Universal Care Services Coleshill

About the service

Universal Care Services Coleshill is a domiciliary care agency and provides personal care to older adults living in their own homes. People supported had frailty due to older age, and some lived with health conditions and others lived with dementia. At the time of the inspection 206 people were in receipt of a package of care from the provider and received the regulated activity of personal care as part of their support.

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

People described staff as kind and their support as good. They felt involved in their care and support. Care was personalised and people’s different needs were responded to. No one had experienced a missed call and as far as possible people had the same staff undertake their care calls.

People felt safe with staff members, who had been trained to protect people from the risks of abuse. Where concerns were raised these were acted on by the registered manager.

Staff got to know people well and knew how to protect them from identified risks of harm or injury. Risk management plans were included in people’s plans of care which staff could refer to.

The provider had systems in place to check the suitability of staff and required pre-employment checks were completed. Staff were trained, and checks were undertaken on their skills and competencies.

People were supported with their prescribed medicines as needed by trained care staff.

Staff understood infection prevention and control measures and actions they should follow in line with Coronavirus guidance. Additional training had been given and this included the use of personal protective equipment.

Staff followed professional healthcare guidance where this had been given. Referrals were made, on people’s behalf to GP’s or other services if required. Staff worked within the principles of the Mental Capacity Act 2005 and understood the importance of gaining consent from people. People were supported to have maximum control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

There were quality assurance systems in place to check the safety and quality of the services. Compliance checks were made by the provider and had identified where improvements were needed and these had been acted on. The provider had contingency plans in place as a response to COVID-19 planning.

Rating at the last inspection

The last rating for this service was Good (published 21 August 2019).

Why we inspected

This was a planned pilot virtual inspection. The report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the Provider.

The pilot inspection considered the key questions of safe and well-led and provide a rating for those key questions. Only parts of the effective, caring and responsive key questions were considered, and therefore the ratings for these key questions are those awarded at the last inspection.

Follow up

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Universal Care Services Coleshill on our website at www.cqc.org.uk.

Universal Care Services Coleshill is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection, 171 people were supported by the service. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where people receive this regulated service, we also consider any wider social care provided.

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

People received safe care. Risks were assessed, and management plans gave staff the information they needed to protect people from risks of harm or injury, such as falls. Staff knew their regular people well and how to keep them safe. People received their medicines as prescribed. Staff were trained and understood the importance of infection prevention and control.

There had been a small number of missed or late calls to people. However, the provider and registered manager had investigated these and measures had been implemented to reduce risks of reoccurrence.

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; the policies and systems in the service supported this practice.

Staff understood the need to gain people’s consent before supporting them with personal care. Staff received an induction and on-going training and were supported through team and one to one meetings.

People and relatives described staff as kind and caring. Some staff were described as ‘going the extra mile’ for people. Where staff did not meet the provider’s expectations and people had raised a concern, these were investigated. The provider’s policies and procedures were followed to address any short-comings in staff’s approach to people and tasks.

Peoples’ care plans were personalised to reflect their personal preferences and choices. Staff used information to engage with people to discuss topics or hobbies of interest to them.

People and their relatives were involved in planning their care and reviews of support took place. They were given opportunities to give feedback and the provider used this to identify where areas of improvement were needed. The provider was currently implementing actions to make improvements following their recent feedback survey analysis.

The provider had systems and processes in place to check on the safely and quality of the services. Some checks required more detail.

The provider and registered manager had agreed an action plan with the local authority and improvements were currently being implemented, within agreed timescales.

Rating at the last inspection (and update)

The last rating for this service was Requires Improvement.

The last comprehensive inspection of this service was on 18 June 2018 and the service was rated Requires Improvement (published 13 August 2018). There were breaches of the regulations. The provider completed an action plan after the inspection to show what they would do and by when to improve. We undertook a focused inspection in the areas of safe and well led on 24 September 2018. We found sufficient improvements had been made to meet the requirement of the regulations, however, improvements needed to be embedded and further improvements made. The service continued to be rated Requires Improvement (published 17 October 2018).

At this inspection we found the provider had made improvements and the service is now rated Good.

