The inspection site visit took place on 25 September 2018 and was announced. This service is a domiciliary care agency. It provides personal care to adults living in their own homes. One hundred people were receiving the regulated activity of ‘personal care’ at the time of our inspection visit. The site visit was carried out by one inspector.

At our previous inspection in June 2018, we found breaches in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. We found breaches of the regulations related to managing risks to people's safe care and treatment. We gave the home a rating of Requires Improvement in all the key questions and served the provider with a Warning Notice. The overall rating of the home was ‘Requires Improvement.’ This inspection was focused on the key questions of safe and well led and to check the provider had implemented the required actions for improvements to be made to met the regulations.

Following our feedback to the provider at our last inspection, the provider agreed to cease the acceptance of new people’s packages of care. The provider told us they wanted to focus on improvements needed, and this was their priority. Since our last inspection, the provider has sent us information about their progress in implementing the required improvements. We have been monitoring the service since our last inspection.

There was a registered manager in post. Following our last inspection in June 2018, a manager from another Universal Care Services branch, had registered with us to also be manager for the provider’s Coleshill branch. The provider had informed us this was on a temporary basis, whilst a new manager was recruited. At this inspection, a new manager had been recruited for the Coleshill branch and was in the process of applying to become registered with us.

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 this inspection we found the required improvements had been made and met the standards of the regulations. However, some people had continued to experience missed care calls. The provider had further improvements planned for; with an emphasis on call monitoring to ensure people consistently received their care calls at the agreed times. The rating continues to be ‘Requires Improvement.’

Overall, people received a safe service though some late and missed calls had occurred since our last inspection due to human error. The provider's planned enhanced improvements to their call monitoring system was due to commence in October 2018 as agreed with the commissioning local authority. We were therefore unable to assess the effectiveness of this during this inspection.

People's medicines were handled safely by trained staff. Staff felt improvements that had been made, by the provider, to the information they had about people’s medicines, made it safer for them to support people with their medicines.

Actions were taken to mitigate the risks of harm or injury to people. Staff had received further training and knew how to identify potential risks to people and how to escalate these to management so concerns could be acted upon. Risk management plans were more detailed and reviewed when needed.

Care staff understood the importance of recording accidents and incidents and now had forms readily available to them. These were completed when needed.

Staff continued to be safely recruited and trained in how to safeguard people from the risks of abuse. The new manager and registered manager; covering the branch, each understood their role in reporting safeguarding concerns as required to the CQC and local safeguarding authoriti

The inspection site visit took place on 18 June 2018 and was announced. This service is a domiciliary care agency. It provides personal care to adults living in their own homes. One hundred people were receiving the regulated activity of ‘personal care’ at the time of our inspection visit. The site visit was carried out by two inspectors.

The service did not have a registered manager. However, a manager from another Universal Care Services branch, who is registered with us for the Corby branch, was covering at Coleshill. This manager has applied to become registered with us for Coleshill as well, though on a temporary basis, whilst a new manager is recruited.

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 the service was rated ‘Requires Improvement’ overall, with the safety of the service being rated 'Inadequate.' We identified four breaches of the regulations. The breaches of the regulations related to medicines not always being administered safely and as prescribed. The provider had not always recorded or acted on complaints received about the service. The provider had not ensured there were enough skilled and appropriately trained staff to meet people’s needs safely. The provider had not ensured staff were properly deployed to meet people’s needs safely. The provider had not planned appropriately to ensure an expansion of the service could be safely managed. Systems designed to check on and improve the quality of the service were not used. People, relatives and staff did not feel well supported by the provider.

We asked the provider to send us a report that said what action they were going to take to make improvements. A detailed report was sent to us and we have been monitoring the service since our last inspection.

At this inspection we found some improvements had been made, though these were insufficient to meet the requirements of the regulations. We identified two continued breaches of the regulations. The overall rating given to the service continued to be Requires Improvement.

People, relatives and care staff felt some improvements had started to be made from February 2018 onwards, when a new management structure was put into place by Clece Care. Most people told us there was greater consistency with the care staff that undertook their care calls now. People and their relatives gave us mostly positive comments about their care staff. Staff felt more able to raise issues with the manager and deputy manager than previously. However, further improvements were needed in all areas. People, relatives and staff were in agreement further improvements were needed and many comments made to us focused on office staff and their role, such as communication, needed improvement.

There was some improvement with systems that checked the quality of the service provided to help it improve now being in place and used. However, these were not always effective. The provider had not ensured staff undertaking audits had the necessary skills to implement improvements when actions needed were identified.

Some improvements had been made to the systems designed to ensure safe administration of medicines. However, these improvements had not been fully implemented to everyone supported by care staff with their medicines. Some people did not have the new, improved medicine administration record. This meant some people continued to be at risk from medicines not always being administered as prescribed because their administration record was not detailed. Some medicine records had signature gaps and action had not been taken to ascertain whether the medicine had been given or not.

People’s needs had been assessed, however

This inspection took place on 7 September 2017.

Universal Care Services Coleshill provides domiciliary care to people in their own homes. At the time of our inspection, 187 people were supported with care.

The service did not have a registered manager. 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. A new manager had been recruited, and the provider assured us an application to ‘register’ the manager with CQC would be made as soon as possible.

The service was last inspected on 28 April 2016, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last inspection the service was rated ‘good’ overall. At this inspection we found improvements were required.

People were not supported by consistent staff, experienced missed care calls, and care calls that did not take place at the times agreed in their care plans. They also received calls that were reduced in length and did not ensure their needs were met.

People did not always have their medicines administered safely and as prescribed. There were gaps in medicine administration, and mechanisms in place to record and audit when medicines were given were not effective which put people at risk.

