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Uriel Care2U Limited Requires improvement

Reports


Inspection carried out on 10 August 2020

During an inspection looking at part of the service

About the service

Uriel Care 2U Ltd is a domiciliary care agency providing personal care to 23 people at the time of the inspection. The service was supporting people who needed care due to their age or disability.

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.

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

The service had made improvements since the last inspection. People’s needs were addressed in care plans and risk assessments and these were more detailed than at the previous inspection. Staff understood the care plans and people using the service told us they had a copy of their care plan and said their care workers provided their care in the way they needed it.

People were supported with their medicines safely by staff who had been trained and assessed as competent to administer medicines.

Recruitment of staff had improved since the last inspection. The provider was now completing appropriate checks on staff when they were employed, to reduce the risk of employing unsuitable people.

The management of the service had also improved. The management team shared responsibilities and carried out audits more effectively. Staff felt well supported by the registered manager and said they enjoyed their work.

Staff completed appropriate training and told us they found the training helpful. Most people using the service said their care workers did their job well and understood their needs.

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. One person’s call times did not meet their needs as the gap between bedtime and getting up was too long. People were happy to receive care from the service but for some people there was no evidence they had consented to their assessments and care plans as these had been signed by staff or the person’s signatures typed in by staff.

People and relatives told us that they felt safe and were appropriately supported by the service and their care workers.

Staff were trained in safeguarding people from abuse but the procedure for reporting safeguarding concerns was unclear so there was a risk staff would not know how to raise a safeguarding alert appropriately. Allegations of abuse were acted on but not reported appropriately.

We have made two recommendations. One is to ensure people’s consent to their care is recorded appropriately and the second is to include details of how a person’s medical condition affects them in their care plans.

Rating at last inspection and update

This was a focused inspection which included checking whether the provider had met the requirements of three Warning Notices in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The last rating for this service was Requires Improvement (published 18 October 2019) and there were four breaches of regulations identified. The concerns related to the unsafe management of people's risks and medicines, poor recruitment processes, unsatisfactory training, and ineffective governance of the service. We took enforcement action against the provider in the form of three warning notices and one requirement notice. At this inspection we found improvements had been made and the provider was no longer in breach of those four regulations. However, we found a new breach of regulation 13 (Safeguarding people) at this inspection. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

The provider completed an action plan after the last inspection to show what they would d

Inspection carried out on 14 August 2019

During a routine inspection

About the service

Uriel Care2U Limited is a domiciliary care agency providing the regulated activity of personal care to people living in their own homes. At the time of the inspection the service was supporting 13 people.

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.

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

The service had failed to make any improvements to the issues we identified following the last inspection.

Risks associated with people’s health and care needs had not been identified and assessed so that care staff could be provided with guidance on how to minimise those risks to keep people safe.

Medicines management and administration processes were not safe. There was a lack of clear information, guidance and records to ensure people were receiving their medicines safely and as prescribed.

The provider did not complete appropriate checks to ensure that only staff assessed as safe to work with vulnerable adults were recruited.

Care plans did not accurately reflect in detail, people’s current care and support needs. Daily records of the support people received did not match people’s support needs as recorded within their care plan.

Management oversight process in place to monitor the quality of care people received were ineffective and did not identify any of the concerns we found as part of this inspection.

Care staff confirmed that they received the appropriate training and support to carry out their role. However, records did not always confirm this, with evidence of poor training provision techniques.

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. However, the policies and systems in the service did not always support this practice.

We have made a recommendation about following the key principles of the MCA 2005 in relation to mental capacity assessments and recording best interest decisions.

People and relatives told us that they felt safe and appropriately supported by the service and the care staff that supported them.

Staff demonstrated how they would identify signs of abuse and the steps they would take to protect people from possible abuse.

Complaints were documented and responded to according the providers policy. People and relatives knew who to speak with if they had any issues to raise.

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 20 August 2018) and there were two breaches of Regulation 12 and 19. Issues identified related to the unsafe management of people’s risks and medicines and poor recruitment processes. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. We also continued to find further areas of concern that required improvement. This service has been rated Requires Improvement for the second time.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

During this inspection we have identified continued breaches of Regulation 12 and 19 in relation to people receiving safe care and treatment and the poor recruitment processes. In addition, we have also identified breaches of Regulation 17 and 18 around ineffective management oversight and the quality of training provision.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representati

Inspection carried out on 25 May 2018

During a routine inspection

This inspection took place on 25 May 2018 and was announced. We gave the provider 48 hours' notice that we would be visiting their main office so that someone would be available to support us with the inspection process.

This was the first inspection of the service since it was registered with CQC in January 2017.

Uriel Care2U Ltd 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 adults of any age who need care due to physical disabilities, illness or those living with dementia. Not everyone using Uriel Care2U Ltd 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 consider any wider social care provided. The service offers domestic assistance services and personal care. At the time of this inspection the service was providing personal care services to twenty-three people. In addition, a night care service and a live – in care service was provided to two people. The majority of people used Uriel Care2U Ltd for reablement, a six-week service following a hospital stay and the others had a more long-term service.

There was a registered manager in post who was also a director of the company. 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 had risk assessments in place which covered specific areas of risk for each person, such as falls, environmental and health risks. In two files there was no environmental risk assessment and there was no risk assessment in the file for risks associated with one person’s medical condition. The registered manager told us that these were in place in people’s homes.

The service had processes in place to ensure the safe administration of medicines. We found problems with one person’s medicines records which indicated that the provider’s systems to ensure medicines were managed safely were not consistently effective. The registered manager informed us after the inspection that they had taken appropriate action to ensure all medicines records were accurate, including more frequent spot checks on the records.

The provider had not consistently followed robust recruitment processes as two staff did not have references as evidence of satisfactory conduct in their previous jobs. Other checks such as proof of identity and criminal record checks had been carried out for all staff employed.

The service carried out an assessment with people to assess their needs before confirming that the service could meet the person’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Care plans detailed people’s needs but some were written on a format which included information which was not relevant to them. People had consented to their assessment and to the service sharing information about them with other relevant professionals but some people had not been asked for their written consent to being provided with care by the service. There was no record of consent to their care plan as they had not signed it.

Care workers had appropriate training and support to enable them to deliver their roles effectively. They told us they were happy working for this service and felt well supported by the registered manager.

Staff supported people who had nutritional and hydration requirements to ensure they ate and drank well and helped them to maintain their health.

People and relatives were happy with the care staff that supported them and thought care workers were caring and respectful of their pri