The previous inspection took place in November 2016. The overall rating from that inspection was requires improvement. This announced inspection took place on 11, 13 and 14 June 2018. This is the second consecutive time the service has been rated Requires Improvement.

At the last inspection on 23 and 25 November 2016, we made recommendations for the provider to make improvements in record keeping in relation to safeguarding investigations. We also raised concerns as meetings between staff and managers were not always documented.

During this inspection we found records related to safeguarding concerns were up to date, however we had concerns related to a lack of knowledge and understanding of staff regarding the correct safeguarding procedure to follow. Records related to meetings between staff and managers were in place, however, the frequency of these meetings was not in line with the providers policy.

This service 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, younger disabled adults and children. At the time of our inspection it was providing care to 218 people.

Not everyone using Universal Care – Beaconsfield 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.

The service had a registered manager in place. 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, their relatives and professionals were generally very positive about the service provided.

However, we had concerns about the safety of the recruitment system for employing new staff as not all relevant checks had been undertaken.

Care plans and risk assessments did not all contain relevant up to date and accurate information. This placed both people and the staff at risk of harm or injury.

Medicines were not safely managed, staff did not always receive up to date training and their competency was not always assessed. There were no effective medicine audits in place to protect people from harm.

People were not always protected from the risk of abuse, as staff training was not regularly up dated. Staff were not aware of how or who to report concerns of abuse to.

Training for staff was not comprehensive, and did not cover the areas they required to carry out their role. Support for staff through one to one supervisions and spot checks were not carried out in line with the provider’s policy.

The service was not compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People were not assisted to have maximum choice and control of their lives. There was a lack of training for staff and understanding by senior staff, to protect people from receiving inappropriate care.

People and their relatives described staff as caring, patient, and helpful. They gave us examples of how staff had gone above the call of duty to them.

The provider had failed to assess the service in relation to people with protected characteristics. They were not able to evidence how they were compliant with the Accessible Standards Framework. We have made a recommendation about this in the report.

People told us the staff protected their privacy and dignity when carrying out personal care.

The provider’s documentation showed how they appeared to respond appropriately to complaints, this was not always the view of the complainant. Staff were not sure how to respond to complaints, and they had received no training in how to do so. We have made a recom

We undertook an announced inspection of Universal Care Beaconsfield on 23 and 25 November 2016.

Universal Care provides a range of services to assist people in their own homes. Support ranged from day to day assistance and the provisions of personal care for people. On the day of our inspection 269 people used the service.

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.

People and relatives told us they felt people were safe. Staff understood their responsibilities in relation to safeguarding people. However the provider had failed to act timely to gain assurance that staff understood their responsibilities when they could not access people’s homes.

Staff had received regular training to make sure they stayed up-to-date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified. People received their medicine as prescribed.

People benefitted from caring relationships with the staff. People and their relatives were involved in their care and people’s independence was actively promoted. Relatives told us people’s dignity was promoted.

Where risks to people had been identified risk assessments were in place and action had been taken to manage these risks. Staff sought people’s consent and involved them in their care where ever possible.

There were sufficient staff deployed to meet people’s needs. The service had safe recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People were supported with their nutrition and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

People and relatives told us they were confident they would be listened to and action would be taken if they raised a concern. The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care. However the provider had not adequately managed a recent safeguarding incident as their investigation was not robust.

Staff spoke positively about the support they received from the registered manager. Staff supervision and other meetings were scheduled as were annual appraisals. Staff told us the registered manager and their managers were approachable and there was a good level of communication within the service. However, meetings were not always recorded to enable the provider to ensure areas raised were addressed and recorded.

Relatives told us the service was friendly, responsive and well managed. Relatives knew the registered manager and staff and spoke positively about them. The service sought people’s views and opinions but did not always act on them. However, people told us they did not always have the opportunity to provide feedback on the service provided.

We have made a recommendation that the provider review their action plan following the safeguarding incident to ensure all actions have been taken to ensure people are safe when care workers are unable to access people’s property.

A single inspector carried out this inspection. When we visited the service 24 February 2014 we had concerns how one standard was managed. We set a compliance action for the provider to improve practice.

The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 4 September 2014 to check if improvements had been made.

Below is a summary of what we found. The summary describes what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service effective?

We found the provider had responded to our concerns around staff support. We found staff were now receiving regular supervisions in line with the providers policy. A new training and recruitment manager had been recruited which allowed care managers time to undertake effective supervisions. We were provided with a new training policy which outlined which core training needed to be refreshed and how often. The provider was in the process of undertaking this requirement.

This meant the service was effective.

We received feedback from 21 people who used the service or their relatives. People described a high level of satisfaction with the standard of care provided. They told us care workers arrived at the time they expected them and stayed the required length of time. People reported good continuity of care, with the same team of care workers supporting them. They said they would communicate directly with the office if they had any concerns. Those people who had done so said any concerns had been addressed satisfactorily. Comments included “What they do for me is very satisfactory,” “No problems at all,” “Excellent,” and “My carers look after me very well.”

We found people’s needs were assessed and care was planned and delivered in line with their individual care plan. Care plans were in place for each person who used the service. We looked at a sample of seven people’s care plans. These showed people’s needs had been assessed and the support they required was identified. Risk assessments had been completed in each file we read and ensured care was delivered in a safe manner.

There were effective recruitment and selection processes in place at the service. We looked at four staff recruitment files. Each file contained the necessary checks and clearances. This ensured staff had the right skills and experience and were suitable to work with vulnerable people.

Staff had not consistently received the support they required. Records showed staff completed a structured induction which gave them a good foundation into the work they undertook. The core training needs for staff had not been identified subsequent to their induction. This meant staff did not have the opportunity to update and refresh their skills, to take account of changes to good practice.

We found variations to the pattern and frequency of staff supervision and appraisals. This meant staff had not received routine evaluation of their performance and development needs, to ensure they supported people appropriately.

The provider had an effective system to regularly assess and monitor the quality of service that people received. A satisfaction survey was conducted in 2013 by an external organisation. The findings of the survey were positive and showed the service had provided a high level of care most of the time, in people’s experiences.

People’s care needs had been assessed before a service was provided. This ensured the service was able to meet those needs. Care records addressed people’s individual care needs and the service to be offered. Care staff had the knowledge and skills required to provide a service which met people’s needs and enabled people to live as independently as possible in their own homes. The people we spoke with told us staff maintained good timekeeping, provided care and support as outlined in the care plan, maintained good relations with the person using the service and their families and took account of people’s wishes.

The people we spoke with expressed a good level of satisfaction with the service. They said it met their needs very well. Care staff provided good support and paid attention to detail. They said they had no concerns about the safety of their relative when receiving care from the service. Some people reported having had problems in communication with the office on occasions but those had not affected their overall favourable opinion of the care provided.

We found the service had arrangements in place to provide the care and support people required. Staff acted in accordance with people’s wishes. The service had procedures to protect people from the risk of abuse. People were looked after by staff who were appropriately trained and supported. The provider had arrangements for monitoring the quality of the service provided to people.