People and their relatives told us they felt safe with the regular staff who supported them. Staff received training to safeguard people from abuse and understood what action they should take in order to protect people from abuse. However, staff did not always feel supported by the provider, and were not confident action would be taken if they reported concerns.

Risks to people’s safety were identified but risk assessments did not always give staff who were unfamiliar with the people they supported, enough information to ensure risks were managed consistently.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. People’s care records included some information on the support they needed with decision making. Staff and the management team did not always have a good understanding of the Mental Capacity Act (2005).

Newly recruited staff did not always receive an effective induction to the service, and we could not be assured that either new or experienced staff had their competence and skills checked by the provider to ensure they remained effective in their roles. Staff had not had the opportunity to attend individual meetings to discuss their work since the previous manager left in May 2017.

People and relatives told us their regular care workers were respectful and treated people with dignity, kindness and respect. However, they told us the provider and office staff did not always respond to them in respectful, caring ways and that communication was not effective. People did not always receive care that was in line with their choices. People’s privacy was maintained.

People’s care records were not always up to date and did not always give staff key information they needed to respond to people’s needs consistently.

People and relatives told us they felt concerns raised by them were not taken seriously and not dealt with effectively. Complaints records kept by the provider did not reflect the nature or volume of complaints and concerns received.

Systems which checked the quality of the service provided to help it improve were not being used. The provider did not ensure staff had the opportunity to meet to share good practice, and did not ensure staff performance was assessed regularly to check they remained competent in their roles.

People, relatives and staff were not suppor

This inspection took place on 28 April 2016.

Universal Care Services Coleshill provides domiciliary care to people in their own homes. Some people required 24-hour care. At the time of our inspection, 93 people were supported with care.

The service had a registered manager. 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 and their relatives told us they felt safe with the staff who supported them. Staff received training to safeguard people from abuse. They were supported by the provider, who acted on concerns raised and ensured staff followed safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were identified and staff were aware of current risks, and how they should be managed.

People were administered medicines by staff who were trained and assessed as competent to give medicines safely. Records indicated people’s medicines were given in a timely way and as prescribed. Checks were in place to ensure medicines were managed safely.

There were enough staff to meet people’s needs effectively, and people told us they had a consistent and small group of staff who supported them, which they appreciated. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived in their homes.

People told us staff asked their consent before undertaking any care tasks. Where people were able to make their own decisions, staff respected their right to do so. Some people’s ability to make their own decisions fluctuated, and there was not always detailed information on this. However, staff and the registered manager had a good understanding of the Mental Capacity Act.

People and relatives told us staff were respectful and treated people with dignity, kindness and respect. People’s privacy was maintained. People were supported to make choices about their day to day lives. For example, they were supported to maintain any activities, interests and relationships that were important to them.

People saw health professionals when needed and the care and support provided was in line with what they had recommended. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences. Some care plans were updated with the most recent information and were detailed, others were not. The registered manager was aware of this and was working on ensuring all were updated. People were involved in how their care and support was delivered, as were their relatives if people needed and wanted them to be.

People and relatives told us they felt able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the registered manager and senior staff were approachable and responsive to their ideas and suggestions. There were systems in place to monitor the quality of the support provided, and the provider regularly sought feedback from people and their relatives with a view to improving the service going forwards.

This inspection was completed by one inspector. We visited the office of Universal Care Service Coleshill. We were told the service supported 45 people and employed 22 staff (including the manager and office staff). We looked at records and spoke with the manager, nominated individual and three staff. The day after our visit we spoke by phone to a further three staff and eight people who used the service. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

The service was registered in 2013. This was its first inspection. The service is managed by Laura Simmonds. The other manager identified at the front of this report now works for a different Universal Care service. They have yet to cancel their registration.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person told us, “I feel safe, I trust them.” The staff we spoke with understood they needed to report any concerns about a person’s safety to the manager. The manager was clear about their responsibilities to report any safeguarding concerns to social services.

People’s records were up to date and reflected people’s current health needs. We saw risk assessments were in place and provided appropriate guidance for staff to follow. We also found care reviews had been completed when required.

Staff records showed recruitment procedures were robust in ensuring staff were safe to undertake care work. Records showed staff had received in-depth training to ensure they supported people safely. Staff we spoke with confirmed this was so.

Is the service effective?

People told us the care they received met their needs. One person told us, “They do what they’re supposed to do. They do a wonderful job.” Another person said, “It’s been smashing, sometimes they do more (than they are expected to do).”

It was clear from speaking with the manager, their senior team and with staff, that staff had a good understanding of how to meet people’s care needs.

Records showed people’s care needs were regularly reviewed and care plans updated to reflect any changes.

Is the service caring?

All people with spoke with told us staff were caring. One person told us, “I never realised there were so many nice people in the world – it’s changed my opinions of youngsters.” Another person said, “The care workers are very good…they treat me with respect.” A third person said, “If I’m a bit down, they talk to me and jolly me along.”

Is the service responsive?

People told us the manager was responsive to any queries or concerns raised. One person told us they had not been happy with a member of staff and this had been dealt with quickly. Another person told us when they first started using the service they were not happy with the time the care workers called in the morning. They told us this was sorted out and care workers came at the time they preferred. This meant the manager responded quickly to people’s comments.

We saw there had been no formal complaints made about the service.

Is the service well-led?

People we spoke with told us they felt able to contact the manager about their care and the manager would deal with any of their issues quickly and effectively.

Staff we spoke with told us they thought the manager was approachable and provided good support. We saw by looking in staff files that staff received regular formal supervision to support them with their work.

We saw staff received appropriate training to provide safe and effective care.

We looked at quality assurance systems. We saw the service had recently collated its annual customer service feedback results. These showed people using the service were very satisfied with the level of care and support provided.