This announced comprehensive inspection was conducted on 24 May and 21 June 2018.

Unite healthcare is a domiciliary care agency which offers care and support to people living in their own homes. The agency has an office based in Rainhill, Merseyside and employs 107 staff. The service was supporting 255 service users at the time of the inspection.

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.

The last comprehensive inspection of Unite Healthcare was carried out in February and March 2017 and was rated Requires Improvement. We had found the registered provider was in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely and quality monitoring systems were not always effective. We asked the provider to complete an action plan telling us how they would address the issues. We found that improvements had been made and the provider was no longer in breach of regulations.

Individual risks to people were accurately assessed and reviewed regularly with measures in place to manage the risks identified and keep people safe from harm.

Staff were aware of different types of abuse and how to report safeguarding incidents. Those that were reported had been done so appropriately. Staff had received appropriate training in safeguarding and were able to explain how to keep people safe from abuse - Staff were also aware of the whistleblowing policy.

Sufficient numbers of suitably trained staff had been deployed to meet people’s needs and provide appropriate support. Staff had received training in areas such as infection control, manual handling, first aid, mental capacity act and food hygiene. Staff were supported in their role with regular supervision.

Accidents and incidents were reported and recorded appropriately. They showed evidence of analysis, review and action taken where needed.

Medicines were managed safely and staff had received appropriate training in order to safely administered medication. Those responsible for administering medication had their competency levels assessed regularly.

Consent for care was not always obtained in accordance with the Mental Capacity Act 2005. However, where issues had been identified around consent the registered manager had put measures in place to address this and provided evidence of these changes throughout the inspection period.

People were supported with their nutritional needs and had access to other health and social care professionals to help maintain their health and well-being.

People receive care and support specific to their needs; care plans were person centred and based on individual needs. However not all care plans provided detailed information regarding a person’s likes/dislikes and social background. The registered manager was aware of this issue and working to address this.

Care records provided detailed information regarding the support required and at what times. However, not all calls were made at the allocated times. There was no evidence that this impacted on the care and support being provided.

We have made a recommendation regarding call times.

People and their relatives had access to information about how to make a complaint if needed; people told us they felt confident making a complaint and those recorded had been dealt with appropriately.

There were systems in place to gather the feedback of people receiving support; feedback about the service was positive.

The service had implemented an electronic care record system that allowed for daily quality monitoring of the service being provided. This system was mostly effective how

This was an unannounced inspection, carried out on 16 and 21 of February 2017 as well as 15 March 2017 following concerns received by the Care Quality Commission.

Unite healthcare is a domiciliary care agency which offers care and support to people living in their own homes. The agency has an office based in Rainhill, Merseyside and employs 130 staff. The service was supporting 300 service users at the time of the inspection.

The last inspection of Unite healthcare was carried out on 4, 5 and 8 August 2016 and the service was rated overall requires improvement.

The registered provider is also the registered manager of the service. 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 two 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 the full version of the report.

People’s needs were assessed and risk assessments were in place. People’s histories, likes and dislikes were not documented within their care plans. This meant staff did not always have essential information to offer person centred care.

We found that not all medicines were managed safely. Clear protocols were not in place to ensure these were administered and recorded in accordance with good practice guidelines. People’s allergies were not recorded on the medication administration records (MARS) or medication care plans. This meant people were at risk of not receiving their medicines safely and staff not having all the information required to keep people safe.

The registered provider had systems in place for assessing and monitoring the quality of the service however; these were not robust and effective. This meant that there was a risk that concerns would not be identified in a timely manner and people’s safety could be compromised.

People felt they could be better informed about which staff would be supporting them and when. However; people told us that staff were caring and attended to their needs. Most people said they had some support staff that attended regularly and knew them well. People told us staff had the right skills to do the job. The registered provider employed sufficient staff to meet the needs of the people they supported.

Recruitment practices were safe and demonstrated only people suitable to work with vulnerable people were employed by the service.

Staff had access to policies and procedures in relation to safe practice. All staff had received regular training in adult safeguarding and demonstrated an understanding of how they would recognise and report signs of potential abuse.

People and their families told us they had been involved in the development of their care plans. The care plans included clear descriptions of people’s preferred routines. Reviews were regularly undertaken and included the people receiving the service. Daily records were completed but did not always include essential information including the date and time of visit. Records were not consistently legible or signed. This meant that audit processes would not always be able to accurately identify when issues had occurred. This could have a potential impact upon the efficiency of any follow up action taken to address these issues.

People knew how to raise concerns or make a complaint. Records showed complaints had been fully investigated in line with the organisational policy and procedure.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw that policies and guidance were available to staff in relation to the MCA. Most staff had received training and had a basic

This was an announced inspection, carried out on 4, 5 & 8 August 2016. ‘48 hours’ notice of the inspection was given because the registered manager is often out of the office supporting staff or providing care. We needed to be sure that they would be available in the office to assist with the inspection.

Unite Healthcare is a domiciliary care agency which offers care and support to people living in their own homes. The agency has offices based in Rainhill, Merseyside and employs 65 care staff.

The last inspection of Unite Healthcare was carried out on 6 November 2013 and we found that the service was meeting all the regulations that were assessed.

The registered provider is also the registered manager of the service. 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 medication was managed satisfactorily.. However; staff failed to accurately and fully complete all areas of the medication administration records (MARS). This meant that there was a risk that they would not identify where safety was compromised and to be able to respond appropriately to concerns in a timely manner.

This was a breach 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 the report.

People’s needs were assessed including any risks. Daily records were maintained for each person. These showed that they had received the care and support as stated in their care plan. Care plans were regularly reviewed.

People had no concerns about their safety and the way they were treated by staff. There were systems in place to protect people from abuse which included training for staff and policies and procedures for staff to follow. Staff demonstrated a good understanding of what action needed to be taken in the event of a person being at risk from harm. Recruitment practices were safe and thorough which helped to ensure that suitable staff were employed at the service. People were supported by the right amount of suitably qualified staff.

Staff treated people in a caring way and spent time to get to know them. Records showed people were supported by a regular staff team. Staff had the right skills for the job and had undertaken all required training.

Staff were confident about dealing with emergency situations and they had details of people and services they could contact if they needed advice, guidance or support at any time of the day or night.

Staff received training and support to carry out their job and they were provided with additional training opportunities to further develop skills for their roles. Staff had their competencies checked and they had access to policies and procedures in relation to safe practice.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw that policies and guidance were available to staff in relation to the MCA. Staff had undertaken training and demonstrated an understanding of this. There were not any people under a court of protection order.

People had access to information about how to complain and they were confident about voicing any concerns they had. Complaints were taken seriously and dealt with in a timely way.

The registered provider had undertaken a full review of the service. There were quality assurance systems in place. Actions were being taken to address areas where practice could be enhanced, and as a result, changes were being been made to help ensure the service moved forward and continually improved.

Unite Healthcare is a newly formed domiciliary care provider.

People we spoke with who used the service were very happy with the care and support they received. A relative told us "The staff are lovely, always well presented in their uniforms and wearing their identification badge.”

Another relative told us “My family member has the same care workers for continuity of care; they feel comfortable with them all.”

We heard from relatives that their family members were treated respectfully.

We reviewed care files and found them to be of a person centred approach.

Unite Healthcare managed staffing levels appropriately and there were suitable arrangements in place to deal with foreseeable emergency cover.

Staff told us they felt well supported by their management and peers. They said they worked well as a team.