All inspections: Unity Community & Care Services Limited

Unity Community and Care Services is a small family run business that provides personal care for people living in their own homes. The service is provided to mostly older people who have needs related to physical frailty or dementia.

This announced inspection took place on the 26, 27 November and on 8 December 2015. The comprehensive inspection was brought forward because of several concerns raised with us about the safety and reliability of the service. We gave the provider 48 hrs notice of the inspection because the location provides a domiciliary care service. This was so we could arrange to visit some people using the service to get their feedback and to ensure the registered manager was available for our visit. 22 people were receiving a service when we visited.

At three previous inspections we had also identified concerns about the adequacy of quality monitoring. The concerns included the timeliness of visits and some late visits and about accuracy of care records. On 19 June 2014, when we inspected the service, we had concerns about

people’s care and welfare, how quality was assessed and monitored and record keeping. Following that inspection, we took enforcement action in relation to people’s care and welfare and required the provider made changes by 5 September 2014.

On 24 September 2014 we inspected the service to check that changes had been made in relation to the care and welfare of people. Although some improvements were made, the service had not improved enough. Visit times remained inconsistent for some people which affected their welfare and safety. Assessment, reviews and care plans were inadequate to meet the needs of people safely and appropriately and to ensure changes were promptly recognised and acted upon. This meant people remained at risk of receiving care that was inappropriate or unsafe.

On the 2 and 3 February 2015 we inspected the service again to follow up whether improvements had been made. At that visit some improvements had been made but we found breaches of regulations relating to consent, staff training, notifications and good governance. We continued to be concerned about the assessment and monitoring of quality. Whilst some systems had been put in place to monitor and check the service, these were not well enough developed to assure and control quality in all aspects of the service.

There was a registered manager in post. 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 provider had a number of quality monitoring systems in place such as a rota planning system, a tracking system to check time and duration of visits and several informal communication and audit systems. At this inspection, although some aspects of the services had improved, some risks remained. This showed there were inconsistencies in people’s experiences of the quality of service. This meant the provider’s quality monitoring systems were ineffective because they had had failed to make adequate improvements to people’s care.

We followed up concerns which had been raised with us about the unreliability of the service due to late or missed visits. Although we found no missed visits, some people reported missed visits but not recently. People also gave us mixed feedback about the timeliness of visits and a number of people did not consistently receive their weekly rotas. One relative said, “Now and again, I get one (a rota) but I haven’t had one for a couple of months now.” This meant people did not always know what time their visit was planned for, or which staff were visiting them.

Some aspects of people’s care records had improved but we also identified issues about the accuracy of some of the care records we looked at. An initial assessment of people’s care needs and any risks was undertaken with them before the service commenced and care plans were developed and agreed in response, with the exception of two people. However, not all care records were reviewed and updated in a timely way when people’s health needs changed, although staff were aware of any changes.

Most people and relatives described positive caring relationships with the staff that supported them. One said, “I’ve no complaints about the carers, they are very good.” Other comments included, “Good staff”, and “They are all very nice, it’s nice to have a little chat with them.” Where people had raised concerns about staff attitudes the management team, they had been dealt with.

People received personalised care that was responsive to their needs. Staff knew people well, and spoke knowledgeably about their care needs and preferences. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with each person’s wishes.

People’s rights were not protected because staff still did not have a full understanding of the requirements of the Mental Capacity Act (MCA) 2005. Where people appeared to lack capacity, staff had not undertaken any mental capacity assessments. This meant there was a lack of clarity about some people’s capacity to consent for their care.

People were aware of the complaints process and complaints were investigated and responded to, with actions taken to make improvements. There was a culture of openness and a willingness to explore gaps within the team and to identify ways to improve these. However, people, relatives, staff and health and social care professionals we spoke with expressed more confidence in the leadership of one member of the management team than in others. We concluded the quality monitoring systems in place were not sufficiently robust because they could not be relied on to identify areas which needed further improvement.

We followed up two safeguarding concerns raised with us and were satisfied they had been appropriately reported to the local authority safeguarding team and were investigated, with improvements made, where needed. Staffing levels at the service were adequate for the number of people the agency cared for and further recruitment was underway. People received their medicines on time and in a safe way.

Staff received regular training and ongoing support through supervision and staff appraisals. They worked closely with local healthcare professionals such as GP’s, community nurses, local therapists and social workers. Health professionals said staff sought advice appropriately about people’s health needs and followed that advice. People who needed help with nutrition and hydration were supported to improve their health through encouragement and prompting to eat and drink.

