Background to this inspection
Updated
16 February 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 checked 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 announced inspection took place on the 26, 27 November and 8 December 2015. We gave the provider 48 hours’ notice of the inspection because the location provides a domiciliary care service. This was so we could arrange to visit some people using the service to get their feedback and to ensure the registered manager was available for our visit.
The inspection team consisted of an inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of home care service. In preparation for the inspection we looked at information we had from previous inspections, from notifications sent by the provider and from direct contact with people.
We visited five people and three relatives and spoke with eleven people or their relatives by telephone to get their feedback and looked at six people’s care records. We spoke with ten staff which included the registered manager, another director in the company, care and office staff. We looked at five staff files, training and supervision records. We looked at the rota system and an electronic tracker system used for monitoring the time and duration of visits, minutes of meetings and feedback from a survey of people completed in July 2015. We contacted health and social care professionals who worked regularly with the service and received feedback from five of them.
Updated
16 February 2016
Unity Community and Care Services is a small family run business that provides personal care for people living in their own homes. The service is provided to mostly older people who have needs related to physical frailty or dementia.
This announced inspection took place on the 26, 27 November and on 8 December 2015. The comprehensive inspection was brought forward because of several concerns raised with us about the safety and reliability of the service. We gave the provider 48 hrs notice of the inspection because the location provides a domiciliary care service. This was so we could arrange to visit some people using the service to get their feedback and to ensure the registered manager was available for our visit. 22 people were receiving a service when we visited.
At three previous inspections we had also identified concerns about the adequacy of quality monitoring. The concerns included the timeliness of visits and some late visits and about accuracy of care records. On 19 June 2014, when we inspected the service, we had concerns about
people’s care and welfare, how quality was assessed and monitored and record keeping. Following that inspection, we took enforcement action in relation to people’s care and welfare and required the provider made changes by 5 September 2014.
On 24 September 2014 we inspected the service to check that changes had been made in relation to the care and welfare of people. Although some improvements were made, the service had not improved enough. Visit times remained inconsistent for some people which affected their welfare and safety. Assessment, reviews and care plans were inadequate to meet the needs of people safely and appropriately and to ensure changes were promptly recognised and acted upon. This meant people remained at risk of receiving care that was inappropriate or unsafe.
On the 2 and 3 February 2015 we inspected the service again to follow up whether improvements had been made. At that visit some improvements had been made but we found breaches of regulations relating to consent, staff training, notifications and good governance. We continued to be concerned about the assessment and monitoring of quality. Whilst some systems had been put in place to monitor and check the service, these were not well enough developed to assure and control quality in all aspects of 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.
The provider had a number of quality monitoring systems in place such as a rota planning system, a tracking system to check time and duration of visits and several informal communication and audit systems. At this inspection, although some aspects of the services had improved, some risks remained. This showed there were inconsistencies in people’s experiences of the quality of service. This meant the provider’s quality monitoring systems were ineffective because they had had failed to make adequate improvements to people’s care.
We followed up concerns which had been raised with us about the unreliability of the service due to late or missed visits. Although we found no missed visits, some people reported missed visits but not recently. People also gave us mixed feedback about the timeliness of visits and a number of people did not consistently receive their weekly rotas. One relative said, “Now and again, I get one (a rota) but I haven’t had one for a couple of months now.” This meant people did not always know what time their visit was planned for, or which staff were visiting them.
Some aspects of people’s care records had improved but we also identified issues about the accuracy of some of the care records we looked at. An initial assessment of people’s care needs and any risks was undertaken with them before the service commenced and care plans were developed and agreed in response, with the exception of two people. However, not all care records were reviewed and updated in a timely way when people’s health needs changed, although staff were aware of any changes.
Most people and relatives described positive caring relationships with the staff that supported them. One said, “I’ve no complaints about the carers, they are very good.” Other comments included, “Good staff”, and “They are all very nice, it’s nice to have a little chat with them.” Where people had raised concerns about staff attitudes the management team, they had been dealt with.
People received personalised care that was responsive to their needs. Staff knew people well, and spoke knowledgeably about their care needs and preferences. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with each person’s wishes.
People’s rights were not protected because staff still did not have a full understanding of the requirements of the Mental Capacity Act (MCA) 2005. Where people appeared to lack capacity, staff had not undertaken any mental capacity assessments. This meant there was a lack of clarity about some people’s capacity to consent for their care.
People were aware of the complaints process and complaints were investigated and responded to, with actions taken to make improvements. There was a culture of openness and a willingness to explore gaps within the team and to identify ways to improve these. However, people, relatives, staff and health and social care professionals we spoke with expressed more confidence in the leadership of one member of the management team than in others. We concluded the quality monitoring systems in place were not sufficiently robust because they could not be relied on to identify areas which needed further improvement.
We followed up two safeguarding concerns raised with us and were satisfied they had been appropriately reported to the local authority safeguarding team and were investigated, with improvements made, where needed. Staffing levels at the service were adequate for the number of people the agency cared for and further recruitment was underway. People received their medicines on time and in a safe way.
Staff received regular training and ongoing support through supervision and staff appraisals. They worked closely with local healthcare professionals such as GP’s, community nurses, local therapists and social workers. Health professionals said staff sought advice appropriately about people’s health needs and followed that advice. People who needed help with nutrition and hydration were supported to improve their health through encouragement and prompting to eat and drink.
We found two breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.