About the service: Unique Care Network Limited is registered to provide the regulated activity of personal care. This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults and younger adults. People had needs that related to old age and could include dementia, health conditions, and/or a physical disability. There were 43 people using this service at the time of our inspection.

People’s experience of using this service:

The provider had not progressed to ensuring everyone's care plan and risk assessment had been reviewed. This meant not everyone had an accurate and up to date care plan with guidance to ensure people were safe. There had been some improvements since our last inspection in putting management plans in place to reduce risks to some people. However, this did not provide assurance that risk management processes would ensure everyone received safe and appropriate care.

At our previous inspection the provider lacked knowledge about safeguarding procedures. At this inspection we saw they still did not understood their responsibilities for keeping people safe, or for sharing information with other agencies. Staff were up to date with safeguarding training and knew how to report any concerns about people’s safety.

Improvements had not been made in the recruitment of staff. The provider had not ensured safe processes were followed. Two staff had been recruited without reference checks to determine their suitability.

Some improvement had been made in relation to scheduling care call times. The provider had implemented an electronic scheduling system which we saw planned call times and monitored the duration. This also included travel time for staff between calls. However, this was in the early stages and only in place in one geographical area. Some people told us they continued to have late calls.

Quality assurance continued to be ineffective and did not pick up on the issues identified at this inspection. These included concerns with sharing potential safeguarding incidents and recruitment checks. Systems and processes were not yet in place to show how the provider was assessing, monitoring and mitigating risks. Whilst records were being reviewed, the provider did not have a system for auditing these. Leadership within the service remained unclear, roles and responsibilities were not defined. Management meetings were not recorded and there was no recorded agenda of the improvements needed or the progress being made.

The registered provider continued to lack knowledge around the regulations and legislation. They had not notified us of two incidents which they are required to do. Post inspection they used the wrong notification reports.

Rating at last inspection: The service was last rated Inadequate on 18 and 21 January 2019 and placed in special measures.

Why we inspected: This was a planned focused inspection based on previous rating of inadequate and the requirement to re inspect services placed in special measures.

Enforcement

We identified a continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and governance. We judged that the breach in safe care and treatment remains as at this inspection there was evidence that sufficient progress had been made with regard to risk management processes within the service. In addition we identified a breach in relation to staff recruitment. The provider has also a breach in relation to seeking people's consent to care and support which was not assessed at this focused inspection.

Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We will continue to monitor the service as per our inspection programme.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This announced inspection was undertaken on 18 and 21 January 2019. We informed the provider 24 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Unique Care Network Limited is registered to provide the regulated activity of personal care. This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults and younger adults. People had needs that related to old age and could include dementia, health conditions, and/or a physical disability. There were 45 people using this service at the time of our inspection.

At the last inspection in March 2017, we judged the service as requires improvement in all five key questions of safe, effective, caring, responsive and well-led and we rated the service requires improvement overall. We also imposed requirement notices for three breaches of regulations because the provider's governance system of checks and audits continued to require further improvement. In addition, the provider had not adhered to safe recruitment procedures. We issued a fixed penalty notice because the provider failed to display their last rating of May 2016 on their website.

The provider was also the registered manager and they were present during our 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.

At this inspection in January 2019 we found the provider's system of checks and audits remained ineffective. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had been made to the systems and processes to audit and monitor the quality of care provided and to meet the Regulations. We also identified additional concerns and breaches of regulations. As a result, the service has been rated as inadequate.

We are considering what further action to take.

As we have rated the service as inadequate, the service will be placed in 'special measures'. Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider's registration of the service, it 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 act 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.

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. 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.

People were not consistently protected from potential harm due to the provider failing to recognise, report and notify the appropriate safeguarding authorities of potential safeguarding concerns. Risks to

This announced inspection was undertaken on 01 March 2017 by one inspector.

The provider is registered to deliver personal care and support to people in their own homes in the community. The provider told us that 22 people were using the service at the time of our inspection. People had needs that related to old age and could include dementia, a variety of health conditions, and/or a physical disability.

The provider was also the registered manager and they were present during our 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.

At our inspection of June 2015 we found that the provider was in breach of the law regarding the quality monitoring of the service as the processes in place were not adequate. At our inspection of April 2016 we found that the quality monitoring of the service had improved to the extent that there was no longer a breach of the law. However, we found that some more improvement was required to ensure that the service was run adequately and safely. At this, our most recent inspection, we found that the quality monitoring had not improved as issues that we found had not been identified by the provider.