We found two breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on the 2 and 3 February 2015 and was announced. Unity Community and Care Services provide personal care for people living in their own homes. The service is provided to mostly older people who have needs related to physical frailty or dementia. When we visited there were 28 people receiving a service.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

We last inspected the service in June 2014 and September 2014. In June 2014 we had concerns about people’s care and welfare, how quality was assessed and monitored and the quality of record keeping. We took enforcement action in relation to people’s care and welfare and required that the provider made changes by 5 September 2014.

We asked the provider to take action about the other areas of concern and they sent us a plan showing that they would have addressed them by the end of October 2014. We inspected the service again on 24 September 2014 to check that changes had been made in relation to the care and welfare of people. We found that the service had not improved enough and asked the provider to send us a detailed plan to ensure improvements would be completed. The provider told us the detailed plan would be completed by the end of December 2014.

The service was not well led. At this inspection we continued to be concerned about the assessment and monitoring of quality. Whilst some systems had been put in place to monitor and check the service, this was not well enough developed to assure and control quality in all aspects of the service.

The requirements for the supervision, appraisal and professional development of the care staff were not met. Although the basic skills of staff were checked from time to time there was insufficient supervision and support to ensure learning and development met the needs of individual staff providing care. Some people told us they thought staff needed more training to meet their needs.

The service was not using the formal framework and guidance relating to mental capacity to ensure best interest decision making. Neither senior staff nor care staff had a sufficiently well-developed understanding of how to ensure people had given their valid consent where they may be unable to make decisions due to mental capacity. This meant there was a risk that some people’s care may not be in their best interests.

The registered manager had not ensured that notifications were made to the Commission of incidents and allegations relating to people using the service.

Improvements had been made in relation to people’s care and welfare. At the last inspection, the service was not being delivered on time and there were missed visits. This left people at risk and in need of safeguarding. Risk assessments were inadequate to guide staff and ensure people were protected from risks associated with their personal care. At this inspection we found the service visit times had significantly improved in the month prior to the inspection. The improvement was reflected in people’s comments about the service. People told us their service was more consistent and reliable. The system for monitoring calls was effective and had helped to eliminate missed calls and reduce the number of late visits. There was a greater transparency about the time spent with each person as the system to monitor this was more effective. People told us they were now getting informed in advance of their visits and also being contacted if their care worker was going to be late or changed.

Most people had received visits by managers from the service for their care and support needs to be reviewed. This meant the care plans were more detailed and up to date and included more information about people and their relevant home circumstances. Risks associated with people’s needs had also been reviewed and described in more detail, so they could be effectively managed. Community health and social care professionals worked closely with the service to assist in the assessments of individual risks, for example relating to skin care, moving and handling and medicines. This was reflected in some of the care plans and helped to ensure people were kept safe and the risk of avoidable harm was reduced.

Record keeping and administration had improved. Some improvement was needed in how discussions and assessments relating to individuals, such as phone calls, were recorded to make sure this information was used to keep care plans and risk assessments up to date.

The service helped people to get access to healthcare when needed. The staff showed awareness of when people needed specialist help and ensured this was arranged promptly.

We found the service was not meeting the all the required standards in relation to staffing, obtaining people’s consent to their care and in making the required notifications of incidents to the Care Quality Commission.

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

A single inspector carried out this inspection. This was a follow-up inspection, to check the provider's progress against areas where we found non-compliance on our previous inspection visit. We considered our inspection findings to in relation to questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? As it was a limited inspection to check specific areas of previous non-compliance, we did not gather evidence to answer all five questions but focused on whether the service was safe and effective.

We spoke with the registered manager, the owner and with seven people using the service and one relative. We inspected the service's records, systems and procedures. We reviewed safeguarding records from the local authority safeguarding team.

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found the provider had not addressed all the issues we identified previously in regard to the safety of the service and one or more of the regulations were not being met in relation to people's care and welfare. In addition other areas of concern were found which affected the safety of the service. Some improvements had been made to the timings of visits; more visits were on time and delivered more regularly by care staff, which meant some people received a consistent and safe service. However there were still missed and late visits which affected people's welfare and safety, especially in relation to support some people needed with food, drinks, medicine and moving around safely. Risk was not being safely managed in relation to some people's lack of mental capacity, moving and handling needs or support needed with medicines. This was because risk assessments were missing or incomplete.

Is the service effective?

