Archived: Unique Care Services

The service had a registered manager who had been in post since September 2014. We were advised following our inspection that the registered manager had resigned and were working their notice period. 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

We identified breaches of regulation 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The systems in place to protect people from the risk of harm were not effective. We found that risk assessments in place did not evidence that risks were mitigated. Clear guidance was not available within care plans to inform staff of the support they should be undertaking. This meant vulnerable people were at risk of harm.

The registered provider had not evidenced that staff had undertaken an induction or that all staff had completed training essential for their role. This meant staff may not have been up to date with skills and knowledge required for their role.

Staff had not received regular supervision and appraisal. This meant that the monitoring of staff performance was not effective and development opportunities were not considered.

The registered provider had audit systems in place for monitoring the quality of the service. These were not fully effective as they had not identified areas for development and improvement.

The registered provider had policies and procedures in place however, these were not all up-to-date and did not reflect current legislation and guidelines.

The registered provider had not notified the Care Quality Commission of all significant events that occurred at the service in line with their legal obligations. This meant that the registered provider was not complying with the law.

Staff were polite and respected people's privacy and dignity. People told us they had some regular staff that were kind and caring.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw the registered provider had policies and guidance available to staff in relation to the MCA. Staff were able to demonstrate a basic understanding of this.

People had access to information about how to complain. The registered provider had a complaints policy and procedure in place.

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.

They currently provide and manage their service from 19 Caldy Drive, Great Sutton, Ellesmere Port CH664RN but this location is not yet registered with the CQC. This is the location that we visited for the purpose of our inspection. The registered provider moved premises following our last inspection and they failed to notify CQC prior to this move taking place.

Unique Care Services is a domiciliary care service based in Ellesmere Port. It offers care and support to approximately 35 people in their own homes within the Ellesmere Port and surrounding area. They employ 21 support and office staff. Not everyone using Unique Care Services receives personal care. 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.

There was a manager at the service that was in the process of applying to the Care Quality Commission to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider's they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we completed our previous inspection on 11, 21 and 27 September 2017 we found concerns relating to Regulation 12 safe, care and treatment, 17 good governance and 18 staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely, care plans were not up to date and regularly reviewed, risk assessments did not mitigate people from possible harm, staff had not received an appropriate induction or training to meet the requirements of their role, policies and procedures did not hold the most up to date information and audit systems had not identified areas for development and improvement.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-led to at least Good. The registered provider sent us an action plan that specified how they would meet the requirements of the identified breaches. During this inspection we found improvements had been made.

This inspection was undertaken to check that improvements had been made to meet the legal requirements planned by the registered provider after our comprehensive inspection on 11, 21, and 27 September 2017. The team of two adult social care inspectors visited the service and inspected against all the five questions we ask about services: Is the service Safe, Effective, Caring, Responsive and Well-led? We found that the registered provider showed improvements across all questions and was meeting the legal requirements.

Although the required improvements had been made a longer term of consistent good practice is required to achieve a rating of good across each domain. We will review the ratings for all domains at our next inspection.

Improvements had been made to the safe management of medicines. Staff had all received up to date training and had their competency assessed. People's medication administration records (MARs) were fully completed and an effective audit system had been introduced.

Improvements had been made to people's risk assessments and care plans. Staff had clear guidance available to them for when they supported people and risks were clearly mitigated. The systems in place protected people from the risk of harm.

Improvements had been made to staff training and support. All staff had undertaken essential training for their role and they received regular support through supervision and team meetings. Regular monitoring of staff was undertaken and used to develop skills or highlight areas for improvement.

Improvements had been made to the policies and procedures. These had all been reviewed and updated and now held the most up to date information and good practice guidance. The registered provider was asked to ensure these were dated to ensure the most up to date copies were always available to offer guidance to staff in their roles and employment.

Improvements had been made to the governance systems undertaken by the registered provider at the service. Regular audits were undertaken and areas for development and improvement were identified and actioned.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw the registered provider had policies and guidance available to staff in relation to MCA. Staff had all received training and demonstrated a basic understanding of this.

Staff recruitment processes were robust and sufficient staff were employed to meet the needs of the people supported.

People were supported by regular staff that knew them well and understood their daily routines. They were treated with dignity and respect by staff that were kind and caring.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

The registered provider had a complaints policy in procedure in place and people told us they knew how to raise concerns.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Audits in respect of medication were not robust. On occasions, medication records did not have signatures recorded with no indication on why medications had not been administered. We found that the auditing of these records had concluded that they were satisfactory when this was not the case. Other auditing of care plans and daily logs were done appropriately. Staff were subject to periodic spot checks so that the quality of support could be measured.

Questionnaires had been sent out to people who used the service and spot-checks undertaken by the registered provider did ask for and record the views of people who used the service.

Staff felt supported by the management team. The registered provider demonstrated an understanding of the need to let people who used the service and others about ratings that would be applied to the service following this inspection. The registered provider was aware of the circumstances in which they needed to report incidents to us.

People told us that they felt safe with the staff team. Staff were able to outline the potential types of abuse and how they could report any concerns. They had received training in this and were familiar with whistle blowing and how poor practice could be raised with other agencies.

Medication systems were in place. Staff received training in this and had their competency checked through spot checks. People who relied on staff to assist in medication told us that this was never missed.

Recruitment records demonstrated that the registered provider had obtained all the necessary checks. This enabled people who used the service to be confident that people who supported them were suitable for their role.

Risk assessments were in place. These outlined the risks people faced through the support they were given as well as risks posed by their home environment. All risk assessments were up to date. Information included the susceptibility people had to falls and the steps staff needed to take when assisting with mobility.

Staff rotas identified when two staff needed to support people at any time. People told us that calls were not missed although delays did occur from time to time.

People felt that the staff team were trained and knowledgeable about their needs. Staff received supervision and appraisals so that their performance could be monitored and that they would be supported.

Provisions of the Mental Capacity Act 2005 were taken into account by the registered provider. Staff had received training in this and had a working knowledge about how to assist people in making decisions for themselves. Assessment information included reference to the capacity of people

.

Staff supported some people with their nutrition. People commented that staff prepared meals which were well cooked and had regards to their likes and dislikes.

People felt cared about. Staff were aware of measures to take to promote the privacy and dignity of people. Information retained by the registered provider focussed on the communication needs of people and the most effective way to provide information to them.

Care plans were person centred and linked to the daily routines of people. They were reviewed and changed as needs changed. Assessment information was in place covering all the needs people had in their daily lives.

People knew how to make a complaint. A complaints procedure was available. Some people had used this and had their concerns listened to. Other preferred a less formal way of complaining and they said that their views had been listened to their satisfaction.