Archived: United Home Care Limited

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.

People told us that they were treated with respect and consideration by their carers. People told us care workers were punctual and stayed for the agreed time. One person said "it is a very good service" another said "I would definitely recommend this service to others".

We found that the individual care needs had been assessed and care plans had been developed in a way which was intended to met people's needs.

People were protected from abuse and staff had a clear understanding of the procedure to take if there were any suspicions of abuse.

Staff members received appropriate training and were given supervision to ensure they were able to do their job and meet the needs of people using the service.

An effective complaints procedure was in place. People told us they knew who to contact if they had a complaint but never had to do so.