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Inspection carried out on 16 January 2018

During a routine inspection

Unity In Care is a domiciliary care agency which is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing personal care to 35 people including children with disabilities.

This inspection took place on 16, 17 January 2018 and was announced. We gave the provider 48 hours' notice that we would be visiting the service. This was because the service provides domiciliary care to people living in their own homes and we wanted to make sure staff would be available in the office. This was also to allow the registered manager time to arrange some home visits for us as part of this inspection.

At the last inspection in February 2016, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provicer to take steps to impove. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good. At this inspection we found improvements had been made.

We rated this service as Requires Improvement in April 2016. Following that inspection, we asked the provider to complete an action plan by September 2016 to show what they would do to improve the key questions 'Is this service safe, and well led. This was because the provider had not operated effective systems or processes to assess, monitor and improve the quality and safety of the service. On this inspection we found improvements had been made.

There was a registered manager in post at the time of the 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. The registered manager was also the director of the service.

People were supported to receive care from the agency following a detailed assessment. This covered all aspects of the care required by the person. Such as how many calls they would need each day, what their needs were in relation to mobility, continence and personal care, moving and handling and nutrition.

The service had a suitable recruitment procedure. Recruitment checks were in place and demonstrated that people employed had satisfactory skills and knowledge needed to care for people. All staff files contained appropriate checks, such as two references and a Disclosure and Barring Service (DBS) check.

Although the registered manager told us there were sufficient staff to meet people’s assessed needs could be met, people comments varied on visits being undertaken at the allocated time. One person told us, “The time keeping of the carers varies and they are often later than the agreed target time, although timekeeping has improved recently after I complained”.

People were generally complimentary about staff and told us that they were treated with kindness and consideration. They had good relationships with their allocated care staff.

Staff took action to minimise the risks of avoidable harm to people from abuse. They understood the importance of keeping people safe and could describe how they would recognise and report abuse in line with the service’s protocols on identifying and reporting abuse of adults and children.

Management of medicines was undertaken in a safe way and recording of such was completed to show people had received the medicines they required. Regular auditing of medicines charts took place to help ensure staff consistently followed best practice.

Staff received effective training in safety systems, processes and practices such as moving and handling, fire safety and infection control. Staff were knowledgeable about their responsibilities in relation to infection control.

Staff had received training and supervisions that helped them to perform their duties. T

Inspection carried out on 27 April 2016

During a routine inspection

Unity in Care Limited domiciliary care agency provides care and support to children and adults in their own homes on a short and long term basis. At the time of our inspection 58 people were using the service. We undertook an announced inspection of the service on 27 April and 6 May 2016.

There was a registered manager in post at the service. 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.

When we last inspected the service on 14 and 16 January 2015 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found robust contingency plans were not in place to ensure people would be safe if their care visits were late or missed and the provider had not sought people’s consent prior to delivering their care. People had not always received support when needed to remain well-nourished and the provider had not operated effective systems to monitor the quality of the service and drive improvement. The provider sent us an action plan and told us they would make the required improvements to meet the regulations by 5 May 2015. At this inspection we found the provider had made improvements to address the concerns we found at our previous inspection. However, we found one ongoing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the governance of the service at this inspection. You can see what action we told the provider to take at the back of the full version of this report.

People and relatives told us people's risks were understood by staff and arrangements were put in place to provide safe care, prevent harm to people and to ensure people received their medicines as prescribed. However, we found people's care records did not always reflect their current needs and the support they required to stay safe and receive their medicines. New care workers and care workers relying on people’s care plans for guidance, would not have all the information they needed to know how to support people appropriately. People might therefore not have received the care they required to stay safe, if staff had to solely rely on the information in people’s care plans to know how to keep them safe.

