You are here

Universal Care Agency Ltd Requires improvement

Reports


Inspection carried out on 4 May 2017

During a routine inspection

This inspection was carried out on 4 and 8 May 2017 and was announced.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults and older persons; some of whom are living with dementia, who live in their own homes. At the time of the inspection 18 were receiving support with their personal care. There were 17 care staff which included one senior care worker, one recruitment co-ordinator and one staff member that planned people’s care. There was a manager who was overseeing the day to day management of the service and a director who was also the nominated individual.

There was not a registered manager at the time of the inspection. A registered manager had not been in post since July 2016. The provider had recruited a manager who would be applying to the Commission to become the registered manager when they commenced their employment for the provider on 16 May 2017. 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.

At the last inspection in December 2016, the service was placed into Special Measures as it was Inadequate overall.

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place or keep services 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.

At our last inspection in December 2016 we found the provider did not always follow safe recruitment processes. At this inspection we found the provider continued to not follow safe recruitment practices.

At the last inspection in December 2016 we found risk assessments were completed but not always dated and did not contain all the information on how risks to people could be minimised. At this inspection we did not find an improvement with this concern.

At the last inspection in December 2016 we found staff did not receive an induction programme and did not always receive training from the provider or have their competencies checked. At this inspection we did not find any improvement with this concern and we found staff did not always receive training which was specific to people’s needs.

At the last inspection in December 2016 we found systems to assess the overall quality and safety of the service were not in place. At this inspection we found quality and safety audits were in place but they were ineffective.

At the last inspection in December 2016 we found people’s personal information was not always kept private. At this inspection we found a person’s personal care plan had been shared with a relative of another person who was in receipt of personal care.

At the last inspection in December 2016 we found there was a lack of communication between the management team, people, staff and external professionals and this had an effect on the care people received. At this inspection we found communication between the manager, staff, people and external professionals had improved but required further improvement.

At the last inspection in December 2016 we found staff and management had a limited understanding of the Mental Capacity Act 2005. People did not always receive timely support from an external health care professional. Care records were mostly personalised although inconsistent with detailing how people would like to receive their care. Complaints received had not always been identified as a complaint, investigated and followed up. The provider and manager had not notified the Commission of two safeguarding concerns and had not investigated these concerns appropriately and staff did notify external health care professionals or receive a supervision. At this inspection we found improvements had been made in these areas.

There were enough staff to meet people’s needs and there was good continuity of care workers. There were no concerns with medicine practices. People received support with food and fluids when required. Staff felt when the manager made themselves available, they were approachable and had a caring nature and felt confident in raising concerns to the manager and felt supported to question practice.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection carried out on 6 December 2016

During a routine inspection

This inspection was carried out on 5 December 2016 and was unannounced.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults and older persons; some of whom are living with dementia, who live in their own homes. At the time of the inspection there were 15 people using the service and of these 15 people eight were receiving support with their personal care. There were six care staff, two senior care staff and two staff that planned people’s care. There was a manager who was overseeing the day to day management of the service and who would be applying to become the registered manager and a director who was also the nominated individual. Both the manager and the director provided care to people.

There was not a registered manager at the time of the inspection. A registered manager had not been in post since July 2016. 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 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.

Safe recruitment processes were not always followed. Checks were not always completed to ensure staff working were off good character and were fit for work. Although care staff knew how to keep people safe and could identify signs or potential abuse, systems were not in place to investigate allegations of potential abuse. Risk assessments were completed but not always dated and information on how to support people with moving and handling was not always included. Although staff occasionally arrived late to people’s visits there were enough staff to meet people’s needs.

People felt staff had sufficient skills and knowledge to care for them; however staff did not always receive an induction programme, training or supervision and appraisal. Staff and management had limited understanding of the Mental Capacity Act 2005 and how it should be used when people were deemed to lack capacity. People did not always receive timely support from an external health care professional.

People’s personal information was not always kept private. Care records were mostly personalised although inconsistent with detailing how people would like to receive their care.

Care plans were in place and people’s needs were regularly assessed and reviewed by staff and people were involved in the assessment of their needs. However care plans may not always be up to date and may not include accurate information about the care they received. Risk assessments were not dated and did not contain all the information on what risks there were to people and how they could be minimised.

Complaints had been received, however had not always been identified as a complaint, investigated and followed up.

There was a lack of communication between the management team, people, staff and external professionals and this had an effect on the care people received. Systems to assess the overall quality and safety of the service were not in place. The provider and manager had not notified the Commission of two safeguarding concerns.

Records kept by the manager to monitor staff training did not always demonstrate the training staff had received. Records were not in place which detailed the safe management of recruitment. Care records and staff records were not always available to view and were not always securely stored.

Staff followed medicines procedures and people were supported with their medicines safely. People were supported to have sufficient food and fluids. Care staff were friendly, kind, polite and treated people with dignity and respect. People received care which respected their day to day decisions and choices.

