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Archived: Universal Care - Beaconsfield

Overall: Inadequate read more about inspection ratings

Chester House, 9 Windsor End, Beaconsfield, Buckinghamshire, HP9 2JJ (01494) 678811

Provided and run by:
Universal Care Limited

All Inspections

26 November 2020

During an inspection looking at part of the service

About the service

Universal Care – Beaconsfield is registered to provide personal care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not routinely and consistently protected from potential risks to their health and well-being as a result of their medical conditions. We found risk assessments were either lacking in detail or omitted altogether. For instance, people who had a diagnosis of diabetes did not routinely have a risk assessment in place.

Risk assessments contained conflicting information or did not provide adequate guidance for staff. We found risk assessments for people prescribed anticoagulant medicines routinely stated “Carers MUST call paramedics immediately if [Name of person] has a bad fall likely to cause internal bleeding, a nosebleed, cut or wound.” No additional guidance for staff was available for what constituted a ‘bad fall’. Risks assessments associated with people’s dietary needs were not routinely effective and staff did not always follow the guidance.

People were placed at risk by poor medicine management. We found some people were given medicine by staff when they were assessed as “self-medicating”. Staff had little information on when to support people with medicines prescribed for occasional use. We found staff failed to routinely record what medicine they administered, which could have led to people receiving more or less than prescribed.

The provider had failed to learn from previous concerns and did not fully investigate incidents, accidents or near misses. This had the potential for people to be out at continued risk.

Staff supporting people did not have up to date and accurate information available to them. This was due to delays in risk assessments or care plans being written or care plans being developed in the office without any communication with the person.

People had the potential to be supported by staff who had not been recruited safely. The provider failed to ensure all the required pre-employment checks were carried out.

People were put at risk from the current coronavirus as office staff who visited people in their own homes were not following government guidance on personal protective equipment and social distancing.

Feedback we received from people and their relatives was in the main positive. Comments included, “I’m very happy with the carers, I’ve never had any problems with them”, “We have got a very nice set of two carers, three weeks on and three weeks off", “They do everything for her “ and “I know the staff well". People described the staff as caring. Comments included, “Extremely kind and very helpful“, “They're beautiful, wonderful and kind” and “The carers take my wife for walks, they’ve all been talented and helpful“.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 13 May 2020). Due to continued concerns about the service a targeted inspection was carried out in June 2020, ratings are not changed as a result of a targeted inspection, however urgent enforcement action was carried out as there were serious concerns about people’s safety. At this inspection we found on-going concerns about the management of the service and continued multiple breaches of regulations. The service remains in special measures.

Why we inspected

We undertook this focused inspection to check whether previous breaches found in relation to Regulation 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We reviewed the key questions of safe and well-led only.

The overall rating for the service has not changed following the targeted inspection carried out in June 2020 and the comprehensive inspection carried out in March 2020 and remains inadequate.

Enforcement

The service has been in breach of regulations since 2018. We have identified continued breaches in relation to risk management, medicine management and record keeping. We took enforcement action to cancel the provider's registration. This means they will no longer be able to provide the regulated activity of personal care to people.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. There are no outstanding representations or appeals. Please see the end of this report for details of enforcement action taken.

Follow up

We will continue to monitor information we receive about the service. We have arranged regular meetings with the provider until they are removed from the register.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

6 March 2020

During a routine inspection

About the service

Universal Care – Beaconsfield is registered to provide personal care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service supported over 200 people.

People’s experience of using this service and what we found

People continued to be placed at risk of harm due to a lack of systems to promote safe care and treatment.

Potential risks to people were not routinely and consistently assessed. Staff were not always aware how to promote people’s safety. People who required support with medicine administration were not always supported in a safe manner.

The provider and registered manager had failed to act on all previous concerns raised and did not routinely have adequate measures in place to ensure people were protected from potential harm. Quality monitoring systems were either ineffective or not in place. We found repeated and continued breaches of the regulations. Legal requirements as stated in the provider’s registration were not routinely complied with. For instance the provider failed to inform us of events it was legally required to do so.

People were not always supported to have maximum choice and control of their lives and staff; the policies and systems in the service did not routinely support this practice. We found staff did not always comply with the Mental Capacity Act 2005.

People’s privacy and dignity was not routinely upheld. We were informed personal information had been shared with people who were not legally entitled to received it. We asked the provider to refer themselves to the Information Commissioner Office, following a data protection breach.

