Unique Care Network Limited

Unique Care Network Limited is a domiciliary care service providing personal care to people in their own homes. People may have needs related to dementia, physical disabilities and sensory impairments. 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. At the time of the inspection eight people were receiving personal care.

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

At our last inspection in March 2019, the provider was in beach of regulations 11, 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not being managed to keep people safe. People had experienced late and missed care calls which impacted on their safety. People’s consent to care was not always sought and some decisions were made by the provider or people’s family and not in line with the law. People were not protected against the risks associated with unsafe staff recruitment practices. The provider had not ensured there were effective quality assurance checks in place to monitor the quality and safety of the service people received.

At this inspection we found that improvements had been made and breaches had been met. These improvements need to be embedded and sustained

The systems in place for monitoring the quality of the service had improved. Audits had been implemented but these still needed to be consistently undertaken and sustained, to ensure people received good outcomes.

Risks to people’s safety were identified with management plans in place to guide staff in supporting people safely. Staff understood how to recognise and report abuse to the appropriate safeguarding authorities. People were happy with the support they received to take their medicines. The numbers of people using the service had significantly decreased, care call scheduling and monitoring of care calls had improved so people did not experience missed calls. The provider had audited existing staff files, they have yet to demonstrate they can follow and sustain safe recruitment practices. People were satisfied that staff followed infection control procedures when in their home.

People were supported by staff who had training and support to meet people's needs. Improvements were noted in carrying out spot checks on staff to check their care practices. Improvements had been made in relation to seeking people’s consent before providing support. 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.

People had consistent support with their meals and staff were mindful of promoting drinks and snacks ensuring these were within reach of people. People maintained control over their health care arrangements and staff responded to changes in people's health conditions and followed the advice of health professionals.

People described staff as caring and considerate. People’s dignity and privacy was protected. The impact of having familiar staff and regular care calls had promoted people’s happiness with the service.

People's needs were assessed and their choices and preferences identified in their care plan. People’s wishes regarding their end of life care had not been discussed with them in case a sudden death occurred. The service was meeting the accessible information standard to provide information for people in a format relevant to them. People knew how to complain and complaints were responded to appropriately.

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 inadequate (published 09 April 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since 15 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

People’s experience of using this service:

The provider had not progressed to ensuring everyone's care plan and risk assessment had been reviewed. This meant not everyone had an accurate and up to date care plan with guidance to ensure people were safe. There had been some improvements since our last inspection in putting management plans in place to reduce risks to some people. However, this did not provide assurance that risk management processes would ensure everyone received safe and appropriate care.

At our previous inspection the provider lacked knowledge about safeguarding procedures. At this inspection we saw they still did not understood their responsibilities for keeping people safe, or for sharing information with other agencies. Staff were up to date with safeguarding training and knew how to report any concerns about people’s safety.

Improvements had not been made in the recruitment of staff. The provider had not ensured safe processes were followed. Two staff had been recruited without reference checks to determine their suitability.

Some improvement had been made in relation to scheduling care call times. The provider had implemented an electronic scheduling system which we saw planned call times and monitored the duration. This also included travel time for staff between calls. However, this was in the early stages and only in place in one geographical area. Some people told us they continued to have late calls.

Quality assurance continued to be ineffective and did not pick up on the issues identified at this inspection. These included concerns with sharing potential safeguarding incidents and recruitment checks. Systems and processes were not yet in place to show how the provider was assessing, monitoring and mitigating risks. Whilst records were being reviewed, the provider did not have a system for auditing these. Leadership within the service remained unclear, roles and responsibilities were not defined. Management meetings were not recorded and there was no recorded agenda of the improvements needed or the progress being made.

The registered provider continued to lack knowledge around the regulations and legislation. They had not notified us of two incidents which they are required to do. Post inspection they used the wrong notification reports.

Rating at last inspection: The service was last rated Inadequate on 18 and 21 January 2019 and placed in special measures.

Why we inspected: This was a planned focused inspection based on previous rating of inadequate and the requirement to re inspect services placed in special measures.

Enforcement

We identified a continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and governance. We judged that the breach in safe care and treatment remains as at this inspection there was evidence that sufficient progress had been made with regard to risk management processes within the service. In addition we identified a breach in relation to staff recruitment. The provider has also a breach in relation to seeking people's consent to care and support which was not assessed at this focused inspection.

Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor the service as per our inspection programme.

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

Unique Care Network Limited is registered to provide the regulated activity of personal care. This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults and younger adults. People had needs that related to old age and could include dementia, health conditions, and/or a physical disability. There were 45 people using this service at the time of our inspection.

At the last inspection in March 2017, we judged the service as requires improvement in all five key questions of safe, effective, caring, responsive and well-led and we rated the service requires improvement overall. We also imposed requirement notices for three breaches of regulations because the provider's governance system of checks and audits continued to require further improvement. In addition, the provider had not adhered to safe recruitment procedures. We issued a fixed penalty notice because the provider failed to display their last rating of May 2016 on their website.

The provider was also the registered manager and they were present during our 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.

At this inspection in January 2019 we found the provider's system of checks and audits remained ineffective. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had been made to the systems and processes to audit and monitor the quality of care provided and to meet the Regulations. We also identified additional concerns and breaches of regulations. As a result, the service has been rated as inadequate.

We are considering what further action to take.

As we have rated the service as inadequate, the service will be placed in 'special measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it 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 act 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.

