Archived: Unique Care Providers

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.

The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Unique Care Providers is registered to provide personal care. Care and support is provided to people who live in their own homes within the localities of Lindley and Deighton. Unique Care Providers also provides care and support to people who live at Bradley Court retirement

living complex. One the day of our inspection 100 people were receiving support with personal care.

At the time of our inspection the service had a manager in post but they were not yet registered with the Care Quality Commission. 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. The manager was not the same manager who had been in post at our last inspection in August 2015. They said they had commenced employment in December 2015 to provide support when the previous manager had left the organisation.

People told us they felt safe and staff said they received training in safeguarding, however, during our inspection we found evidence of two potential safeguarding incidents which had not been reported to either the local authority safeguarding team or to the Care Quality Commission. This evidenced a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Peoples care plans contained risk assessments but these did not always cover all aspects of peoples care and support needs.

People told us staff were often late, particularly at weekends or when their regular carer was not on duty.

People’s medicines were not managed safely. We saw gaps in people’s medicine records and hand written entries that did not record all the information required to ensure the medicine was administered as prescribed. The application of creams was not included on the organisations medicines risk assessment. This evidence demonstrates a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not all the people who used the service felt staff had the skills to meet their needs.

We saw evidence new staff received induction and there was on-going training and supervisions provided for staff.

Where people lacked capacity a mental capacity assessment had been completed.

People told us staff were kind and caring. People’s care plans included if a summary of their life history and also if they had a preference for the gender of their care worker. Only one person we spoke with said staff did not always maintain their privacy as they did not always close the door to their flat.

Although people told us if they were unhappy with the service they would complain, we found complaints were not always logged and recorded.

The organisation did not have a registered manager in place. Concerns highlighted in previous inspections had still not been addressed. During our inspection the board of directors were unable to clearly evidence they had clear oversight of the organisation and could not demonstrate areas of non-compliance were being addressed. Audits that were completed did not identify concerns highlighted by us during our inspection. People were not protected from unsafe or inappropriate care. This evidence demonstrates a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take 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 within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

We found the registered manager was on holiday the days we visited the service. Therefore we spoke with the care co-ordinator and a senior care worker.

As part of our inspection we looked at three support records of people who used the service. We saw the records contained information that was person centred and provided sufficient information to enable care staff to meet the needs of the individual.

We also looked at the daily log sheets where staff recorded the details of the care and support they had provided. We found these records reflected the care and support staff had provided.

On the second day of our visit, we looked at the complaints log and the office calls register. During our analysis of these records we identified three incidents where people's safety and welfare had been put at risk.

People we spoke with told us they felt safe. They told us they would know what to do if they had a problem.

We checked the recruitment records for six staff and saw evidence that the company had undertaken the majority of checks before staff began work.

We saw evidence in each of the files we looked at that new employees had received induction training.

We saw the company had a complaints procedure which gave details of who to complain to and the timescales in which a complaint would be acknowledged and investigated.

During our visit we looked at the care records for five people who use the service. We saw evidence in each of the records we looked at that assessments had been carried out to ensure people's care and treatment needs could be met.

Feedback from people who use the service was all positive. Comments included:

'I am happy with the carers, they are excellent'.

'I feel the care workers are good at what they do and are nearly always on time'.

'I have found the carers are fine and I have had no issues with the service I receive'.

'The carers are usually very reliable and are very pleasant, respectful and caring.'

People who use the services told us they were very satisfied with the care they received. They also told us they were included in developing their personal care support packages and had the opportunity to express their views and opinions about the service. People also confirmed staff were courteous, treated them with dignity and maintained their independence by involving them in their care.