At our previous inspection we found the service did not always have systems in place to pro-actively identify shortfalls in the service and drive improvements. The provider was eager to develop and improve the service and had introduced some additional governance arrangements following our previous inspection. However, we found further improvement was needed to improve the effectiveness of these systems in identifying shortfalls so that action would be taken promptly to address risks and improve the service for people. For example, in relation to care plan and medicine record audits.

Staff, people and relatives told us they were experiencing a cultural change in which people, relatives and staff were increasingly working together as a team and people told us the longer they used the service the more confident they felt to influence the way their care was delivered.

At our previous inspection we found although the provider had plans in place to deal with foreseeable emergencies, these were not sufficiently robust to ensure the needs of people who used the service would continue to be met as needed. Where delays in care delivery had occurred people had not always been informed promptly to determine whether they could remain safe until staff arrived. At this inspection we found improvements had been made. Changes had been made to the scheduling of people’s visits to ensure staff had sufficient travel time between visits and when visits were changed staff had to confirm that they were aw

Inspection carried out on 14 and 16 January 2015

During an inspection to make sure that the improvements required had been made

Unity in Care Limited domiciliary care agency provides care and support to people in their own homes on a short and long term basis. At the time of our inspection 48 people were using the service.

There was a registered manager in post at the service. 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.

We carried out an inspection of this service in response to information we had received about people’s care visits being late and being missed. We found the service was not always reliable when staff absences or client emergencies occurred that could impact on other people’s visits. People were not assured that they would receive the care they needed at the time they needed it. Though the provider had plans in place to deal with foreseeable emergencies, these were not sufficiently robust to ensure the needs of people who used the service would continue to be met as needed. Where delays occurred people were not always informed promptly to determine whether they could remain safe until staff arrived.uk

People did not always get the time they required to complete their personal care routine at their own pace. They did not always receive the time they needed between visits. This made people feel rushed. Relatives were concerned people were being deskilled as they were not given the time they needed to do things at their own pace. These concerns had been identified by the registered manager during home visits and she had addressed this with staff in September 2014 but improvement was still required.

We received varying views about the staff, the culture of the service and its leadership. Most people were positive and described staff as respectful, caring, and helpful. However, some people did not always experience kindness and consideration. People and relatives knew how to raise concerns but did not have confidence that their concerns would be addressed to their satisfaction. They did not experience the provider to be open to their feedback which at times made them feel they were not listened to and not empowered to influence improvement.

Though the provider strived to improve the outcomes for people effective quality assurance systems were not in place to drive improvement and develop risk strategies. The registered manager used the opportunity when out working with people and staff to assess the quality of the service. Some audits had been completed but systems in place did not effectively identify factors that could impact on the operation of the service, such as the concerns we found.

People were supported by trained staff who received regular supervisions to support them to develop their knowledge and skills. Information in people’s care plans were not always sufficient to instruct staff to care for people consistently in line with professional guidelines. Systems for reporting and escalating concerns were not always implemented effectively to ensure action was taken to keep people healthy.

Though people told us they were supported to have enough to eat and drink, we were concerned people did not consistently receive the support they needed to eat at their pace and eat at the times they needed to.

We found although people and their relatives were encouraged to plan their own care, care plans did not record people’s involvement. Where people’s relatives were involved in decision making records did not evidence if it was their preference or whether they lacked the capacity to make decisions independently. The provider did not have suitable arrangements in place to obtain the consent of people in relation to the care provided. People who lacked the capacity to consent to their care might not have been identified to ensure arrangements were put in place to gain consent in line with the Mental Capacity Act (2005) requirements.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 15, 19 July 2014

During an inspection in response to concerns

This inspection was carried out by a social care inspector whose focus was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

On the day of our inspection the service was providing care and support to 45 people in their homes and employed 43 staff to meet people’s needs. During our inspection we spoke with the registered manager, the business administrator, a care coordinator and ten care workers. We also spoke with nine people who use the service, and three relatives of people who use the service. We visited four people in their homes and spoke with five people on the telephone.

This is a summary of what we found;

Is the service safe?

