You are here

Universal Care - Beaconsfield Inadequate

We are carrying out a review of quality at Universal Care - Beaconsfield. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary

Overall summary & rating


Updated 11 March 2020

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

Inspection areas



Updated 11 March 2020

The service was not safe.

Details are in our safe findings below.


Requires improvement

Updated 11 March 2020

The service was not always effective.

Details are in our effective findings below.



Updated 11 March 2020

The service was caring.

Details are in our caring findings below.


Requires improvement

Updated 11 March 2020

The service was not always responsive.

Details are in our responsive findings below.



Updated 11 March 2020

The service was not well-led.

Details are in our well-led findings below.