Staff felt when the manager made themselves available, they were approachable and had a caring nature and felt confident in raising concerns to the manager and felt supported to question practice.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. 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 18 January 2016

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

We carried out an announced comprehensive inspection of this service on 24 June 2015. Four breaches of the legal requirements were found. Recruitment and selection procedures were not followed, robust or safe. Staff who were recruited did not have the skills, experience and appropriate training to meet people’s needs. Supervisions and appraisals were not completed for staff. Systems were not in place to identify, record, handle and respond to complaints by people and other persons in relation to the regulated activity. The provider did not have effective systems to improve the quality and safety of the service provided. After the comprehensive inspection, two warning notices were served on the registered provider and registered manager requesting that they meet the legal requirements by 21 September 2015. We also requested the provider send us an action plan for further breaches of the legal requirements. The provider and registered manager wrote to us to say what they would do to meet legal requirements in relation to these breaches and that they would meet them by 21 September 2015.

We undertook this announced focused inspection on 18 January 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Universal Care Agency Ltd on our website at www.cqc.org.uk

At the inspection on 18 January 2016 we found that sufficient improvements had been made and the provider and registered manager had met the requirements of the warning notices.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults and older persons in their own homes. At the time of the inspection there were ten people using the service. There were twelve care staff who provided care to people, a registered manager two recruitment officers and one co-ordinator who scheduled people’s care and managed staff recruitment.

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 service carried out safe recruitment and selection processes before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

Staff were provided with appropriate support, induction, supervision and professional development. However staff were not always appraised.

The provider had an effective system in place to deal with complaints, but did not always deal with requests about people’s care in a timely manner.

Improvements had been made in assessing the quality of the service and monitoring of staff training, incidents and accidents.

We found the provider had made some improvements with understanding their role and responsibilities. The provider had informed the Local Authority and investigated the potential safeguarding concern; however the Commission had not been notified of a report of potential abuse.

Inspection carried out on 24 June 2015

During a routine inspection

This inspection took place on 24 June 2015. Forty eight hours’ notice of the inspection was given because the service is small and the manager was often out reviewing people's care needs and supporting staff. We needed to be sure they would be in.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults some of whom are living with dementia, who live in their own homes. At the time of the inspection there were nine people using the service. There were 17 care staff and two staff that planned people’s care.

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.

People gave us complimentary comments about the service they received. People felt happy, safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

Recruitment and selection processes were not always followed to ensure the safety of people because appropriate checks had not been carried out to ensure staff were suitable to work in a care setting.

People felt their needs were met by care staff that had the knowledge, skills, experience and right attitude to provide their care. However staff did not always have supervision and appraisal or fully complete their induction programme before working unsupervised. Training was not monitored to ensure care practice was regularly updated.

People’s experiences were listened to but the registered manager did not always identify them as a complaint and follow their procedures to monitor and learn from them.

The registered manager did not have a system in place to analyse, identify and learn from incidents and accidents. Audits had not been completed to assess the quality of the service. The registered manager was unable to demonstrate they had completed and returned their Provider Information Return. Records were not in place to ensure persons were employed safely and continually supported to provide personal care.

Care staff received training on safeguarding and had a good knowledge of how to keep people safe which included recognising different types and signs of potential abuse and unexplained bruising and marks or a change in behaviour. Environmental, manual handling and behaviour risk assessments were in place. However they were not always dated so it was difficult to tell if they were the most up to date document. There were clear procedures for supporting people with their medicines.

People said there were enough care staff to meet their needs and keep them safe. However on occasions care staff would not arrive on time. People felt this was not a big concern as they were always informed when care staff would be late.

Where people lacked capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People were supported to have enough to eat and drink and supported to access healthcare services.

People felt involved in their care planning and said care staff were friendly, polite and treated people with dignity and respect. People’s care plans were personalised and took into account their choices and preferences. People’s needs were regularly assessed and reviewed. People were involved in the assessment of their needs, and were always involved in their care planning and had choice and control over the care being provided.

Staff felt confident in raising concerns to the registered manager and were supported to question practice. Staff said management were very good, very supportive and open.

We found a number of breaches 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 this report.

Inspection carried out on 24 June 2013

During a routine inspection

We saw the consent and agreement of people was obtained prior to care and support being provided. Care plans were developed with people who used the service. This meant people received the care and support they needed and wished for.

People who used the service were protected from the risk of infection because staff had received relevant training and there was appropriate guidance for them to follow.

People were cared for by staff who received relevant training and support. The provider had a system to regularly assess and monitor the quality of service that people received.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 21 November 2012

During a routine inspection

We spoke with relatives of two people who used the service. They expressed that they were happy with care and support provide by Universal Care Agency Ltd. They told us that staff knew how to provide the care and support in the manner their family member liked. They told us “the carers are really good, hard workers” and “we are really happy with them”. We were told that care staff always discussed what care and support was needed with the person receiving care and relatives if appropriate.

There was not an effective process in place for monitoring and planning training. The provider had an arrangement for staff to attend training at care homes. However this training was not specific to a service provided by a domiciliary care service. There was no plan for training for the forthcoming year.

We were told by people who used the service that staff were rarely late for their calls. They told us that staff contacted them if there was any reason if the care visit was going to be delayed. This was confirmed in conversations we had with members of staff.

There was a plan for quality assurance that included seeking the views of people who used the service. This was due to be implemented in December 2012.