We looked at six care plans, only one of which had been signed by either the person using the service or their representative. This meant that the provider could not be sure that people understood or were in agreement with their care arrangements. Care planning and reviews were areas which still required improvement. Although some care plans had been updated, the information provided was not specific enough to the person and their abilities and did not describe all the circumstances relevant to their care needs. Some people's care plan had not been reviewed for over a year. This meant there was a risk that people were receiving care not appropriate or in line with their individual needs.

A single inspector carried out this inspection. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff showed awareness of how to identify and spot signs of harm and how to report them. At the last inspection we found that the service was not delivered in a way which ensured people's care and welfare needs were met. At this inspection we found that this had not improved. The service delivered to people in their homes was often late or missed altogether. Not all people's needs were reviewed and recorded accurately. As appropriate information was not maintained, people could not be sure that they were protected against the risk of unsafe or inappropriate care.

Is the service effective?

Staff were supported through supervision and training. We spoke with eight people who used the service and three people's relatives. Two relatives told us they were highly satisfied with the care. However four people told us they did not receive any information when staff were going to be late. Three people told us that they would like to receive information in advance about who was going to be visiting them.

Is the service caring?

One relative told us, 'the staff have been very kind and very helpful. The communication is fantastic. 'People told us that that when they received care, the staff were respectful and polite, and that they were treated with dignity. Some people told us that sometimes care was missed or late however they were satisfied with the care when it arrived.

Is the service responsive?

We found two examples where the agency had effectively improved the care when issues were brought to their attention. One relative told us that they had appreciated the changes made to their care. However in a survey to people, most said they were not aware of the complaints policy. Four of the eight people we spoke with told us they could not get hold of someone at the office to raise a concern or that when they left a message, they did not get a reply. One person told us they did not receive an apology when their care was missed.

Is the service well-led?

We found that the systems to monitor the quality were ineffective. For example, late or missed visits were not brought to the attention of the management team in a timely way. This meant that risks were not being well managed. People told us they did not feel they had enough information about who was going to visit them. The provider had sought the views of people and had encouraged staff to formally report their views, however the responses were insufficiently analysed and acted upon. Records were found to be in need of improvement.

We spoke with two people who received support from the service, the registered manager, managing director, HR manager, and support staff. We also spoke with one relative on the phone, and one relative at a person's home.

Both people told us that although there had been some issues with their visits being late, and in one instance, missed completely, overall they were satisfied with the support they received. One said 'I'm happy with the support once they do turn up.' Another told us 'I wouldn't be here if it weren't for the carers. They're all very good.'

One relative told us they were very happy with the care their relative received and said 'From my relatives point of view they're always there for them. It's peace of mind for all of us.' The same relative said 'X is well taken care of, they have a wonderful rapport with them, they're so happy.' Another relative stated that the agency had been supporting their relative for over four years and had been satisfactory during that time, however they had also experienced lateness of visits and in the week before the inspection a morning visit had been missed.

We found that people had comprehensive care plan files, which contained lots of information on how and when people wanted to be supported. This meant support staff could be clear about what type of support a person needed, and which parts of tasks they were able to do for themselves.

Whilst at the service we heard and saw staff talking with people and offering them choice and support in a friendly and patient way.

During the inspection we spoke with three people who used the service and three family members about the care and support they or their relative received. We spoke to them either in person or on the telephone. One person we spoke with told us, "The care my (relative) receives is very good. The carers are very good and always punctual." Another person told us that, "I can't praise them enough. They make my (relative's) life a joy."

We looked at five sets of care records. These showed that the individual needs of the person they related to had been assessed and plans of care set up to show how those needs were met. Documentation differed between those funded by the local authority and those funding their own care and we noted that the privately funded care packages were reviewed less frequently than those funded by the local authority.

We discussed safeguarding procedures with the provider and with two of the care staff. They were aware of the different forms abuse can take and what to do if they witnessed or were told about abuse.

We looked at measures taken by the provider to assess the quality of the care they provided, and saw that feedback was very positive.

This inspection took place on 22 December 2011. The purpose of this inspection was to review the improvements made by the agency following our inspection in September 2011 when we made compliance actions in respect of outcomes 9: Management of medicines, and outcome 13: Staffing. We also made improvement actions in respect of outcome1: Respecting and involving people who use services, outcome 7: Safeguarding people who use services from abuse, and outcome 16: Assessing and monitoring the quality of service provision.

During this inspection we looked at the systems the agency had put in place to ensure people receive a safe and efficient service that met their needs. We did not visit any people who received a service.

We found that the agency had made significant improvements in the way medicines were managed. Staff had received further training and instructions on medicine administration. Medicine administration recording systems had been improved. Each person who received assistance with their medicines had been assessed to establish the level of support needed. A full list of every medicine the person took had been clearly printed and placed in the person's care plan file. A medicine administration chart had been completed each month and returned to the office when completed. The office had checked the returned forms for any irregularities.