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Follow up

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

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

At our previous inspection in June 2018, we found breaches in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. We found breaches of the regulations related to managing risks to people's safe care and treatment. We gave the home a rating of Requires Improvement in all the key questions and served the provider with a Warning Notice. The overall rating of the home was ‘Requires Improvement.’ This inspection was focused on the key questions of safe and well led and to check the provider had implemented the required actions for improvements to be made to met the regulations.

Following our feedback to the provider at our last inspection, the provider agreed to cease the acceptance of new people’s packages of care. The provider told us they wanted to focus on improvements needed, and this was their priority. Since our last inspection, the provider has sent us information about their progress in implementing the required improvements. We have been monitoring the service since our last inspection.

There was a registered manager in post. Following our last inspection in June 2018, a manager from another Universal Care Services branch, had registered with us to also be manager for the provider’s Coleshill branch. The provider had informed us this was on a temporary basis, whilst a new manager was recruited. At this inspection, a new manager had been recruited for the Coleshill branch and was in the process of applying to become registered with us.

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 this inspection we found the required improvements had been made and met the standards of the regulations. However, some people had continued to experience missed care calls. The provider had further improvements planned for; with an emphasis on call monitoring to ensure people consistently received their care calls at the agreed times. The rating continues to be ‘Requires Improvement.’

Overall, people received a safe service though some late and missed calls had occurred since our last inspection due to human error. The provider's planned enhanced improvements to their call monitoring system was due to commence in October 2018 as agreed with the commissioning local authority. We were therefore unable to assess the effectiveness of this during this inspection.

People's medicines were handled safely by trained staff. Staff felt improvements that had been made, by the provider, to the information they had about people’s medicines, made it safer for them to support people with their medicines.

Actions were taken to mitigate the risks of harm or injury to people. Staff had received further training and knew how to identify potential risks to people and how to escalate these to management so concerns could be acted upon. Risk management plans were more detailed and reviewed when needed.

Care staff understood the importance of recording accidents and incidents and now had forms readily available to them. These were completed when needed.

Staff continued to be safely recruited and trained in how to safeguard people from the risks of abuse. The new manager and registered manager; covering the branch, each understood their role in reporting safeguarding concerns as required to the CQC and local safeguarding authorities. There had been no new concerns since our last inspection.

There continued to be enough staff employed to undertake care calls to people and meet their individual needs. Improvement had been made to rota care call scheduling which meant staff had sufficient time in-between care calls to reach their next visit, without arriving later than the agreed time.

Overall, improvement had been made to staff using the provider’s system of ‘logging in and out’ of care calls to people. The number of incidences of missed and late calls to people had decreased since our last inspection. However, some missed and late calls had been logged due to scheduling errors. Further improvements to the provider’s call monitoring system was due to be implemented in October 2018 following the provider's meetings with the local authority commissioning the services. The provider had needed to meet with commissioners, to discuss their proposed changes to their call monitoring system, because the system used formed a part of their contract with the local authority who purchased care packages on behalf of people.

There were improvements of systems that checked the quality of the service provided to help identify where improvements were required. Feedback was sought from people, relatives and staff. Audits had effectively identified where further improvements were needed and recorded actions taken.

Staff felt more supported through increased communication, team meetings and one to one supervision meetings. When staff poor performance was identified, management addressed this following the provider’s procedures.

The service did not have a registered manager. However, a manager from another Universal Care Services branch, who is registered with us for the Corby branch, was covering at Coleshill. This manager has applied to become registered with us for Coleshill as well, though on a temporary basis, whilst a new manager is recruited.

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 the service was rated ‘Requires Improvement’ overall, with the safety of the service being rated 'Inadequate.' We identified four breaches of the regulations. The breaches of the regulations related to medicines not always being administered safely and as prescribed. The provider had not always recorded or acted on complaints received about the service. The provider had not ensured there were enough skilled and appropriately trained staff to meet people’s needs safely. The provider had not ensured staff were properly deployed to meet people’s needs safely. The provider had not planned appropriately to ensure an expansion of the service could be safely managed. Systems designed to check on and improve the quality of the service were not used. People, relatives and staff did not feel well supported by the provider.

We asked the provider to send us a report that said what action they were going to take to make improvements. A detailed report was sent to us and we have been monitoring the service since our last inspection.

At this inspection we found some improvements had been made, though these were insufficient to meet the requirements of the regulations. We identified two continued breaches of the regulations. The overall rating given to the service continued to be Requires Improvement.

