About the service:

Universal Care Agency Ltd is domiciliary care agency which provides support and personal care to people living in their own home. Not everyone using Universal Care Agency received 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 take into account any wider social care provided. At the time of our inspection sixteen people were receiving a regulated activity from the service.

People’s experience of using this service:

People told us they were happy being supported by staff from Universal Care Agency Ltd. They told us their needs were met in a personalised way by staff who were kind and caring. People also told us they felt their rights were upheld, they were empowered to make their own choices and were involved in the development of their care plans. However, we identified significant concerns with the leadership and management of the service.

The provider did not have any oversight of the day to day operations of the service and had not acted promptly when an allegation of abuse was made. Governance arrangements and quality assurance systems were not robust. The manager had not used effective systems to carry out quality monitoring and was out of touch with a number of key areas of the service.

The service met the characteristics of Requires Improvement in four areas and Inadequate in one area. More information is in the full report.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 17 April 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Enforcement:

The provider was operating from a location that was not registered with the Care Quality Commission. During the inspection, we visited an office of the address 141 Albert Road, Southsea and found that regulated personal care activity was being managed directly from this address. We are currently taking action to address these issues in line with our enforcement policies and procedures.

Two breaches of regulatory requirements were identified at this inspection. We are currently considering our regulatory response. Full information about CQC's regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Universal Care Limited 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 older adults, people living with dementia, mental health impairments, physical disabilities, sensory impairment and younger adults. The domiciliary care agency office is situated within the Cosham area of Portsmouth.

This inspection was undertaken on the 6 and 12 March 2018. Not everyone using Universal Care Limited 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 take into account any wider social care provided. At the time of the inspection 18 people were receiving a personal care service from Universal Care Limited.

This service was in Special Measures as the well led section of the report had been rated inadequate following two consecutive inspections. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and it is therefore no longer rated as inadequate overall or in any of the key questions. Therefore, this service has now been removed from Special Measures as per CQC’s Special Measures Policy.

Following the inspection in May 2017 three breaches of regulations were identified. At this inspection we found action had been taken to become compliant with these although further work was required to ensure the newly introduced quality assurance procedures were embedded in practice and identified all areas for improvement we found during the inspection.

The service did not have a registered manager at the time of the inspection. 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 appointed a person to manage the service who had applied to become registered with the Care Quality Commission. Their application was being assessed at the time of the inspection.

Some risks to people had been individually assessed and risk management plans were in place to mitigate these risks. However, records did not show that these had been reviewed and these did not cover all risks which had been identified during the assessment process.

At the time of the inspection staff were not administering oral medicines to anyone. Where staff were prompting people to take medicines recording systems were not in place. We have made a recommendation that the service follows best practice guidance and introduces appropriate recording tools for the administration and prompting of medicines including prescribed topical creams.

We received positive feedback from people about the service. People who used the service expressed satisfaction and spoke highly of the staff and provider’s representative. All the people and family members who were asked if they would recommend the service to others said they would.

People and their families told us they felt safe. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people in their own homes. There were sufficient numbers of care staff to maintain the schedule of visits and ensure a high level of continuity for people. Staff completed an induction programme and were appropriately supported in their work. Staff had received relevant training and arrangements were in place to refresh this regularly.

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This inspection was carried out on 4 and 8 May 2017 and was announced.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults and older persons; some of whom are living with dementia, who live in their own homes. At the time of the inspection 18 were receiving support with their personal care. There were 17 care staff which included one senior care worker, one recruitment co-ordinator and one staff member that planned people’s care. There was a manager who was overseeing the day to day management of the service and a director who was also the nominated individual.

There was not a registered manager at the time of the inspection. A registered manager had not been in post since July 2016. The provider had recruited a manager who would be applying to the Commission to become the registered manager when they commenced their employment for the provider on 16 May 2017. 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.

At the last inspection in December 2016, the service was placed into Special Measures as it was Inadequate overall.

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place or keep services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection in December 2016 we found the provider did not always follow safe recruitment processes. At this inspection we found the provider continued to not follow safe recruitment practices.

At the last inspection in December 2016 we found risk assessments were completed but not always dated and did not contain all the information on how risks to people could be minimised. At this inspection we did not find an improvement with this concern.

At the last inspection in December 2016 we found staff did not receive an induction programme and did not always receive training from the provider or have their competencies checked. At this inspection we did not find any

This inspection was carried out on 5 December 2016 and was unannounced.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults and older persons; some of whom are living with dementia, who live in their own homes. At the time of the inspection there were 15 people using the service and of these 15 people eight were receiving support with their personal care. There were six care staff, two senior care staff and two staff that planned people’s care. There was a manager who was overseeing the day to day management of the service and who would be applying to become the registered manager and a director who was also the nominated individual. Both the manager and the director provided care to people.

There was not a registered manager at the time of the inspection. A registered manager had not been in post since July 2016. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Safe recruitment processes were not always followed. Checks were not always completed to ensure staff working were off good character and were fit for work. Although care staff knew how to keep people safe and could identify signs or potential abuse, systems were not in place to investigate allegations of potential abuse. Risk assessments were completed but not always dated and information on how to support people with moving and handling was not always included. Although staff occasionally arrived late to people’s visits there were enough staff to meet people’s needs.

