Uriel Care2U Limited

Uriel Care2U Limited is a domiciliary care agency providing personal care and support to people with varied needs including older people and people living with dementia. At the time of the inspection the service was providing personal care to 2 people living in their own homes in the local community.

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

Risks to people were not always managed consistently as certain risks associated with people’s health were not assessed. The lack of appropriate risk assessments meant people were at an increased risk of harm.

People spoke positively of the staff providing care to them. The service carried out checks to ensure only the right staff were recruited. However, these checks were not always clearly documented which affected the reliability of the relevant records.

Quality assurance systems were not always effective to ensure issues were identified and improvements were made and sustained in a timely manner.

Systems were in place to protect people from abuse. Staff were aware of their duties to report any safeguarding concerns.

Infection control measures were in place to protect people from the risk of infections.

People and their relatives were pleased with the care and support they received. They were also given the opportunity to be involved and provide feedback on their care.

The service worked in partnership with other agencies to make sure people received safe and effective care.

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 requires improvement (published 29 July 2022) and there were breaches of regulations. We issued 2 Warning Notices to the provider for the breach of regulations 13 and 17 following the inspection. 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 had met the requirements of the Warning Notices. However, due to concerns identified at this inspection, the provider remained in breach of regulations, and the overall rating for the service has remained as requires improvement.

This service has been rated requires improvement for the last 4 consecutive inspections.

Why we inspected

We undertook this focused inspection to check that the provider had followed their action plan, to confirm they now met legal requirements and to check if they had met the requirements of the warning notice we previously served.

This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. For the key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Uriel Care2U Limited on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to providing safe care and the overall management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

Due to a lack of improvement, we have requested an urgent action plan from the provider to understand what they will do to improve the standards of quality and safety. We will also meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Uriel Care2u Limited is a domiciliary care service providing personal care to adults with a range of support needs including people living with dementia. At the time of the inspection the service was providing personal care to seven people living in their own homes in the local community.

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

Risks to people were not well managed. We found significant issues with safeguarding, risk assessments, staff recruitment, training and support which placed people at increased risk of harm.

Most people and relatives told us they felt safe with the support provided. However, concerns about people using the service were not always responded to appropriately. We found instances where the local authority and CQC had not been notified of safeguarding concerns.

Management oversight of the service was ineffective and did not identify the issues we found during the inspection. Managers were not completing checks in some areas where we found concerns. We found CQC notifications had not been submitted as required.

People’s risks were not always assessed and documented in their care records with clear guidance for staff to follow. We were not assured people’s care visits were being effectively monitored.

People were not always supported by staff who were recruited safely in line with procedure.

Staff told us they felt supported. However, we found people were not always supported by staff who had been appropriately trained, supervised and had their individual performance reviewed.

We made a recommendation around managing of medicines.

We made a recommendation around managing complaints.

We made a recommendation around the personalisation of people’s care records.

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 and their relatives told us they were involved in planning and reviewing people’s care and staff understood people’s likes and dislikes.

Staff told us they could raise concerns with the management team. Most people and relatives told us they were satisfied with the service.

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 requires improvement (published 27 October 2020) and there was a breach 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 the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

At our last inspection we recommended the provider ensure people’s consent to care is properly recorded in line with MCA and at the previous inspection we recommended the provider follow best practice in relation to end of life care. At this inspection we found the provider had acted on these recommendations and some improvements had been made. At the last inspection we also recommended the provider ensure people’s medical conditions are considered when planning and meeting their needs. At this inspection we found the service had not acted on this recommendation and improvements had not been made.

Why we inspected

We carried out an announced comprehensive inspection of this service on 10, 12, 13, 14 August 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their safeguarding practice.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Uriel Care2U Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We found several breaches of regulation and issued the provider with warning notices in relation to safeguarding and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Uriel Care 2U Ltd is a domiciliary care agency providing personal care to 23 people at the time of the inspection. The service was supporting people who needed care due to their age or disability.

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.

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

The service had made improvements since the last inspection. People’s needs were addressed in care plans and risk assessments and these were more detailed than at the previous inspection. Staff understood the care plans and people using the service told us they had a copy of their care plan and said their care workers provided their care in the way they needed it.

People were supported with their medicines safely by staff who had been trained and assessed as competent to administer medicines.

Recruitment of staff had improved since the last inspection. The provider was now completing appropriate checks on staff when they were employed, to reduce the risk of employing unsuitable people.

The management of the service had also improved. The management team shared responsibilities and carried out audits more effectively. Staff felt well supported by the registered manager and said they enjoyed their work.

Staff completed appropriate training and told us they found the training helpful. Most people using the service said their care workers did their job well and understood their needs.

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. One person’s call times did not meet their needs as the gap between bedtime and getting up was too long. People were happy to receive care from the service but for some people there was no evidence they had consented to their assessments and care plans as these had been signed by staff or the person’s signatures typed in by staff.

People and relatives told us that they felt safe and were appropriately supported by the service and their care workers.

Staff were trained in safeguarding people from abuse but the procedure for reporting safeguarding concerns was unclear so there was a risk staff would not know how to raise a safeguarding alert appropriately. Allegations of abuse were acted on but not reported appropriately.

We have made two recommendations. One is to ensure people’s consent to their care is recorded appropriately and the second is to include details of how a person’s medical condition affects them in their care plans.

