole the service was caring.

Is the service effective?

Care and support plans reflected people's needs, choices and preferences and any changes to their needs had been identified and updated to ensure their needs were met. Support for staff was provided through training, supervision and an appraisal of their work. 'Spot' checks were undertaken to monitor staff practices to ensure they were competent and provided care appropriately and according to the organisation's procedures. Specialist training had been accessed to ensure staff had the knowledge and skills to provide support for people whose needs required specialist support.

We saw documentation which informed us one family member had fed back to the registered manager that the first visit their relative received had been a bit early. However, the registered manager responded appropriately and changed the time of visit to accommodate their relative's preferences. This showed the registered had responded to their concerns and accommodated their wishes and preferences.

Improvement since our last visit showed the service is effective in meeting the needs of the small number of people they presently provide with care and support.

Is the service responsive?

We noted improvements had been made since our visit in March 2014. We saw examples in which care plans had been updated when people's needs had changed. We saw detailed guidelines in place for staff to follow when there had been changes to one person's pressure area care. The support plan identified the role of the carers in supporting the individual in relation to pressure area care. The support plan made it clear if there were any changes or concerns staff were to report them to the office who in turn would contact the district nurse to arrange a visit. We saw an example where staff had reported a concern to the office and to family members. This ensured all relevant people were informed of any changes and appropriate health care professionals to ensure their health and welfare.

During our visit we found discrepancies on one individual's financial transaction record. The registered manager responded to the findings immediately and made an appropriate referral to the local authority who are the safeguarding lead. The registered manager informed us they had met with both the staff and the person themselves and put strategies in place to ensure any subsequent risks were minimised. These included risk assessing the situation again and putting measures in place such as keeping receipts for any transactions and requiring both the staff and individuals to check the returned monies and sign the transaction record as correct. The registered manager informed us they would also audit any transaction records to ensure they were completed correctly and prevent any re occurrences. Whilst measures were put into place to ensure people were not at risk of potential financial abuse we have not been able to test that this compliance has been sustained.

The findings demonstrated the service was responsive to people's needs and changing needs.

Is the service well led?

People's opinions were sought by way of telephone monitoring surveys. We noted such telephone calls had been made since our visit in March 2014. Telephone monitoring calls had been made in July 2014 to gain feedback on the quality of service people received. No concerns had been raised and they rated the service they received as 'good' and one person had rated it as 'excellent.'

The registered manager had made steps to address the failings found during our last inspection in March 2014. Since our visit in March 2014 it was evident the number of packages of care and carers to support them had significantly reduced. We were informed by the registered manager the service currently provided care and support to nine people. These packages of care were provided by a total of three staff plus the registered manager who was providing some lunchtime visits. This in turn enabled the registered manager to concentrate some time on making improvements to the quality of service. Whilst some improvements have been made it will not be evident if this would be sustainable if the service was providing care to a larger number of service users.

We did receive feedback from two people, one being a person who used the service and one a relative, who both felt the registered manager could be ''evasive''. One told us ''She (the registered manager) is always right, you can't be right.'' and the other told us that they had raised concerns about staff cutting corners in relation to domestic tasks. They both said the registered manager was not very good at resolving issues and was evasive.

The findings demonstrated to us the service was generally being well led. We will be able to test that this compliance has been sustained at our next inspection.

We set a compliance action for the provider to improve practice. The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 12 March 2014 and 26 March 2014 to check if improvements had been made. We also visited people's homes on the 19 March 2014. We looked at peoples care plans, medication records, recruitment procedures, staffing levels, supervision appraisals and training, and how the quality of the service was monitored.

We found people's needs had not been reassessed to ensure care provided remained appropriate and safe. We saw risks were not monitored appropriately to ensure the safety and wellbeing of people who used the service. We found people had not always received their planned care visits, which placed them at risk.

We found people were put at risk of harm as medication was not assessed, recorded and monitored to ensure the safety of people using the service in line with the provider's policy.

People could not be sure they were supported by staff who were assessed as suitable to work with vulnerable adults. We saw regular occasions were new staff had been sent out to work without the required checks.