People felt staff had sufficient skills and knowledge to care for them; however staff did not always receive an induction programme, training or supervision and appraisal. Staff and management had limited understanding of the Mental Capacity Act 2005 and how it should be used when people were deemed to lack capacity. People did not always receive timely support from an external health care professional.

People’s personal information was not always kept private. Care records were mostly personalised although inconsistent with detailing how people would l

We carried out an announced comprehensive inspection of this service on 24 June 2015. Four breaches of the legal requirements were found. Recruitment and selection procedures were not followed, robust or safe. Staff who were recruited did not have the skills, experience and appropriate training to meet people’s needs. Supervisions and appraisals were not completed for staff. Systems were not in place to identify, record, handle and respond to complaints by people and other persons in relation to the regulated activity. The provider did not have effective systems to improve the quality and safety of the service provided. After the comprehensive inspection, two warning notices were served on the registered provider and registered manager requesting that they meet the legal requirements by 21 September 2015. We also requested the provider send us an action plan for further breaches of the legal requirements. The provider and registered manager wrote to us to say what they would do to meet legal requirements in relation to these breaches and that they would meet them by 21 September 2015.

We undertook this announced focused inspection on 18 January 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Universal Care Agency Ltd on our website at www.cqc.org.uk

At the inspection on 18 January 2016 we found that sufficient improvements had been made and the provider and registered manager had met the requirements of the warning notices.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults and older persons in their own homes. At the time of the inspection there were ten people using the service. There were twelve care staff who provided care to people, a registered manager two recruitment officers and one co-ordinator who scheduled people’s care and managed staff recruitment.

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 carried out safe recruitment and selection processes before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

Staff were provided with appropriate support, induction, supervision and professional development. However staff were not always appraised.

The provider had an effective system in place to deal with complaints, but did not always deal with requests about people’s care in a timely manner.

Improvements had been made in assessing the quality of the service and monitoring of staff training, incidents and accidents.

We found the provider had made some improvements with understanding their role and responsibilities. The provider had informed the Local Authority and investigated the potential safeguarding concern; however the Commission had not been notified of a report of potential abuse.

This inspection took place on 24 June 2015. Forty eight hours’ notice of the inspection was given because the service is small and the manager was often out reviewing people's care needs and supporting staff. We needed to be sure they would be in.

Universal Care Agency Ltd is a domiciliary care service which provides care and support to adults some of whom are living with dementia, who live in their own homes. At the time of the inspection there were nine people using the service. There were 17 care staff and two staff that planned people’s care.

There was a registered manager in post at the time of the inspection. 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.

People gave us complimentary comments about the service they received. People felt happy, safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

Recruitment and selection processes were not always followed to ensure the safety of people because appropriate checks had not been carried out to ensure staff were suitable to work in a care setting.

People felt their needs were met by care staff that had the knowledge, skills, experience and right attitude to provide their care. However staff did not always have supervision and appraisal or fully complete their induction programme before working unsupervised. Training was not monitored to ensure care practice was regularly updated.

People’s experiences were listened to but the registered manager did not always identify them as a complaint and follow their procedures to monitor and learn from them.

The registered manager did not have a system in place to analyse, identify and learn from incidents and accidents. Audits had not been completed to assess the quality of the service. The registered manager was unable to demonstrate they had completed and returned their Provider Information Return. Records were not in place to ensure persons were employed safely and continually supported to provide personal care.

Care staff received training on safeguarding and had a good knowledge of how to keep people safe which included recognising different types and signs of potential abuse and unexplained bruising and marks or a change in behaviour. Environmental, manual handling and behaviour risk assessments were in place. However they were not always dated so it was difficult to tell if they were the most up to date document. There were clear procedures for supporting people with their medicines.

People said there were enough care staff to meet their needs and keep them safe. However on occasions care staff would not arrive on time. People felt this was not a big concern as they were always informed when care staff would be late.

Where people lacked capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People were supported to have enough to eat and drink and supported to access healthcare services.

People felt involved in their care planning and said care staff were friendly, polite and treated people with dignity and respect. People’s care plans were personalised and took into account their choices and preferences. People’s needs were regularly assessed and reviewed. People were involved in the assessment of their needs, and were always involved in their care planning and had choice and control over the care being provided.

Staff felt confident in raising concerns to the registered manager and were supported to question practice. Staff said management were very good, very supportive and open.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We saw the consent and agreement of people was obtained prior to care and support being provided. Care plans were developed with people who used the service. This meant people received the care and support they needed and wished for.

People who used the service were protected from the risk of infection because staff had received relevant training and there was appropriate guidance for them to follow.

People were cared for by staff who received relevant training and support. The provider had a system to regularly assess and monitor the quality of service that people received.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We spoke with relatives of two people who used the service. They expressed that they were happy with care and support provide by Universal Care Agency Ltd. They told us that staff knew how to provide the care and support in the manner their family member liked. They told us “the carers are really good, hard workers” and “we are really happy with them”. We were told that care staff always discussed what care and support was needed with the person receiving care and relatives if appropriate.

There was not an effective process in place for monitoring and planning training. The provider had an arrangement for staff to attend training at care homes. However this training was not specific to a service provided by a domiciliary care service. There was no plan for training for the forthcoming year.

We were told by people who used the service that staff were rarely late for their calls. They told us that staff contacted them if there was any reason if the care visit was going to be delayed. This was confirmed in conversations we had with members of staff.

There was a plan for quality assurance that included seeking the views of people who used the service. This was due to be implemented in December 2012.