Archived: United Home Care Limited

Updated 17 May 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8 December 2015 and was announced. We told the provider two working days before our visit that we would be coming because the location provided a domiciliary care service for people in their own homes and the service was small and so we wanted to be sure the registered manager would be available.

The inspection was carried out by one inspector.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We obtained feedback from the local authority's brokerage team prior to our inspection.

We spoke with the registered manager and the staff member who carried out assessments of people using the service. We reviewed two people’s care records and documents relating to the management of the service including, three staff records and incident records. After the inspection we contacted one person who used the service to ask them for their views and experiences of the service. Some people who used the service had complex needs and were not able, or chose not, to talk to us. We also tried to make contact with three relatives but only managed to speak with one to obtain their feedback on the service. Two care staff and the assessor also provided their views on the service after the inspection. One care staff member and the assessor were the relatives of the registered manager.

Updated 17 May 2016

We undertook an announced inspection of United Home Care Limited on 8 December 2015. We told the provider two working days before our visit that we would be coming because the location provided a domiciliary care service for people living in their own homes and the service was small so we wanted to be sure the registered manager would be available.

The service had temporarily closed for approximately ten months from the end of 2014 as the registered provider (also the registered manager) had needed to shut the service during this period. The service had re-started operating again and supporting people in October 2015.

We last inspected the service in April 2013. At that inspection we found the service was meeting all the regulations that we assessed.

The service was family run and the registered manager’s wife and daughter also worked for the service as a care worker and assessor.

United Home Care Limited provides a range of services to people in their own home including personal care. People using the service had a range of needs such as physical disabilities and dementia. The service offered support to people over the age of 18 years old. At the time of our inspection 4 people were receiving personal care in their home.

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.

Medicines were not always managed safely and we could not confirm people received their medicines as prescribed.

Risks to people and others were not well managed and people did not have the necessary risk assessments in place in relation to known risks to ensure staff safely supported them..

Recruitment systems were unsafe as the provider did not always ensure they obtained all the necessary checks before staff worked with people using the service.

There were concerns regarding how staff were being deployed in the service. The staff team was small and there were no contingency plans should a staff member not be available to work, thus potentially a person using the service might not receive all their home visits.

Our findings during the inspection showed that new staff did not receive an induction to the service or receive training in a timely manner on areas such as moving and handling and the administration of medicines, to prepare them for their roles.

Although there were systems in place to assess people's capacity and their ability to consent to the care and support they received, processes were not followed in working with the local authority to ensure people who needed a formal mental capacity assessment took place.

The provider had limited systems in place to monitor the quality of the care provided and these did not provide appropriate information to identify issues with the quality of the service. The registered manager had not been aware of their duties to act in accordance with the Mental Capacity Act 2005 and neither had they identified any of the issues we found during this inspection.

Feedback from a person using the service was positive. They spoke highly of the staff who visited them and said they felt safe receiving the service. A relative was also happy with the support their family member received.

People’s needs were assessed before they received a service and care plans identified their needs.

There was a complaints policy and procedure in place and people and their relatives knew to contact the service or the local authority if they had a concern.

Staff documented the drinks and meals people ate so that this could be monitored if a person was at risk of dehydration or malnutrition.

We have made a recommendation that the registered person should seek relevant current guidance and information on the Mental Capacity Act 2005.

We found breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the registered person not following safe care recruitment procedures, no contingency plans in place to ensure there were staff available to always cover the home visits, poor records relating to the management of medicines, failing to carry out detailed risk assessments and guidance on people’s needs, not sufficiently supporting staff through providing an induction to the service and training for new staff. There was also a lack of quality assurance checks and audits and the registered manager was not aware of their duties in relation to the Mental Capacity Act neither had they identified the issues we found during this inspection.

CQC has taken the appropriate regulatory response to resolve the problems we found.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's

registration.