People told us they had developed a good relationship with staff comments included “They are lovely, brilliant”, “I found them excellent” and” I’m very happy.”

People and their relatives told us they knew how to make a complaint and would not hesitate to contact the office.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 1 October 2019) At this inspection enough improvement had not been made/sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified continued breaches in relation to risk management, record keeping related to medicines and staff training. The provider failed to notify CQC of certain events, to comply with the Mental Capacity Act 2005 and to monitor and improve the quality of the service to people. We have identified a further breach of regulations as the provider failed to notify us of changes to directors of the limited company.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The period for representations and appeals has concluded and we have begun the process for cancelling the provider's registration.

21 August 2019

During a routine inspection

About the service

Universal Care Beaconsfield provides care in people’s own homes. It provides a service to older adults and young disabled adults. Approximately 200 people were receiving care at the time of our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they felt safe using the service and spoke positively about the support they received. People felt their privacy, dignity and independence were respected. They expressed a high level of satisfaction in a recent independent survey and would recommend the service to others.

People who used the service and staff described a positive culture at the service. Staff said there was good teamwork and an inclusive workplace. They told us they would feel confident in raising any concerns with managers.

The service was responsive to people’s changing needs. We saw examples where people had been referred to other agencies so their needs could be re-assessed. There was also liaison with family members. People’s complaints were investigated by the service and responded to promptly and an apology given.

We found the service had not always taken appropriate measures to protect people from the risk of avoidable harm. People’s care plans did not always contain guidance care workers needed to support people with their health conditions. This placed people at risk of ineffective and unsafe care. There were also no end of life care plans, to make sure people’s needs and wishes were recorded.

Where people were supported with their medicines, we found records had not been always been maintained to an acceptable standard. The service had not ensured care workers had been properly assessed and observed before they were permitted to handle people’s medicines, to ensure this was done safely.

Staff had received training on safeguarding people from abuse. People we spoke with and staff we contacted did not express any concerns. We found some instances where the service had not made referral to the local authority, to report safeguarding incidents. This meant the service was not always following proper procedures to protect people and alerting statutory agencies.

Robust recruitment practice was not always followed. A care worker had been allowed to start on a basic level Disclosure and Barring Service (DBS) check, rather than enhanced level. This checks for criminal convictions and inclusion on lists of people unsuitable to work with vulnerable people. There was no risk assessment, supervision or checks of the care worker until their enhanced DBS check was completed. This potentially placed people the care worker supported at risk of harm.

Staff said they felt supported. They said there were back-up systems for them to contact a manager or senior if they needed advice. New workers completed an induction which included training the provider considered mandatory. However, care workers were not observed and assessed in the workplace to ensure they provided appropriate levels of support. We found patterns of supervision varied. Some new care workers had not received supervision or other support until after three or five months of working. We did not see any evidence of appraisals being undertaken to discuss staff performance and their developmental needs.

Care was not being provided in line with the Mental Capacity Act (2005). The service had not always obtained verification of Lasting Power of Attorney documents, so it could be assured of consulting people who had legal authority to act on others’ behalf. There were also no records of the service holding best interest meetings where people lacked capacity. Therefore we could not be certain people were supported to have maximum choice and control of their lives and were supported by staff in the least restrictive way possible and in their best interests.

The service had developed policies but these were not always fit for their intended purpose. Recommendations have been made about the service’s policies on the Equality Act 2010 and the Accessible Information Standard.

Leadership and monitoring of the service were not effective in ensuring people received good quality care which kept up to date with legislation and best practice. The registered manager had not demonstrated an understanding of their responsibilities in meeting the regulations. We found there had not been satisfactory progress in meeting the breaches from the last inspection. We had also not been informed of all events which providers and registered managers are required to notify us about.

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

Rating at last inspection

The last rating for this service was requires improvement (report published 7 August 2018) and there were multiple breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Universal Care Beaconsfield on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches at this inspection in relation to staff recruitment practice, staff support, monitoring of the service, consent to care, mitigating risks to prevent avoidable harm, ensuring people received appropriate care and support to meet their needs. We have identified a further breach in relation to notification of significant events.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

The period for representations and appeals has concluded and we have begun the process for cancelling the provider's registration.

16 June 2020

During an inspection looking at part of the service

About the service

Universal Care – Beaconsfield is registered to provide personal care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection the service supported approximately 140 people.

