Unicare (London) Limited

Unicare (London) Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and people with a range of physical and sensory disabilities as well as people living with dementia.

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. At the time of the inspection the service was providing care and support to 16 people.

People’s experience of using this service and what we found

People received safe care from staff who knew them well. There were safeguarding policies in place and the registered manager and staff knew how to identify and report concerns.

There were enough staff available to support people. Staff had the necessary training and experience.

People told us they were treated with respect, kindness and compassion. People were supported by a small but consistent staff team who knew them well.

Risks to people were assessed, managed and reviewed. Medicines were managed in a safe way. There were effective infection control procedures in place.

People had access to health and social care professionals where required in a timely way. People were supported by staff to maintain a balanced diet where this was part of their care package.

Quality assurance system and processes were robust and effective.

The service worked in partnership with other agencies to make sure people received the right care and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 14 March 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected Unicare (London) Limited on 8 June 2016 and rated it ‘Good’ overall with the key question of safe rated as ‘Requires Improvement’. This was because we found that the service had not obtained criminal record checks and references for all care staff at the time of their induction.

At this inspection we found that the service had made the required improvements in relation to this, however we found a number of concerns around risk assessments, medicines management and administration and the management oversight processes of the service.

This means that the service is no longer rated ‘Good’ and has been rated as ‘Requires Improvement’.

Unicare (London) Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people and people with a range of physical and sensory disabilities as well as people living with dementia.

This service also provides care and support to people living in one ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Unicare (London) Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection the service was providing care and support to 33 people.

A registered manager was in post at the time of this inspection. 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.

Although care plans identified people’s risks associated with their health and social care needs, the service had not assessed specific risks associated with people’s health and medical needs. This meant that care staff were not provided with direction and guidance on how to minimise the identified risk to keep people safe and free from harm.

Medicines management and administration processes were not always safely followed. Gaps in recording, incomplete information about medicines and lack of instruction about the level of support people required with their medicines, meant that people may not always have been receiving their medicines safely and as prescribed.

Management oversight processes in place did not identify the issues and concerns that we found especially around the lack of appropriate risk assessments and medicine administration and recording.

Care staff were supported to carry out their role through induction, regular training, supervision and annual appraisals. However, competency assessments completed to assess staff understanding and knowledge in areas such as medicines administration had not been completed appropriately.

Assessments of people's care and support needs were carried out before they started using the service to confirm that the service could meet their needs effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had consented to their care and support and where people were unable to consent, relatives had been involved in the care planning process where appropriate.

Care plans were person centred and recorded peoples, likes, dislikes, preferences, cultural and religious requirements and background history. This enabled care staff to provide care and support that was responsive to their needs.

Care plans were current and reflective of people’s needs.

People and their relatives confirmed that they felt safe with the care staff that supported them. The registered manager and care staff demonstrated a good understanding of safeguarding and were able to describe the steps they would take to protect people from abuse.

The service carried out a variety of checks to ensure that only those staff identified as safe to work with vulnerable adults were recruited. There was enough staff available to meet people's care and support needs.

People were also supported with their nutritional and hydration requirements where this had been identified as an assessed need.

People and their relatives told us that they were happy with the care and support that they received and that care staff were caring and kind with whom they had developed positive relationships with.

People and their relatives knew who to speak with if they had any concerns or complaints to raise and were confident that these would be dealt with appropriately.

People, their relatives and staff spoke positively of the leadership and management of the service.

At this inspection we found the provider to be in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy with the service, that staff turned up on time and were able to meet their needs well. The staff were caring and people were treated respectfully. Most people received the same staff to attend to their care needs, which helped to build trusting relationships.

We saw that care plans were individualised and up to date and risk assessments were in place to help staff to support people safely. People or their representatives were involved in making decisions about care packages. There were individualised plans for each person’s care delivery that staff followed.

People were supported to maintain good health, and staff worked effectively with other health and social care professionals. The service supported people to maintain a balanced diet.

Staff told us they felt well supported and we saw that regular supervision and training had taken place.

The provider had prioritised quality assurance processes and systems since the last inspection and records and audit documentation that the provider spot checked care to ensure the quality was good. We could also see they checked records on a regular basis and this contributed to the service now being well led.

Medicines were managed safely and we saw that the provider checked people’s records in their homes to ensure they were completed accurately.

The service obtained references and Disclosure and Barring Service certificates [DBS] checks prior to people being employed permanently. However, as part of their induction prior to starting work trainee staff were shadowing experienced care staff in people’s homes, sometimes prior to all the paperwork being in place. They were also being supervised giving medicines whilst not being employed by the service.

We have made two recommendations in relation to the induction process and the giving of medicines without being employed by the service.

At this visit, we found that our concerns had been addressed. The provider's updated safeguarding policy now provided details on what would happen if abuse was suspected or alleged. Most staff had now completed training on safeguarding. Further training had also been provided on both dementia and medication. There was evidence of the training of new staff members before they started working in people's homes. This meant that the provider was taking reasonable steps to ensure that staff were trained to provide care to people safely and to an appropriate standard.

We also found that appropriate recruitment checks were now in place. These were acquired before new staff members started working in people's homes, and were in place for established staff. This meant that the provider's recruitment systems now ensured that no-one was employed to provide personal care unless they were of good character and had the necessary skills and experience to do so.

However, we found that the provider did not have an effective system of making sure that appropriate recruitment checks were made before new staff started providing care to people in their homes. This failed to ensure that new staff were of good character.

We found that the provider's safeguarding policy did not ensure that people were safeguarded against the risk of abuse by means of taking reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We also found that the provider did not have suitable training arrangements in place to ensure that staff were appropriately supported in relation to their responsibilities of delivering care to people safely and to an appropriate standard.

We are taking action to ensure the provider becomes compliant with the regulations.

We found the planning of care, to meet people's individual needs and ensure their welfare and safety, was not always up-to-date or accurately reflected people's current needs, which could affect care delivery. For example, some people felt that some care workers could be more punctual. One relative told us they had had, 'three occasions since August when only one carer had turned up,' when two had been needed and scheduled.

Appropriate recruitment checks were not always in place for new staff before they worked in people's homes. Training had not always been provided to staff in relation to their responsibilities of delivering care to people safely and to an appropriate standard. We also found the provider's systems for assessing and monitoring the quality of service provision were not effective.