Background to this inspection
Updated
4 February 2021
The inspection
We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector and one inspection manager. An Expert by Experience made telephone calls to people and their relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and specialist housing.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 26 November 2020 and ended on 02 December 2020. We visited the office location on 26 and 27 November 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. Whilst at the service we asked the registered manager to advise us on what improvements they had made since our last inspection and provided a further opportunity for them to share this with us after the site visit. We used all of this information to plan our inspection.
During the inspection
We spoke with four people who used the service and four relatives about their experience of the care provided. We spoke with six members of staff including the registered manager, quality and compliance manager, care co-ordinators and recruitment manager.
We reviewed a range of records. This included looking at 14 care records in total, safeguarding records, training records, complaints records and recruitment files for four staff. A variety of records relating to the management of the service, including policies and procedures were requested from the provider.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We reviewed record the provider sent us and received email feedback from staff, relatives, one person and one healthcare professional.
Updated
4 February 2021
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’.