We also found that the agency had implemented new reporting systems for staff to inform one of the managers immediately they found any errors, omissions or changes in a person's medication. We saw completed medication incident report forms that showed that staff had recognised where there were potential problems and had acted promptly. We saw that the managers had followed these incident up promptly and taken appropriate action to address the problem and prevent recurrence.

We also looked at the staffing levels for the agency. We found that two new care workers had been recruited and none had left. This had resulted in more staff available to cover for sickness and holidays. This also meant that the manager and senior staff team could spend more hours in the agency office to carry out management tasks. We heard that the whole staff team were much happier as a result and systems were running much more smoothly. The office was manned from 9am most days, and at the latest by 9.30am. This meant that telephone calls could be answered in a confidential and efficient manner.

At the time of this review the agency provided personal care to over 50 people. Two people jointly own and mange the agency and we have referred to them throughout this report as the providers. There was a team of nine care workers including the providers and a senior care worker/administrator who provided care to people every day.

We visited five people in their homes, and also talked to six people who received a service and two relatives on the telephone. All of the people we talked to said they were very happy with the service. We heard many positive comments about the agency including 'I am delighted with them!' and 'I find them very professional.'

People told us they received time sheets from the agency every week to let them know who will be visiting, and what day and time. They told us the carers always visited at near enough to the expected time, and never missed a visit. They said that if the carer they were expecting to visit was running late, or off sick, someone from the agency office has always phoned to let them know. At previous inspections of the agency we found some people experienced missed or late visits. Following our inspections the providers told us they were going to take a range of actions to make sure the reliability of the service was improved. During this inspection people told us the improvements have been successful and they can now feel confident that carers will not let them down. However, we found there were still some weaknesses in the office systems that may leave people at risk of missed visits in the future.

We saw care plans for every person we visited. The care plans gave good information about every aspect of their health and personal care needs. They explained clearly how people wanted to be assisted. People told us they were happy with the information in their care plans and were confident the plans were up to date, and the care workers completed all of the tasks listed.

We looked at the way the agency has assisted people with their medicines. All of the five people we visited needed varying levels of help with their medicines. One person we visited told us they were unsure if they had taken their medicines that morning. We asked the agency to investigate this as a matter of urgency. They found that the care worker had failed to administer the person's medication as instructed in the person's care plan. We found that, despite a number of improvements made by the agency following previous inspections, there were still weaknesses in the procedures for medicine administration. .

We looked at the employment procedures followed by the agency. At the time of this review the team of care workers was small. The team of nine care workers included the two providers, one of their relatives, and a senior care worker/administrator. The agency had good recruitment, induction and training procedures in place. Eight members of the staff team held a relevant qualification. People we talked to praised the care workers. We heard that there had been very few concerns raised by people about any of the care workers, but where there had been concerns the management team had acted quickly to remove the care worker and to make sure that the care worker did not visit the person again.

At previous inspections of the agency we found that the management of the agency was poor due to the low numbers of care workers employed resulting in the providers and senior care worker/administrator leaving the office unmanned every morning to carry out care visits. Following the previous inspections the providers told us they would take action to make sure the agency office was open from 9.30am every morning. However, on the first day of this review the office was not open until 10.45am. Until the office was open the telephone calls were diverted to one of the providers while they were carrying out care visits. This raised issues of confidentiality. The office was untidy and there were weaknesses in the management systems.

Devon Adult and Community Services told us they spoke to 4 people during November 2010 who receive a care service from Unity Community and Care Services. They said they had found the agency had improved in recent weeks and they were now mostly satisfied with the service. They said that people usually received a timetable with the name of the care workers, and the day and time of their visit before the beginning of the week. A few timetables were still arriving late. They said the service had become more reliable and consistent, and the management of the service had improved.

We did not talk to any people who use the service during our visit. We will talk to people when we carry out our next planned review of the service that will take place approximately 3 months after this responsive review.

Archived: Unity Community & Care Services Limited

All Inspections

26, 27 November and 8 December 2015

During an inspection looking at part of the service

2 , 3 Febuary 2015

During a routine inspection

24 September 2014

During an inspection looking at part of the service

19 June 2014

During a routine inspection

13 December 2013

During a routine inspection

21 March 2013

During a routine inspection

21 December 2011

During an inspection looking at part of the service

1 September 2011

During an inspection looking at part of the service

26 October 2010

During an inspection in response to concerns