We found there were not always sufficient numbers of suitably trained and experienced staff available to meet people's needs appropriately. Staff told us they did not feel supported in their roles. We found staff supervision and appraisals were not being undertaken in line with the provider's policy and staff training was sporadic and out of date. This meant staff did not receive the training and support they required to perform their roles effectively and safely.

We found there were no effective systems or procedures in place to monitor the quality of the service provided for people. We saw some telephone calls to people and spot checks were undertaken, however trends and patterns were not identified or actioned.

Another person said they would recommend the company to other people. They were very pleased with the care they received and said they did not feel rushed. They said they were able to contact the office if staff were running late.

Two people felt their care was rushed. One person said they were happy with the service they received overall. Two people said they had experienced occasions where they had not received their medication.

We saw care plans were in place for each person. These were detailed and provided comprehensive assessments of people's needs. Risk assessments were in place to reduce the likelihood of injury or harm to people. Records showed some people had not received all the visits they required. In some instances, visits had been much later than scheduled. Two of the four people who provided feedback had experienced late or missed visits. This meant people's needs were not met on those occasions.

Staff said there was generally enough time to carry out all the required tasks in the time they were given. They told us two staff always visited people whose care plans or risk assessments required this. It was highlighted some of the newer care packages needed more time than was allocated. Staff said the provider had asked them to document this so that a case could be presented to increase people's support.

We looked at recruitment practice. The files we looked at showed appropriate checks were carried out before staff began work. For example, checks were made for criminal convictions and inclusion on lists of people unsuitable to work with vulnerable persons.

Staff received appropriate professional development. We spoke with three members of staff who provided care to people. Each person said they had received an induction, in line with the nationally recognised Skills for Care induction. Systems were in place to supervise staff and check their practice.

We found staff undertook five days of training covering topics such as moving and handling, first aid, safeguarding and health and safety. This equipped them with the skills and knowledge to carry out their duties safely.

Improvements had been made to people's care plans, medication administration and records. This meant people's care needs were being met. Effective auditing systems had been developed. This ensured practices were being monitored to ensure people got the required care to meet their needs.

We spoke with five people who used the service and three relatives. People told us they were satisfied with their care. They told us they got regular carers, who generally arrived on time and stayed for the agreed time. People who required two handed calls told us two staff were provided for those calls, although in the past this was not always the case. One person told us their morning call was too early but liked the carer so much that they accepted it. This was fed back to the agency to address to ensure the person got a call at a time more convenient to them.

We spoke with one office staff member and four care staff. Staff told us they were inducted, trained, supervised and supported in their roles. We saw records were in place to confirm this. This ensured staff were suitably skilled and supported to meet people's needs.

Improvements had been made to the way peoples' records were being managed in that they were being returned to the office and audited. Risk assessments were in place and being developed in relation to risks posed to people as a result of their physical, medical and mental health needs. This enabled the monitoring of the standard of record keeping and the care delivered so that the provider could be ensured peoples' needs were being met.

We spoke with three people who used the service and six relatives. People were satisfied with their care and felt this had improved in recent months. They told us they got regular carers, carers were generally on time and they stayed for the agreed time. People and their relatives could not recall being given a copy of the complaints procedure. They said complaints and concerns raised were generally listened to. This ensured issues raised were acted on to improve the service to people.

We spoke with two office staff and five care staff. Staff were inducted, trained and formal supervisions and appraisals had commenced. This would provide staff with the skills and knowledge to meet people's needs.

Quality monitoring systems were being developed. A business and financial plan were being worked on, record keeping and filing had improved to safeguard people.

People told us they felt safe. They told us they did not receive regular carers. Some people liked this as it gave them variety, others said they would like to have the same carers all the time but knew it was not possible. They commented that the carers were generally on time but they could be late for the morning and evening calls due to the traffic. They said they turned up most of the time. A relative told us that they didn't get regular carers and that carers were often late and didn't stay for the agreed time.

People told us they felt staff were suitably trained and inducted. A relative commented that new staff did not appear to be properly trained and inducted as they did not always know what to do.

People told us they were asked their view on the agency. They told us the manager had recently being involved in care calls. They felt this was positive.

One person told us they were aware of the complaints procedure. Another person commented that the agency was responsive to queries and concerns. Other people told us they were not aware of the complaints procedure but their family members were.

A relative told us they had made several complaints to the agency. They commented that 'the agency listens but do not hear'.