People’s experience of using this service and what we found

We found people were placed at continued risk of avoidable harm. The provider had not always identified or assessed risks posed to people. The provider did not always ensure people’s needs were assessed prior to supporting them.

People were supported by staff who had not received training to care for them safely. People with end of life care needs had been supported by staff who had not received any end of life training, We found staff were not equipped or trained to deal with emergency situations.

People were supported by staff with prescribed medicines which were not always listed on their care plan.

The provider has an inspection history of ineffective management. At this inspection we found an ongoing lack of leadership and skills to manage the service. Records were not routinely updated to reflect people’s needs or decisions made about their care and support. We found the provider continued to fail to meet the fundamental standards and meet the requirements of the regulations.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 13 May 2020). At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations. We have not changed the rating as this was a targeted inspection.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to ongoing concerns received about risk management, assessment of needs and the lack of effective managerial oversight. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We have identified repeated and continued breaches in relation to risk management, record keeping related to supporting people, medicine management and staff training. The provider has continued to fail to notify CQC of certain events and monitor and improve the quality of the service to people.

Please see the action we have told the provider to take at the end of this report.

Follow up

Since the last comprehensive inspection in March 2020 we have met with the provider to seek reassurance on the improvements they intend to make. We will continue to work with the provider with support from the local authority to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service remains in 'special measures' and has been since the 2019 inspection. This means we will keep the service under review and monitor their improvement action plan. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will use our powers and the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

11 June 2018

During a routine inspection

The previous inspection took place in November 2016. The overall rating from that inspection was requires improvement. This announced inspection took place on 11, 13 and 14 June 2018. This is the second consecutive time the service has been rated Requires Improvement.

At the last inspection on 23 and 25 November 2016, we made recommendations for the provider to make improvements in record keeping in relation to safeguarding investigations. We also raised concerns as meetings between staff and managers were not always documented.

During this inspection we found records related to safeguarding concerns were up to date, however we had concerns related to a lack of knowledge and understanding of staff regarding the correct safeguarding procedure to follow. Records related to meetings between staff and managers were in place, however, the frequency of these meetings was not in line with the providers policy.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children. At the time of our inspection it was providing care to 218 people.

Not everyone using Universal Care – Beaconsfield receives a 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.

The service had a registered manager in place. 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, their relatives and professionals were generally very positive about the service provided.

However, we had concerns about the safety of the recruitment system for employing new staff as not all relevant checks had been undertaken.

Care plans and risk assessments did not all contain relevant up to date and accurate information. This placed both people and the staff at risk of harm or injury.

Medicines were not safely managed, staff did not always receive up to date training and their competency was not always assessed. There were no effective medicine audits in place to protect people from harm.

People were not always protected from the risk of abuse, as staff training was not regularly up dated. Staff were not aware of how or who to report concerns of abuse to.

Training for staff was not comprehensive, and did not cover the areas they required to carry out their role. Support for staff through one to one supervisions and spot checks were not carried out in line with the provider’s policy.

The service was not compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were not assisted to have maximum choice and control of their lives. There was a lack of training for staff and understanding by senior staff, to protect people from receiving inappropriate care.

People and their relatives described staff as caring, patient, and helpful. They gave us examples of how staff had gone above the call of duty to them.

The provider had failed to assess the service in relation to people with protected characteristics. They were not able to evidence how they were compliant with the Accessible Standards Framework. We have made a recommendation about this in the report.

People told us the staff protected their privacy and dignity when carrying out personal care.

The provider’s documentation showed how they appeared to respond appropriately to complaints, this was not always the view of the complainant. Staff were not sure how to respond to complaints, and they had received no training in how to do so. We have made a recommendation about this in the report.

People did not always have an end of life care plans or associated risk assessments in place. Without this the provider could not be certain they would be providing care for people in line with their preferences and choices for their end of life care.

There had been a change in senior staff over the last few months; however, we found there were other inconsistencies in the management of the service. There had been weak leadership. Senior staff had not received adequate training to enable them to assess the skills of care staff. No audits were in place to ensure the quality of the service and make changes when necessary.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

23 November 2016

During a routine inspection

We undertook an announced inspection of Universal Care Beaconsfield on 23 and 25 November 2016.

Universal Care provides a range of services to assist people in their own homes. Support ranged from day to day assistance and the provisions of personal care for people. On the day of our inspection 269 people used the service.