Medicine systems had not sufficiently improved since our previous two inspections when we found that improvements were needed to prevent any potential risk of errors and ill health to people who used the service. Staff recruitment processes had not improved since our previous inspection to ensure that all staff checks were carried out in a timely manner to prevent any risk of unsuitable staff being employed. The current staff/ staffing levels had not prevented some late or missed calls. People and their relatives confirmed that there had not been any experiences of abuse. Staff had received safeguarding training and knew how to report any concerns they may have.

People and their relatives had mixed views about the effectiveness of the service. Their views varied from good to feeling that some improvements were needed. Staff felt supported in their job roles on a day to day basis. However, annual appraisal systems were not used. Staff had received the training they required to them to be able to carry out their work. Staff ensured that they received consent from people prior to support being provided. People’s medical needs could be met where this was required.

Complaints procedures were available but not in different methods that could make them easier to understand or read. Complaints had been looked into but there was no on-going analysis to determine patterns, trends or learning. Systems to determine people’s satisfaction with the service had not been widely used. People’s needs had been assessed and reviewed to ensure information was appropriate and current.

Audit processes had failed to identify issues that they should have done to ensure a safe, well-led service. The provider had failed to display their last inspection rating on their website as they must do by law. People and their relatives confirmed that they knew who the registered manager was and were familiar with him.

You can see what action we told the provider to take at the back of the full version of this report.

This announced inspection took place on 4 April 2016 and was carried out by one inspector.

The provider is registered to deliver care and support to people in their own homes in the community. 13 people received a service on the day of our inspection. People’s needs related to old age, health conditions, and/or a physical disability. The majority of people lived with a family member, or had input from a family member.

At our last inspection in June 2015 we found that the provider was in breach of the law regarding the quality monitoring of the service as the processes in place were not adequate. Since that time because of concerns the local authority who contract with the service suspended new placements. The local authority has lifted the suspension with an agreement that they will not fund more than ten care packages at any time. We found that the quality monitoring of the service had improved to the extent that there was no longer a breach of the law. However, we found that some more improvement was required to ensure that the service was run adequately and safely.

The provider was also the registered manager and they were present during our 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.

Medicine systems had improved since our last inspection of June 2015 however, further improvements were needed to prevent any potential risk of errors and ill health to people who used the service.

Staff recruitment processes had also improved since our last inspection of June 2015 but more improvements were needed to ensure that all staff checks were carried out in a timely manner to prevent any risk of unsuitable staff being employed.

People and their relatives that we spoke with told us that the service was good. They also told us that they felt safe. People and their relatives confirmed that there had not been any experiences of abuse.

Staffing was adequate to provide a consistent service and people who used the service described the staff as being nice and kind.

The registered manager/provider as at our previous inspection knew that they needed to recruit staff on an on-going basis to ensure that they had enough staff to meet people’s needs. Staffing levels were not placing people at risk of not receiving the care and support they needed or at the right time.

Staff told us that they felt supported in their job roles on a day to day basis. The registered manager/provider told us that some improvement was needed as staff supervision had not always been frequent and formal staff meetings had not been held.

Staff had not received training in relation to the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguarding (DoLS) which would give them a greater in-sight to ensure there was no possibility of people being unlawfully restricted.

We found that a complaints procedure was available for people to use. People and their relatives told us that they were confident that any dissatisfaction would be looked into or dealt with.

Our inspection took place on 22 June 2015. It was the first inspection we had carried out of this service as the provider, although registered before that time, had only started to deliver care towards the end of 2014. The provider had a short amount of notice that an inspection would take place. This was because the office of the service was not always open. We needed to ensure that the registered manager/ provider would be available to answer any questions we had or provide information that we needed.

The provider is registered to deliver personal care. They provide care to people who live in their own homes within the community. At the time of our inspection 11 people received personal care from the provider. All people of the people who used the service lived with a family member.

The provider was also the 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.

The registered manager/provider was not up-to-date with what was required of them regarding the law. The provider told us that they had not consistently carried out medicine audits and the audits and checks they had undertaken had not been recorded.

All people and their relatives that we spoke with told us that the service was good. They also told us that they felt safe and this was confirmed by their relatives. People who used the service described the staff as being nice and kind.

The registered manager/provider knew that they needed more staff. However, staffing levels at the time of our inspection were not placing people at risk of not receiving the care and support they needed or at the right time.

We found that a complaints procedure was available for people to use. People and their relatives told us that they were confident that any dissatisfaction would be looked into or dealt with effectively.

Staff told us that were felt adequately supported in their job roles. However, the registered manager/provider told us that they were aware that some improvement was needed as the supervision and involvement of staff was lacking.

Although staff had some understanding, their knowledge was limited regarding the legalities of the Mental Capacity Act and the Deprivation of Liberty Safeguarding (DoLS).

We saw that there were systems in place to protect people from the risk of abuse but these were not always followed.

You can see what action we told the provider to take at the back of the full version of the report.