People, relatives and care staff felt some improvements had started to be made from February 2018 onwards, when a new management structure was put into place by Clece Care. Most people told us there was greater consistency with the care staff that undertook their care calls now. People and their relatives gave us mostly positive comments about their care staff. Staff felt more able to raise issues with the manager and deputy manager than previously. However, further improvements were needed in all areas. People, relatives and staff were in agreement further improvements were needed and many comments made to us focused on office staff and their role, such as communication, needed improvement.

There was some improvement with systems that checked the quality of the service provided to help it improve now being in place and used. However, these were not always effective. The provider had not ensured staff undertaking audits had the necessary skills to implement improvements when actions needed were identified.

Some improvements had been made to the systems designed to ensure safe administration of medicines. However, these improvements had not been fully implemented to everyone supported by care staff with their medicines. Some people did not have the new, improved medicine administration record. This meant some people continued to be at risk from medicines not always being administered as prescribed because their administration record was not detailed. Some medicine records had signature gaps and action had not been taken to ascertain whether the medicine had been given or not.

People’s needs had been assessed, however potential risks of harm or injury to people were not consistently identified.

Actions had not been consistently taken by the provider following a serious incident of an accidental house fire. The fire occurred outside of the agency’s care calls, during March 2018. Timely action had not been taken to ensure risks to people currently using the service, from potential fires, were assessed and actions taken to minimise those risks.

People had experienced missed and late care calls and did not always find it possible to contact on-call staff when the office was closed.

Care staff understood the importance of recording accidents and incidents. However, accident and incident reports were not consistently logged at the office and there was no overall system in place for accident analysis and actions were not always taken to minimise the risks of reoccurrence.

Some improvements had been made to how complaints were handled.

Staff understood their responsibilities to protect people from the risks of abuse. Staff had been trained in what constituted abuse and would raise concerns under the provider’s safeguarding policies. The provider checked staff’s suitability to deliver care and support during the recruitment process.

Staff had received training in the Mental Capacity Act 2005 and worked in line with this to promote people’s best interests. Staff offered choices to people and gained consent before, for example, supporting them with personal care.

There were enough staff employed to undertake care calls to people. However, people did not always receive their care calls at the agreed times because care call scheduling did not always allow staff sufficient travel time between calls. The call monitoring system was not effective in identifying missed or late calls to people.

Improvements had been made to ensure staff received training and used their skills, knowledge and experience to, overall, provide effective and responsive care. Further plans were in place to refresh care staff skills.

People were supported to eat and drink enough and care staff left people with drinks when needed.

We found continued 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 the report.

Universal Care Services Coleshill provides domiciliary care to people in their own homes. At the time of our inspection, 187 people were supported with care.

The service did not have 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. A new manager had been recruited, and the provider assured us an application to ‘register’ the manager with CQC would be made as soon as possible.

The service was last inspected on 28 April 2016, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last inspection the service was rated ‘good’ overall. At this inspection we found improvements were required.

People were not supported by consistent staff, experienced missed care calls, and care calls that did not take place at the times agreed in their care plans. They also received calls that were reduced in length and did not ensure their needs were met.

People did not always have their medicines administered safely and as prescribed. There were gaps in medicine administration, and mechanisms in place to record and audit when medicines were given were not effective which put people at risk.

People and their relatives told us they felt safe with the regular staff who supported them. Staff received training to safeguard people from abuse and understood what action they should take in order to protect people from abuse. However, staff did not always feel supported by the provider, and were not confident action would be taken if they reported concerns.

Risks to people’s safety were identified but risk assessments did not always give staff who were unfamiliar with the people they supported, enough information to ensure risks were managed consistently.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. People’s care records included some information on the support they needed with decision making. Staff and the management team did not always have a good understanding of the Mental Capacity Act (2005).

Newly recruited staff did not always receive an effective induction to the service, and we could not be assured that either new or experienced staff had their competence and skills checked by the provider to ensure they remained effective in their roles. Staff had not had the opportunity to attend individual meetings to discuss their work since the previous manager left in May 2017.

People and relatives told us their regular care workers were respectful and treated people with dignity, kindness and respect. However, they told us the provider and office staff did not always respond to them in respectful, caring ways and that communication was not effective. People did not always receive care that was in line with their choices. People’s privacy was maintained.