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. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were not consistently protected from potential harm due to the provider failing to recognise, report and notify the appropriate safeguarding authorities of potential safeguarding concerns. Risks to people's health and safety were not sufficiently identified and risk management plans were not consistently in place. Incidents had not been analysed to identify trends to help prevent the risk of similar occurrences in future. Systems were in place to ensure staff were suitable to work with people in their own homes. There were not enough staff deployed to ensure people received the support they needed at the agreed times. This had impacted on people’s well-being and quality of life. People said not all staff followed infection control or hygiene procedures when in their home.

Staff had not consistently had support or competency checks to monitor their practice and ensure they worked to the required standards. People told us that staff sought their permission before providing care and support. However, we identified that the registered provider had not consistently understood their obligations under the Mental Capacity Act (2005). People said staff supported them with their meals and drinks but not always at the right times. There had been a delay in recognising and referring concerns regarding a persons deteriorating health.

People told us that staff who regularly supported them were kind, polite and respectful. Some staff were described as less respectful and people felt rushed. People did not feel listened to and described being distressed by the experiences of missed calls and difficulty in building relations with unfamiliar staff. Language barriers had affected people’s ability to communicate with some staff. People told us they made decisions about how they wanted their care provided but staffing issues meant their preferences were at times not known or followed.

People did not feel their care and support was consistently responsive to their needs. Call times had impacted on people’s choices and routines which were not always met in the way they preferred. People’s support plans were not up to date to provide staff with sufficient guidance on how to meet their needs which meant they did not always receive personalised care. People’s complaints had not always been listened or responded to or used to improve people's care experiences.

People and their relatives were not satisfied with the service they received or the way it was managed. The systems in place to assure the safety, quality and consistency of the service were not effective. Checks and audits had not identified areas for improvement. The provider had not taken timely or sufficient action to improve aspects of the service. There was a lack of notifications to CQC to share risk within the service.

You can see what action we told the provider to take at the back of the full version of the report.

The provider is registered to deliver personal care and support to people in their own homes in the community. The provider told us that 22 people were using the service at the time of our inspection. People had needs that related to old age and could include dementia, a variety of health conditions, and/or a physical disability.

The provider was also the registered manager and they were present during our 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.

At our inspection of June 2015 we found that the provider was in breach of the law regarding the quality monitoring of the service as the processes in place were not adequate. At our inspection of April 2016 we found that the quality monitoring of the service had improved to the extent that there was no longer a breach of the law. However, we found that some more improvement was required to ensure that the service was run adequately and safely. At this, our most recent inspection, we found that the quality monitoring had not improved as issues that we found had not been identified by the provider.

Medicine systems had not sufficiently improved since our previous two inspections when we found that improvements were needed to prevent any potential risk of errors and ill health to people who used the service. Staff recruitment processes had not improved since our previous inspection to ensure that all staff checks were carried out in a timely manner to prevent any risk of unsuitable staff being employed. The current staff/ staffing levels had not prevented some late or missed calls. People and their relatives confirmed that there had not been any experiences of abuse. Staff had received safeguarding training and knew how to report any concerns they may have.

People and their relatives had mixed views about the effectiveness of the service. Their views varied from good to feeling that some improvements were needed. Staff felt supported in their job roles on a day to day basis. However, annual appraisal systems were not used. Staff had received the training they required to them to be able to carry out their work. Staff ensured that they received consent from people prior to support being provided. People’s medical needs could be met where this was required.

Complaints procedures were available but not in different methods that could make them easier to understand or read. Complaints had been looked into but there was no on-going analysis to determine patterns, trends or learning. Systems to determine people’s satisfaction with the service had not been widely used. People’s needs had been assessed and reviewed to ensure information was appropriate and current.

Audit processes had failed to identify issues that they should have done to ensure a safe, well-led service. The provider had failed to display their last inspection rating on their website as they must do by law. People and their relatives confirmed that they knew who the registered manager was and were familiar with him.

You can see what action we told the provider to take at the back of the full version of this report.

The provider is registered to deliver care and support to people in their own homes in the community. 13 people received a service on the day of our inspection. People’s needs related to old age, health conditions, and/or a physical disability. The majority of people lived with a family member, or had input from a family member.

At our last inspection in June 2015 we found that the provider was in breach of the law regarding the quality monitoring of the service as the processes in place were not adequate. Since that time because of concerns the local authority who contract with the service suspended new placements. The local authority has lifted the suspension with an agreement that they will not fund more than ten care packages at any time. We found that the quality monitoring of the service had improved to the extent that there was no longer a breach of the law. However, we found that some more improvement was required to ensure that the service was run adequately and safely.

The provider was also the registered manager and they were present during our 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.

Medicine systems had improved since our last inspection of June 2015 however, further improvements were needed to prevent any potential risk of errors and ill health to people who used the service.

Staff recruitment processes had also improved since our last inspection of June 2015 but more improvements were needed to ensure that all staff checks were carried out in a timely manner to prevent any risk of unsuitable staff being employed.

People and their relatives that we spoke with told us that the service was good. They also told us that they felt safe. People and their relatives confirmed that there had not been any experiences of abuse.

Staffing was adequate to provide a consistent service and people who used the service described the staff as being nice and kind.

The registered manager/provider as at our previous inspection knew that they needed to recruit staff on an on-going basis to ensure that they had enough staff to meet people’s needs. Staffing levels were not placing people at risk of not receiving the care and support they needed or at the right time.

Staff told us that they felt supported in their job roles on a day to day basis. The registered manager/provider told us that some improvement was needed as staff supervision had not always been frequent and formal staff meetings had not been held.

Staff had not received training in relation to the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguarding (DoLS) which would give them a greater in-sight to ensure there was no possibility of people being unlawfully restricted.

We found that a complaints procedure was available for people to use. People and their relatives told us that they were confident that any dissatisfaction would be looked into or dealt with.