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Inspection carried out on 3 April 2019

During a routine inspection

About the service

This service provides care and support to people living in their own homes. The Harrogate office is the headquarters for support provided across the North East, East Midlands, the North West, and Yorkshire. People are supported in single occupancy houses, shared houses in multi occupancy or in individual flats in larger complexes. Not everyone using UBU – Harrogate receives 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 416 people were using the service. 143 people of who were receiving a regulated service.

People’s experience of using this service

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways. People’s care needs were holistically assessed, and care was mostly provided in line with current best practice guidance. Some relatives thought there could be a more consistent staff approach to enhance people’s quality of care. We have made a recommendation regarding the management of some medicines.

Staff worked together to provide people with seamless care when they accessed services and moved between services. Most people had support, which clearly focused on them having as many opportunities as possible to gain new skills and become more independent. They were supported to follow their interests and pursuits including in the wider community and accessed education and work opportunities. Relatives told us people with more complex health care needs did not always have the opportunities they would wish.

People were encouraged to develop and maintain relationships both within the service, with family and loved ones, and in the community. There were some inconsistencies about care delivery and the ability of staff to evidence effective, sustained improvements in some cases. We have made a recommendation regarding the management of complaints.

The provider and management had completed a range of monitoring visits and audits. When these had identified issues, action had been taken to resolve them. They had strong values of improving people’s support and providing high quality care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Many people using the service lacked capacity to make specific decisions and there were appropriate systems in place to make them. People had care plans which were personalised and provided a wealth of information for staff to use to support their needs and wishes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated Good (report published 14 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Inspection carried out on 9 August 2016

During a routine inspection

We inspected UBU-Harrogate on 9 and 11 August 2016. This was an announced inspection. We informed the provider the week before that we would be visiting to inspect. We did this because we wanted to make sure the registered manager would be available at the registered location office.

At the last inspection of UBU-Harrogate on 15 April and 22 May 2014 the provider was meeting all the regulations that were assessed.

UBU-Harrogate provides personal care to people who live independently on their own or in shared houses or individual flats in larger complexes. The registered location is in Harrogate in North Yorkshire. It provides a range of care and support services to 420 people in 102 properties over the North West, North Yorkshire, West Yorkshire, the East Midlands and in the North East of England. Most people who use the service are young adults with a mental health illness and / or learning disability.

The service has a registered manager. 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.

Comprehensive risk assessments were completed and these covered practical and emotional issues. Risk assessments were reviewed and updated on a regular basis.

Staff had a good understanding of safeguarding processes and followed these in practice. A document called ‘Keeping safe’ was held on people’s records and this included useful information on how to keep safe on the internet. People were given special cards called ‘alert’ cards, which they could use to contact a senior manager in the organisation if they had any worries or were upset.

Staffing was organised according to agreed care packages. Where new services had been developed we were told that staff had been recruited to these posts, meaning staff could be recruited with shared interests with the people they supported. People told us that they were involved in the interview process, and looked to appoint staff who were kind.

Some areas had staff vacancies. However, appropriate measures were in place to address these.

There were detailed care plans around the support people needed to take their medicines safely.

Training was well organised and staff were knowledgeable about the needs of the people they worked with to support them as individuals.

We have made a recommendation in relation to the interpretation and delivery of the Mental Capacity Act 2005 (MCA). Best interests meetings and documentation about the use of monitoring equipment was not as clearly documented as they should be to demonstrate that decisions were made in line with the principles of the MCA.

We received positive feedback from people who used the service. We saw that where they had raised issues people were listened to and action was taken in response.

Care planning and assessments were very detailed and these were updated to reflect people’s current and changing needs. We have made a recommendation that the provider reviews best practice guidance on care planning for people who use mental health services, to enhance staff understanding and knowledge and support the smooth transition of people between services.

Good systems were in place for people to give feedback on the service they received through survey responses, audits and meetings.

Effective management systems were in place for the provider to monitor the quality of the service and drive improvement. This included independent monitoring through accredited awards such as the Investors in People gold award and Customer First award. Senior managers knew people very well and provided a person centred, inclusive culture for the benefit of people using the service.

Inspection carried out on 15 and 22 May 2014

During a routine inspection

UBU Harrogate is a care service that provides support to people living in their own homes. The agency office is based in central Harrogate with car parking spaces to the rear. Services are provided over a large geographical area which includes; Middlesbrough, Tyneside, York, Leeds, Darlington, North Yorkshire, Lincoln and Nottingham. The service is registered to provide a domiciliary care service to people, offering support with either personal care or daily living tasks. We were told that the service supported over 400 people. Some people were supported in single occupancy houses, some in shared houses and some in individual flats in larger complexes. Most of the people were young adults with a mental health illness and/or learning disability.

At the time of our visit the manager was in the process of registering as a manager with the Care Quality Commission (CQC). A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People told us they were happy with the support provided. They said they liked the staff and felt safe. People’s needs were assessed so that these were known to staff; some health care professionals told us that staff knowledge could be improved on. This included assessments about risks in people’s lives and the support staff would provide. This helped people to live their lives as they chose.

People had some restrictions in their lives and had been given appropriate support to understand and manage these. When people required additional support with decision making this was provided.

People were supported by the right amount of trained staff, although some concerns as to staff competence were raised in feedback from questionnaires. Additionally, in some areas staff turnover had caused concerns.

People’s personal preferences and needs were usually known and recorded. This helped to make sure staff met these needs. People were happy with the support they received to live their lives and to maintain their independence.

People felt staff were kind and polite. Staff told us about people’s needs and were positive when talking about people.

Systems were in place to raise concerns but not everyone felt able to do this or had a positive experience of this.

There were management systems in place to enable the service to review standards. This included supervising staff and consulting with people. However, feedback from professionals varied and it was clear that the structures in place had not identified these areas for improvement.

Inspection carried out on 22 July 2013

During a routine inspection

People experienced care, treatment and support that met their needs and protected their rights. People told us they were happy with the care and support people received. Comments from relatives included "X benefits from the support from their carers" and "X has been helped greatly by their carer and I could not be more content with their care."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Detailed policies for safeguarding and whistle blowing were in place for staff to follow and refer to. We saw appropriate referrals were made to the Local Authority Safeguarding Teams.

Staff received appropriate professional development. We spoke with 13 members of staff in a variety of roles. They told us they received a good level of support to enable them to carry out their role and were supported in their personal development.

The provider had effective system in place to regularly assess and monitor the quality of service that people received. The systems in place ranged from checks by staff in the individual supports to reports to the Chief Executive. All staff said they felt the audit arrangements in place at UBU were effective in ensuring a quality service was provided.

Inspection carried out on 12 September 2012

During a routine inspection

People who used the service or their representatives told us they were happy with the service received. They said they got regular care workers who they were able to get to know. Peoples comments included, �I couldn�t ask for better, I have a lovely team looking after me.� �Staff are kind, support me and make sure I am alright.� �We are treated as ourselves and who we want to be."

People�s needs were assessed and care was planned and delivered in line with their individual support plan. People who used the service told us, �Everything they do for me is done well.� One person commented, �I get very good care, staff are kind and considerate.� One representative, told us they thought the 'overall view' of relatives was that 'UBU is a cut above the rest and they try that bit harder to provide a good standard of care.'