People’s care records were not always up to date and did not always give staff key information they needed to respond to people’s needs consistently.

People and relatives told us they felt concerns raised by them were not taken seriously and not dealt with effectively. Complaints records kept by the provider did not reflect the nature or volume of complaints and concerns received.

Systems which checked the quality of the service provided to help it improve were not being used. The provider did not ensure staff had the opportunity to meet to share good practice, and did not ensure staff performance was assessed regularly to check they remained competent in their roles.

People, relatives and staff were not supported by the management team, and did not feel the service was well managed or effective.

We found 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 the report.

Universal Care Services Coleshill provides domiciliary care to people in their own homes. Some people required 24-hour care. At the time of our inspection, 93 people were supported with care.

The service had 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.

People and their relatives told us they felt safe with the staff who supported them. Staff received training to safeguard people from abuse. They were supported by the provider, who acted on concerns raised and ensured staff followed safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were identified and staff were aware of current risks, and how they should be managed.

People were administered medicines by staff who were trained and assessed as competent to give medicines safely. Records indicated people’s medicines were given in a timely way and as prescribed. Checks were in place to ensure medicines were managed safely.

There were enough staff to meet people’s needs effectively, and people told us they had a consistent and small group of staff who supported them, which they appreciated. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in their homes.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. Some people’s ability to make their own decisions fluctuated, and there was not always detailed information on this. However, staff and the registered manager had a good understanding of the Mental Capacity Act.

People and relatives told us staff were respectful and treated people with dignity, kindness and respect. People’s privacy was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People saw health professionals when needed and the care and support provided was in line with what they had recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. Some care plans were updated with the most recent information and were detailed, others were not. The registered manager was aware of this and was working on ensuring all were updated. People were involved in how their care and support was delivered, as were their relatives if people needed and wanted them to be.

People and relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the registered manager and senior staff were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided, and the provider regularly sought feedback from people and their relatives with a view to improving the service going forwards.

The service was registered in 2013. This was its first inspection. The service is managed by Laura Simmonds. The other manager identified at the front of this report now works for a different Universal Care service. They have yet to cancel their registration.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person told us, 'I feel safe, I trust them.' The staff we spoke with understood they needed to report any concerns about a person's safety to the manager. The manager was clear about their responsibilities to report any safeguarding concerns to social services.

People's records were up to date and reflected people's current health needs. We saw risk assessments were in place and provided appropriate guidance for staff to follow. We also found care reviews had been completed when required.

Staff records showed recruitment procedures were robust in ensuring staff were safe to undertake care work. Records showed staff had received in-depth training to ensure they supported people safely. Staff we spoke with confirmed this was so.

Is the service effective?

People told us the care they received met their needs. One person told us, 'They do what they're supposed to do. They do a wonderful job.' Another person said, 'It's been smashing, sometimes they do more (than they are expected to do).'

It was clear from speaking with the manager, their senior team and with staff, that staff had a good understanding of how to meet people's care needs.

Records showed people's care needs were regularly reviewed and care plans updated to reflect any changes.

Is the service caring?

All people with spoke with told us staff were caring. One person told us, 'I never realised there were so many nice people in the world ' it's changed my opinions of youngsters.' Another person said, 'The care workers are very good'they treat me with respect.' A third person said, 'If I'm a bit down, they talk to me and jolly me along.'

Is the service responsive?

People told us the manager was responsive to any queries or concerns raised. One person told us they had not been happy with a member of staff and this had been dealt with quickly. Another person told us when they first started using the service they were not happy with the time the care workers called in the morning. They told us this was sorted out and care workers came at the time they preferred. This meant the manager responded quickly to people's comments.

We saw there had been no formal complaints made about the service.

Is the service well-led?

People we spoke with told us they felt able to contact the manager about their care and the manager would deal with any of their issues quickly and effectively.

Staff we spoke with told us they thought the manager was approachable and provided good support. We saw by looking in staff files that staff received regular formal supervision to support them with their work.

We saw staff received appropriate training to provide safe and effective care.

We looked at quality assurance systems. We saw the service had recently collated its annual customer service feedback results. These showed people using the service were very satisfied with the level of care and support provided.