There was 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 and relatives told us they felt people were safe. Staff understood their responsibilities in relation to safeguarding people. However the provider had failed to act timely to gain assurance that staff understood their responsibilities when they could not access people’s homes.

Staff had received regular training to make sure they stayed up-to-date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives told us people’s dignity was promoted.

Where risks to people had been identified risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where ever possible.

There were sufficient staff deployed to meet people’s needs. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People were supported with their nutrition and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

People and relatives told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care. However the provider had not adequately managed a recent safeguarding incident as their investigation was not robust.

Staff spoke positively about the support they received from the registered manager. Staff supervision and other meetings were scheduled as were annual appraisals. Staff told us the registered manager and their managers were approachable and there was a good level of communication within the service. However, meetings were not always recorded to enable the provider to ensure areas raised were addressed and recorded.

Relatives told us the service was friendly, responsive and well managed. Relatives knew the registered manager and staff and spoke positively about them. The service sought people’s views and opinions but did not always act on them. However, people told us they did not always have the opportunity to provide feedback on the service provided.

We have made a recommendation that the provider review their action plan following the safeguarding incident to ensure all actions have been taken to ensure people are safe when care workers are unable to access people’s property.

4 September 2014

During an inspection looking at part of the service

A single inspector carried out this inspection. When we visited the service 24 February 2014 we had concerns how one standard was managed. 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 4 September 2014 to check if improvements had been made.

Below is a summary of what we found. The summary describes 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 effective?

We found the provider had responded to our concerns around staff support. We found staff were now receiving regular supervisions in line with the providers policy. A new training and recruitment manager had been recruited which allowed care managers time to undertake effective supervisions. We were provided with a new training policy which outlined which core training needed to be refreshed and how often. The provider was in the process of undertaking this requirement.

This meant the service was effective.

24 February 2014

During a routine inspection

We received feedback from 21 people who used the service or their relatives. People described a high level of satisfaction with the standard of care provided. They told us care workers arrived at the time they expected them and stayed the required length of time. People reported good continuity of care, with the same team of care workers supporting them. They said they would communicate directly with the office if they had any concerns. Those people who had done so said any concerns had been addressed satisfactorily. Comments included 'What they do for me is very satisfactory,' 'No problems at all,' 'Excellent,' and 'My carers look after me very well.'

We found people's needs were assessed and care was planned and delivered in line with their individual care plan. Care plans were in place for each person who used the service. We looked at a sample of seven people's care plans. These showed people's needs had been assessed and the support they required was identified. Risk assessments had been completed in each file we read and ensured care was delivered in a safe manner.

There were effective recruitment and selection processes in place at the service. We looked at four staff recruitment files. Each file contained the necessary checks and clearances. This ensured staff had the right skills and experience and were suitable to work with vulnerable people.

Staff had not consistently received the support they required. Records showed staff completed a structured induction which gave them a good foundation into the work they undertook. The core training needs for staff had not been identified subsequent to their induction. This meant staff did not have the opportunity to update and refresh their skills, to take account of changes to good practice.

We found variations to the pattern and frequency of staff supervision and appraisals. This meant staff had not received routine evaluation of their performance and development needs, to ensure they supported people appropriately.

The provider had an effective system to regularly assess and monitor the quality of service that people received. A satisfaction survey was conducted in 2013 by an external organisation. The findings of the survey were positive and showed the service had provided a high level of care most of the time, in people's experiences.

25 February 2013

During a routine inspection

People's care needs had been assessed before a service was provided. This ensured the service was able to meet those needs. Care records addressed people's individual care needs and the service to be offered. Care staff had the knowledge and skills required to provide a service which met people's needs and enabled people to live as independently as possible in their own homes. The people we spoke with told us staff maintained good timekeeping, provided care and support as outlined in the care plan, maintained good relations with the person using the service and their families and took account of people's wishes.

The people we spoke with expressed a good level of satisfaction with the service. They said it met their needs very well. Care staff provided good support and paid attention to detail. They said they had no concerns about the safety of their relative when receiving care from the service. Some people reported having had problems in communication with the office on occasions but those had not affected their overall favourable opinion of the care provided.

We found the service had arrangements in place to provide the care and support people required. Staff acted in accordance with people's wishes. The service had procedures to protect people from the risk of abuse. People were looked after by staff who were appropriately trained and supported. The provider had arrangements for monitoring the quality of the service provided to people.