Uriel Care2U Limited received an overall rating of Requires Improvement at this focused inspection, with continued regulatory breaches under Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to inconsistent risk assessments and ineffective quality assurance systems. This is the fourth consecutive Requires Improvement rating, and the CQC has requested an urgent action plan and will meet with the provider to discuss improvements.
Concerns (5)
criticalCare planning: “one person who had diabetes did not have any risk mitigation plan in place around this condition to help staff take the right actions if the person fell ill.”
criticalStaff training: “Staff training records showed staff had not been trained in key areas, such as first-aid and health and safety.”
criticalGovernance: “Auditing systems had not identified the issues we found where certain risk assessments around people's health were not in place.”
moderateRecord keeping: “details of pre-employment checks were not always clearly recorded. For example, the second references for 2 staff members were not dated.”
moderateStaff competency: “Where staff wrote down the wrong answers...there was no evidence that these discussions took place. This meant there was a risk the service did not properly assess staff knowledge.”
Strengths
· Safeguarding systems and processes were in place and staff knew their responsibilities to report concerns.
· Staff recruited safely with identity checks, references, employment history and DBS checks in place.
· Infection control measures including PPE access and regular training were in place.
· People and relatives expressed satisfaction with care, describing the service as 'absolutely brilliant'.
· Service collaborated with other agencies including local authorities and multi-disciplinary teams.
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service and duty of candourGood
Uriel Care2U Limited improved in several areas since its previous inspection, resolving prior breaches related to medicines management, recruitment, training and governance, but identified a new breach of Regulation 13 due to inadequate safeguarding procedures and failure to notify CQC of two allegations of abuse. The service remains rated Requires Improvement for the third consecutive inspection, with additional concerns around consent recording and insufficient detail in care plans regarding medical conditions and nutrition.
Concerns (7)
criticalSafeguarding: “The service did not have a clear safeguarding procedure detailing the local authority's procedure. The provider didn't use the local authority's procedure for raising a safeguarding alert.”
criticalSafeguarding: “The service did not notify us of two safeguarding allegations as required.”
criticalMissed or late visits: “One person's night time and morning call were 17 hours apart which was too far apart as they were unable to use the toilet in that time.”
moderateConsent / capacity: “Senior staff understood the MCA, but had signed consent on behalf of people on several documents or typed the person's signature.”
moderateCare planning: “Three care plans stated that the person's health condition 'affects my ADLs' but gave no further explanation. This information was insufficient to inform staff.”
moderateIncident learning: “The local authority told us the registered manager did not respond to their request for further information regarding a substantiated safeguarding alert.”
minorCare planning: “There was a lack of information in people's care plans about their nutritional needs and preferences.”
Strengths
· Medicines received, stored, administered and disposed of safely; staff trained and assessed as competent to administer medicines.
· Recruitment practice had improved with criminal records checks, references and proof of identity completed for all staff.
· People described care workers as 'lovely', 'kind' and 'gentle' and were satisfied with their care.
· Staff felt well supported by the registered manager and described training as beneficial and refresher training was provided.
· The service introduced new call monitoring systems alerting management if a care worker had not arrived on time.
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and management; using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards
Uriel Care2U Limited was rated Requires Improvement overall, with Safe downgraded to Inadequate due to breaches in safeguarding, risk management, recruitment and staffing. CQC issued warning notices for safeguarding (Reg 13) and good governance (Reg 17), with further breaches of Regulations 12, 18 and 19.
Concerns (15)
criticalSafeguarding: “Systems and processes in place to report, record and investigate any potential abuse were not established and operated effectively.”
criticalGovernance: “Management oversight of the service was ineffective and did not identify the issues we found during the inspection.”
criticalCare planning: “risks associated with people's health conditions had not been assessed and documented in their care records with clear guidance for staff to follow.”
criticalMissed or late visits: “a relative raised a concern about several missed care visits which they told us had previously been reported to the management team.”
criticalStaff training: “staff had not completed training in several mandatory topics such as first aid, food hygiene, MCA and health and safety.”
criticalStaff competency: “Recruitment checks and processes were not always completed in line with procedure to ensure staff were recruited safely.”
criticalRecord keeping: “the service was not maintaining appropriate records of safeguarding concerns and CQC had not been notified of the two allegations of abuse.”
moderateSupervision / appraisal: “most staff were not being supervised regularly in line with procedure and most longer-term members of staff had not received an appraisal within the past year.”
moderateIncident learning: “Where incidents had occurred, there was no record of management oversight in order to record actions, identify trends and opportunities for learning and improvement.”
moderateMedication management: “not all staff had their competency assessed within the past year in line with national guidance.”
moderateComplaints handling: “we found the concerns had not been appropriately recorded in line with procedure.”
moderatePerson-centred care: “Care plans and risk assessments lacked details of people's individual risks, preferences and choices.”
moderateLeadership: “We were not assured of the registered manager's understanding of their regulatory responsibilities.”
moderateConsent / capacity: “not all staff we spoke to were not able to demonstrate an understanding of the MCA and records showed staff had not completed training”
minorInfection control: “not all staff had refreshed their training in infection prevention and control within the past year.”
Strengths
· Most people and relatives told us they felt safe with the support provided.
· Care staff demonstrated an understanding of their responsibility to report safeguarding concerns.
· People supported to have maximum choice and control of their lives in least restrictive way.
· People and relatives told us they were involved in planning and reviewing care.
· Staff told us they felt supported and could raise concerns with the management team.
Quality-Statement breakdown (16)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced diet
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Good
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement
well-led: Working in partnership with othersRequires improvement
Requires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportNot rated
responsive: Meeting people's communication needsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement