Unite Highland Care

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a breach of the legal regulations in relation to good governance. The provider did not have good oversight of the service and did not have a system in place to monitor the quality or safety of the service people received. The registered manager and staff did not have a good awareness about the key guidance or legislation they should follow to ensure people's rights were upheld. The providers management of risk was poor and there was no evidence lessons were learned or improvements made. There was a poor culture within the service, staff told us they were not always supported, were monitored by CCTV and blamed if things went wrong.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from staff about the culture of the service. Some staff told us they did not always get the time off they needed, and they were not told in advance of the calls they would be covering which had an impact on their lives. Staff told us they did not always get the support they needed. Comments included, “We don’t see our rota on time. I think it should be a month so we can plan.”, “They need to do better for staff.”, “I feel 60% supported. There could be better welfare for staff.”, “I expect the management to assist me and they could improve greatly on staff welfare. Communication could be better.”, “They should listen to concerns from staff. They should be forming relationships with staff.” and “Working hours for staff, our rota should be communicated to us a month ahead. Every week it changes, and we have our lives and family outside of work.”

Systems and processes were not effective to ensure there was a positive culture within the service. The registered manager did not demonstrate a positive listening culture. Some relatives told us their concerns were not always listened to or acted on. The provider and registered manager had not ensured robust systems and processes were in place to ensure people received safe care and treatment. Staff did not receive adequate oversight to ensure their practice and delivery of care and support ensured people were safe. The provider had poor oversight of the service, an open culture of reporting and learning lessons was not embedded in the service.

The registered manager told us incorrect information relating to people and was not always open and honest with us. They did not give us the information we requested when we asked for it. For example, we asked the provider about the people they supported on a number of occasions. They did not tell us about a further 2 people who were provided care and said this had been an ‘oversight’. We were alerted to one of the people because the local authority had contacted us about this particular person. Some staff told us the CCTV installed in people’s homes was a way for the provider to monitor them. Comments included, “Yes, they talk about it (what they’ve seen on CCTV) in meetings.”, “Whatever you do just know that someone is watching everything you are doing.” and “For the management to see how you are tending to the service users and we are not allowed to use phones when we work so I think the management see. We have disciplinary. I have not been a victim but I know other people who have been called to order. They will give you warning.” The registered manager told us they had used the CCTV as part of a staff members disciplinary.

We were not assured with the registered manager’s integrity during the assessment. They could not provide us with evidence or answers about the safety of people. For example, management of incidents. We were not assured we were told about all of the incidents or accidents that had affected people. The registered manager did not lead by example, they lacked knowledge around the requirements of people in supported living. They did not have a regard for the associated guidance or best practice. Staff did not have an understanding around this or how people were restricted unnecessarily and were restricted with choice or control over their lives. The provider had no governance or quality assurance process to ensure people received compassionate, safe care and support. Concerns we raised to the provider and registered manager were not known or identified through their systems. The registered manager did not understand or demonstrate compliance with regulatory and legislative requirements. We identified that not all notifications were submitted to CQC, or all safeguarding concerns to the local authority safeguarding team had been reported.

Although some staff told us they felt supported by the provider and registered manager, our assessment identified concerns. The registered manager and provider had not ensured there was a supportive culture where staff felt empowered to speak up. When staff raised concerns, managers did not listen. For example, staff were told to complete their training even when they had raised concerns about the time, they had been allocated to do this and the concerns that training was not well embedded. CCTV was used to monitor staff performance.

There was a closed culture within the service which impacted on people's outcomes. A closed culture is a poor culture in health and social care services that increases the risk of harm to people. The provider was not open and transparent when we requested information. Information recorded did not give an accurate or true picture of the care and support people received. For example, staff logged out from peoples calls from a different location so we could not be assured people received all of the support they required for the agreed time.

The registered manager provided no evidence to demonstrate how staff equality or diversity was promoted or supported. Some staff told us they were watched on the CCTV and would be in trouble for using their mobile phones. Some staff told us it was difficult to maintain a work life balance due to rosters not being available in advance.

During a meeting in July 2024 it was discussed that a person who smoked was not allowed to smoke (illegal substances) in their home. The minutes from the meeting recorded, ‘Staff to ensure no smoking in the house. Staff to reiterate to (person) they can only smoke in garden or outside. The speaker instructed staff to thoroughly check (person’s) pockets and bag when they enter the house to ensure they are not bringing in any prohibited items. The speaker stated that if (person) is found smoking in their room, it means the proper checks were not carried out.’ This demonstrated a culture where staff were blamed rather than included in finding appropriate solutions to support people in the least restrictive way.

The registered manager told us they completed checks on the quality of the service but provided no evidence of this. They told us they managed risks to people through staff meetings, there was no detailed information in the meeting minutes which provided assurances about how incidents had been dealt with or lessons learned. The registered manager had no oversight of the service. They failed to identify the significant and widespread concerns identified within this assessment. Services that provide health and social care to people are required to inform the CQC and local authority of important events that happen in the service. We were not assured all incidents had been shared with us or appropriately reported. Following our assessment, we reported an incident to the local authority safeguarding team.

The provider and registered manager did not have systems in place to identify the serious concerns found during the assessment. Oversight of the service was poor and ineffective. The registered manager had not implemented any quality assurance systems to ensure they had sufficient oversight of the service. There were no audits to provide assurance about the quality and safety of the service. The registered manager failed to assess people's needs robustly or implement care and support plans which gave staff all of the information required to provide care and support to people safely. The registered manager did not proactively manage risks to people or learn lessons and relied on other individuals, including healthcare professionals, to monitor people’s health and provide safe care. The registered manager failed to ensure robust recruitment checks were carried out to ensure the suitability of staff and safeguard people from potential harm or abuse. Governance processes were poor and did not keep people safe, protect people’s rights or provide good quality care and support. The provider did not ensure staff had the right skills or knowledge to support people well and the checks they conducted on staff competency were poor.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider, registered manager and staff did not have a good understanding of how to make improvements happen. For example, staff did not have a good awareness about how they were placing restrictions on people without a full and appropriate assessment. The registered manager failed to recognise the improvements that were needed to ensure documentation, such as care plans, were reflective of people's currents needs. Staff were not supported to prioritise time to develop their skills or undertake training in a meaningful manner which would positively impact on the care they provided.

There were significant and widespread concerns in the service which the provider had failed to identify. People had been harmed or were at risk of harm. Oversight and processes to ensure a safe and caring service was provided was absent. There was no evidence of lessons being learned even after significant events where people had been hospitalised. The registered manager could not demonstrate they kept up to date with national policy to inform improvements to the service. There was no evidence the registered manager and provider reviewed best practice. There was no evidence the provider listened to or learnt from feedback and this was confirmed by some of the relatives we spoke to. Although surveys and questionnaires were given to people there was no evidence of any action taken in response to make improvements at the service.