People told us that they felt safe and received excellent care from their regular care workers but sometimes the care staff arrived either too early or too late. One person told us, “They are so kind and look after me really well, although sometimes they are late.”

Each person had risk assessments and management plans for the activities of daily living, including the action needed to reduce risks. For example we saw a risk assessment detailing how staff should support a person whilst having a shower to prevent them falling.

On the day of inspection Unity in Care staff were only authorised to prompt people to take their medicine from a pharmacy monitored dosage system, which was clearly identified in people’s needs assessment and care plan. People told us that staff supported them where necessary with their medicine, in accordance with their care plan. This meant that the provider had ensured that people had safely taken their medicines.

During our last inspection on 13 May 2014 we found that that the provider had not always operated effective recruitment procedures. We also found that the provider had not completed all of the required checks to ensure people who use the service were cared for by staff of good character. We asked the provider to take action to improve the recruitment system and to ensure that all required checks had been completed. During our follow up inspection on 15 July 2014 we found that provider had made the required improvements.

We found that the provider had an effective recruitment and selection process. This meant that people were safe because their health and welfare needs had been met by staff who were fit, appropriately qualified and physically and mentally able to support them.

Immediately prior to our inspection concerns had been raised regarding an incident where the provider had not kept some confidential information securely. We found that the manager had immediately contacted people to inform them and to take appropriate action to ensure their safety. We noted that this matter had been investigated thoroughly and staff had received appropriate guidance to prevent a recurrence.

Is the service effective?

Where people had the capacity to make decisions about their care they had been supported to do so. Where people lacked the capacity to make specific decisions the provider had assessed this and was following the correct legal processes to make decisions in people's best interests.

Where people needed support with more complex health needs we saw there were effective person-centred care plans which detailed the care required and how to deliver it. We spoke with staff who told us they had received additional training from district nurses in relation to percutaneous endoscopic gastrostomy (PEG) feeding and catheter care, which we saw recorded in the service training records. PEG feeding is a form of tube feeding for people who are unable to or have difficulties in swallowing.

Is the service caring?

People were supported by kind and compassionate staff, who spoke with people in a caring manner. One person told us, “They will always help me with anything but know if I’m trying to pull a fast one, so they always encourage me to do what I can for myself.” Another person told us, “My carer is so caring and nothing is too good for me. If they think I need anything they tell the manager who sorts it out straight away.”

We reviewed an incident where one person experienced a seizure. Appropriate support was called for and provided by health professionals. This person did not wish to attend hospital but was still shaken and required support. We noted that the care worker arranged to stay with this person whilst they recovered and the service arranged other staff to cover their calls.

Is the service responsive?

People’s views about their care had been sought. Where people had made requests in relation to their care these had been met. We saw evidence that when people’s care needs had changed the service had been responsive to this. They had recognised changes in people's needs and engaged other services to ensure appropriate actions were taken to meet these.

Staff told us that the registered manager expected to be told if there were any changes in people’s needs immediately. For example one care worker had raised concerns regarding a person’s deteriorating mobility. We found the registered manager visited this person the following day to reassess their needs and revised their care plan. We noted that staff had been quickly notified of the increased support required by this person.

The service had a complaints system which was readily accessible to people. This ensured staff listened to their concerns and responded to them effectively. People knew how to make a complaint if they were unhappy. They told us that they frequently received visits from the registered manager or care coordinator. One person told us, "Every time I've had a problem it has been sorted out quickly."

Is the service well-led?

The service had a registered manager in place and staff told us that the service was well led. One care worker told us, “The manager encourages everyone to improve their skills. You can go to them with problems and they are very understanding but they will not tolerate poor care.” A relative of one person told us, “What you see is what you get with the manager. They keep telling me they can’t sort things out if they don’t know what’s happening. So whenever I have a problem I call her and she sorts it out.”