Rating at last inspection and update

This was a focused inspection which included checking whether the provider had met the requirements of three Warning Notices in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good Governance) and Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The last rating for this service was Requires Improvement (published 18 October 2019) and there were four breaches of regulations identified. The concerns related to the unsafe management of people's risks and medicines, poor recruitment processes, unsatisfactory training, and ineffective governance of the service. We took enforcement action against the provider in the form of three warning notices and one requirement notice. At this inspection we found improvements had been made and the provider was no longer in breach of those four regulations. However, we found a new breach of regulation 13 (Safeguarding people) at this inspection. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with them to discuss how they could improve their repeated requires improvement rating.

Why we inspected

This was a planned focused inspection based on the previous rating and included checking compliance with warning notices served at the last inspection. We looked at the key questions of safe, effective, caring and well -led at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safeguarding people and responding to allegations of abuse at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Uriel Care2U Limited is a domiciliary care agency providing the regulated activity of personal care to people living in their own homes. At the time of the inspection the service was supporting 13 people.

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.

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

The service had failed to make any improvements to the issues we identified following the last inspection.

Risks associated with people’s health and care needs had not been identified and assessed so that care staff could be provided with guidance on how to minimise those risks to keep people safe.

Medicines management and administration processes were not safe. There was a lack of clear information, guidance and records to ensure people were receiving their medicines safely and as prescribed.

The provider did not complete appropriate checks to ensure that only staff assessed as safe to work with vulnerable adults were recruited.

Care plans did not accurately reflect in detail, people’s current care and support needs. Daily records of the support people received did not match people’s support needs as recorded within their care plan.

Management oversight process in place to monitor the quality of care people received were ineffective and did not identify any of the concerns we found as part of this inspection.

Care staff confirmed that they received the appropriate training and support to carry out their role. However, records did not always confirm this, with evidence of poor training provision techniques.

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. However, the policies and systems in the service did not always support this practice.

We have made a recommendation about following the key principles of the MCA 2005 in relation to mental capacity assessments and recording best interest decisions.

People and relatives told us that they felt safe and appropriately supported by the service and the care staff that supported them.

Staff demonstrated how they would identify signs of abuse and the steps they would take to protect people from possible abuse.

Complaints were documented and responded to according the providers policy. People and relatives knew who to speak with if they had any issues to raise.

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 Requires Improvement (published 20 August 2018) and there were two breaches of Regulation 12 and 19. Issues identified related to the unsafe management of people’s risks and medicines and poor recruitment processes. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. We also continued to find further areas of concern that required improvement. This service has been rated Requires Improvement for the second time.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

During this inspection we have identified continued breaches of Regulation 12 and 19 in relation to people receiving safe care and treatment and the poor recruitment processes. In addition, we have also identified breaches of Regulation 17 and 18 around ineffective management oversight and the quality of training provision.

Please see the action we have told the provider to take at the end of this report.

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.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

This was the first inspection of the service since it was registered with CQC in January 2017.

Uriel Care2U Ltd is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to adults of any age who need care due to physical disabilities, illness or those living with dementia. Not everyone using Uriel Care2U Ltd receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service offers domestic assistance services and personal care. At the time of this inspection the service was providing personal care services to twenty-three people. In addition, a night care service and a live – in care service was provided to two people. The majority of people used Uriel Care2U Ltd for reablement, a six-week service following a hospital stay and the others had a more long-term service.

There was a registered manager in post who was also a director of the company. 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 service had risk assessments in place which covered specific areas of risk for each person, such as falls, environmental and health risks. In two files there was no environmental risk assessment and there was no risk assessment in the file for risks associated with one person’s medical condition. The registered manager told us that these were in place in people’s homes.

The service had processes in place to ensure the safe administration of medicines. We found problems with one person’s medicines records which indicated that the provider’s systems to ensure medicines were managed safely were not consistently effective. The registered manager informed us after the inspection that they had taken appropriate action to ensure all medicines records were accurate, including more frequent spot checks on the records.

The provider had not consistently followed robust recruitment processes as two staff did not have references as evidence of satisfactory conduct in their previous jobs. Other checks such as proof of identity and criminal record checks had been carried out for all staff employed.

The service carried out an assessment with people to assess their needs before confirming that the service could meet the person’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Care plans detailed people’s needs but some were written on a format which included information which was not relevant to them. People had consented to their assessment and to the service sharing information about them with other relevant professionals but some people had not been asked for their written consent to being provided with care by the service. There was no record of consent to their care plan as they had not signed it.

Care workers had appropriate training and support to enable them to deliver their roles effectively. They told us they were happy working for this service and felt well supported by the registered manager.

Staff supported people who had nutritional and hydration requirements to ensure they ate and drank well and helped them to maintain their health.

People and relatives were happy with the care staff that supported them and thought care workers were caring and respectful of their privacy, dignity and wishes.

The service had processes in place which dealt with complaints and concerns. The registered manager was making ongoing improvements to the service with support from a management team. At the time of the inspection there was no effective call monitoring system to ensure staff arrived on time to people’s homes and stayed the agreed length of time. The provider had purchased a suitable electronic call monitoring system but it was not yet working effectively.

People using the service and staff working for them gave positive feedback about the registered manager. We found two breaches of legal requirements, relating to safe care (risk assessments and medicines) and staff recruitment. You can see what action we asked the provider to take at the end of the full version of this report.