Prior to our inspection site visit, we spoke with people and staff on 23 and 24 August 2018 to gain their feedback. Our inspection site visit took place on 28 August 2018 and was announced. This service is a domiciliary care agency. It provides personal care to adults living in their own homes. At the time of our inspection visit, 244 people were receiving the regulated activity of ‘personal care.’

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.

At the last inspection, during March 2017, the service was rated ‘Requires Improvement’ overall. We found the service was not consistently responsive to people’s needs because they had not ensured staff always had the information they needed to support people in a way they wanted. Quality monitoring systems were not always effective and the service was not consistently well led.

At this inspection we found some areas of improvement had been made. However, the overall quality of services provided had not been sufficiently improved and some previously good areas had not been sustained. We found two 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. However, people felt further improvements were needed. Prior to our inspection visit, the provider had recognised improvements in the service delivery were required to ensure people received a safe, effective, caring and responsive service.

The provider had appointed a business consultant who was supporting them to introduce more effective systems to check the quality of the service provided and identify actions needed to help it improve. Many of these were ‘work in progress’ or planned for; with timescales for implementation.

People’s health, safety and wellbeing was not consistently maintained because, on occasions, some people experienced missed or late calls. Risk management plans did not always contain the information needed so that staff knew how to safely move and handle people using equipment. Staff were trained and, overall, had the skills and knowledge they needed. The effectiveness of moving and handling needed to be improved upon. Staff did not always ensure they wore their identity badge when undertaking call visits to people in their homes.

People knew how to make a complaint about the services they received when these fell short of their expectations. However, complaints were not always recorded, investigated or responded to.

The provider undertook pre-employment checks prior to staff starting work, to ensure their suitability to provide care and support to people. Staff were trained to protect people from the risks of abuse.

Staff had received training in the Mental Capacity Act 2005 and, overall, worked in line with this to promote people’s best interests. Staff gained consent before, for example, supporting people with personal care.

There were enough staff employed to undertake care calls to people and meet their individual needs, although rota care call scheduling meant care calls did not always take place at the times arranged.

People were supported to eat and drink enough and care staff left people with drinks when needed.

We found 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 the report.

This inspection took place on 15 March 2017.

Universal Care Services Nuneaton provides domiciliary care to people in their own homes. At the time of our inspection, 177 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.

The home was last inspected on 19 May 2015, when we found the provider was compliant with the fundamental standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated ‘good’ overall.

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 told us they were administered medicines by staff safely and as prescribed. However, there were some gaps in medicine records.

There were enough staff to meet people’s needs effectively. 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. People’s care records did not always include information on the support they needed with decision making. However, staff and the registered manager had a good understanding of the Mental Capacity Act (2005).

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.

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 not always up to date and did not always give staff key information they needed to respond to people’s needs consistently. People were not always supported by regular staff, and were not always informed if staff were going to be late.

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.

Systems in place to check the quality of the service provided and to help it improve were not effective. 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.

This inspection took place on 19 May 2015. The provider was given two days’ notice of our inspection. This was to arrange for staff and people to be available to talk with us about the service.

Universal Care Services Nuneaton is a large domiciliary agency which provides personal support to people in their own homes. The agency provides support to people in Nuneaton and the surrounding area, and to people in Coventry. At the time of our inspection the service was supporting approximately 180 people, and had employed approximately 70 staff.

The service has 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 using the service and staff treated them well. However, whilst people mostly received their care calls, there were times, particularly in the Nuneaton area, when staff did not come at the planned times and people were not always told staff were going to be late.

In the Nuneaton area, the provider found it challenging to recruit and retain staff to meet people’s needs. This meant people did not always receive continuity of care, as staff they were familiar with; either left the service, or were moved to support other people who used the service. The provider was recruiting new staff at the time of our visit and was looking at ways of improving staff retention rates.

Care workers understood how to protect people they supported from abuse. People and their relatives thought staff were kind and responsive to people’s needs.

Care workers received training considered essential to provide health and social care safely and to meet the needs of people they cared for. However, staff did not always record medicines given to people in the way they had been trained. Management and staff understood the principles of the Mental Capacity Act 2005 (MCA), and supported people in line with these principles.

People told us they knew how to make a complaint if they needed to; however some people were not satisfied with the way their complaints had been managed.

The management had a good understanding of the service’s strengths and areas for improvement. They had already identified some of the issues we found during our visit and started to work to make the required improvements. There was an open and fair culture which operated at the service.