People were protected from the risk of inappropriate or unsafe care because the provider had an effective system to identify, assess and manage risks to their health, safety and welfare. We found that the provider had reviewed people's care plans and risk assessments to reflect changes in their needs.

Inspection carried out on 13 May 2014

During a routine inspection

We undertook this inspection as we had been alerted by other agencies of an ongoing investigation in relation to a potential breach of the Safeguarding Vulnerable Groups Act 2006. The Act places a legal duty on all providers working with vulnerable groups to undergo an advanced vetting process of all employees to determine their suitability to work with children and vulnerable adults. During our inspection the outcome of this investigation was not known.

We looked at the staff recruitment and selection procedures operated by the agency. We looked in detail at the recruitment files of eight care workers. These demonstrated that the provider did not always operate effective recruitment procedures.

We found that the provider had satisfied themselves that applicants were physically and mentally fit for the work prior to employment being offered.

The provider had systems in place to satisfy themselves that applicants had the qualifications, skills and experience which were necessary for the work to be performed. However evidence of this was not always available

The provider did not complete all the required checks to ensure people who use the service were not placed at risk of being cared for by inappropriate staff. These include checks to ensure that people were of good character. For example the provider did not obtain a full employment history of all candidates. Although the provider had a system in place to track and record that criminal checks had been undertaken the outcome of checks carried out, prior to 2011 had not been recorded. These checks were still used for two employees. The provider could not reassure themselves that the two employees, who had criminal checks carried out prior to 2011, did not have criminal convictions that might make them unsuitable to work with vulnerable people.

The provider had a system in place to assess and monitor the potential risks to people where employees’ criminal convictions had been disclosed. However the provider’s initial risk assessments were not detailed and robust enough to ensure that all the potential risk had been identified and monitoring measures evaluated to ensure they had been effective. We found following intervention from outside agencies the provider had reviewed their risk assessment for a care worker and a more robust monitoring plan had been formulated.

Inspection carried out on 28 November 2013

During a routine inspection

We spoke with five people who used this service during telephone calls after the inspection visit. We attempted on several occasions to contact four members of staff whose details we were supplied with but we only managed to speak with one of these staff. We spoke with staff at the office and the registered manager during the inspection visit.

People told us that they thought the care staff were kind, friendly and caring. One person said "The staff at this agency genuinely care for me". Another person said "The carers on a Tuesday are excellent". People's general view was that staff provided the care they needed but, at times, either the visit times or the consistency of the care could be slightly improved. People did comment that they felt able to and would raise these issues with the registered manager and they were confident they would be listened to.

We found that people had been asked for their consent prior to any care having been delivered and staff had been trained to understand the requirements of the Mental Capacity Act 2005.

We found that people's needs had been assessed and care had been delivered that usually met those needs in a way that protected people's safety.

We found that staff had been trained and adequate equipment and systems were in place to protect people from the risk of infection.

We found that staff were well supported to carry out their roles.

We found that people had access to an effective complaints procedure.

Inspection carried out on 18 December 2012

During a routine inspection

We spoke with two members of staff, an administrator and the registered manager during the inspection. Following the inspection visit we spoke, by telephone, with two service users and three relatives.

People and their relatives were very complimentary about the service provided by this agency. They all said that staff generally arrived on time or they had been informed if staff were delayed and staff stayed for the full visit or longer if needed. People told us the staff were always kind and treated them with respect.

People said that they had built up a good rapport with their teams of staff and one relative said their family member looked forward to the staff visits. One person who used the service said the staff enabled them to remain as independent as possible and they always felt safe when the staff were caring for them.

People said they were fully involved in planning their care and the staff provided the care that they or their relatives required in a way that suited people's needs.

We found that the agency was effectively managed and the registered manager was committed to monitoring the quality of the service and making improvements. The imporvements had been based on the feedback they received from staff, the people who used the service and relatives.

The staff we spoke with were positive about their roles and the support they received from the manager. The staff told us how they would appropriately respond to any allegations or suspicions of abuse.