Archived: Unique Care Providers

Updated 18 November 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 5 September 2016 and was announced. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure the manager would be available to meet with us. The inspection was completed by one adult social care inspector. We also visited Unique Care Provider’s office on 15 September 2016, this visit was also announced.

Before the inspection we reviewed all the information we held about the service including notifications, we also spoke with the local authority contracting team. The registered provider had also submitted a Provider Information Return (PIR) for the service. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During our visit we spent time looking at 13 people’s care plans and related documentation, we also looked at four records relating to staff recruitment and training, and various documents relating to the service’s quality assurance systems. We spoke with two members of the board of directors the manager, a care co-ordinator and a carer. Following the inspection we spoke with five care staff on the telephone, three people who used the service, five relatives and one friend of a person who used the service.

Updated 18 November 2016

The inspection of Unique Care providers took place on 5 and 15 September 2016 and was announced. We previously inspected the service on 27 and 28 January 2016, at that time we found the registered provider was not meeting the regulations relating to safeguarding, safe care and treatment and governance. We rated the service as inadequate overall and placed it in special measures. This inspection was to see whether improvements had been made.

Unique Care Providers is registered to provide personal care. Care and support was provided to approximately 100 people who lived in their own homes within the localities of Lindley and Deighton and to a number of people who lived at Bradley Court retirement living complex. However, on the day of our inspection only two people were receiving support with personal care. This was as a result of the registered provider’s contract with the local authority not being renewed and during August 2016 the majority of staff and all local authority contracted service users were transferred to other registered providers in the local area.

The service had a manager in place they were not yet registered with the Care Quality Commission (CQC), however, the manager told us they had commenced their registration application. A registered manager is a person who has registered with the CQC 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.

Many of the issues identified at our inspection on 27 and 28 January 2016 had still not been addressed. Where people were prescribed ‘as needed’ medicine there were no person specific protocols completed to provide staff with guidance to ensure the medicine was administered safely. The registered provider’s medicines risk assessment form had not been updated to include safe administration of creams. Hand written entries on people’s medicines administration records lacked the necessary detail to ensure these medicines were administered safely. Although audits had been commenced there was no evidence to suggest practises had changed or improved as a result. Only one of the five care staff we spoke with said their competency to administer people’s medicines had been assessed. This evidenced a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a system in place to ensure potential employees were checked for their suitability to work with vulnerable people. There was no system in place to ensure late or missed calls were automatically alerted to office staff.

Staff were able to tell us about different types of abuse and the action they would take if they had concerns about a person’s welfare. However, we could not clearly evidence from the training records whose training was up to date and whose needed to be refreshed.

The majority of staff training was completed online, with staff also receiving practical moving and handling training. The training matrix identified many staff required training, however dates of previous training had not been included so we were unable to identify the staff who had not competed training and which staff were simply due to refresh their training. When we checked the training records for the staff who had continued their employment with the registered provider we found their training was not up to date; this including moving and handling. Two of the staff who had continued their employment with the registered provider had not had supervision for twelve months. This evidenced a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff we spoke with told us how they supported people to make decisions in their daily lives. We saw evidence in one of the care plans we reviewed that a mental capacity assessment had been completed and a best interests meeting held as the person lacked capacity to manage their own medicines.

Staff had access to GP telephone numbers to enable them to access peoples GPs if required.

People we spoke with told us staff were caring and kind. People’s care plans provided a brief insight into people’s life background including family and work life. Staff prompted people to make choices, for example, what clothes they wanted to wear. Staff also took steps to maintain people’s privacy, dignity and independence.

Where a complaint was brought to the attention of the manager, they took action to investigate and address the issues raised.

Care plans were kept in people’s homes. Care plans were detailed and recorded people’s preferences. Not all care plans were reviewed and updated to ensure they were an accurate reflection of people’s needs. Specific aspects of people’s care were not always recorded in all areas of their care plan. People’s daily logs and completed MARs were not always returned to the office for review in a timely manner.

The previous five inspections of this service have identified regulatory breaches and enforcement action was taken against the registered provider following the previous two inspections. The registered provider has consistently failed to provide safe, effective and responsive care to people. At this inspection we found previously highlighted concerns had still not been addressed. The service did not have a registered manager in place; the manager present at the inspection commenced their employment on 31 May 2016. We identified two policies which did not refer to the current Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was no policy in place regarding staff supervision or business continuity. A board member who was the registered providers nominated individual was not aware of a particular staff member’s training and supervision was not up to date. They were unaware how often people’s care plans should be updated had only completed the online medicines training ‘this week’ despite completing a medicines audit on 18 August 2016. These examples clearly demonstrate a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our inspection 27 and 28 January 2016, the overall rating for this service was ‘Inadequate’ and the service was therefore placed in ‘special measures’. The overall rating for this service following this inspection is also ‘Inadequate’. The service therefore remains in special measures. As not enough improvement has been made since our last inspection we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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.

You can see what action we told the provider to take at the back of the full version of the report.