Unique Care Network Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed 4 quality statements in the safe key question and identified 2 breaches of legal regulations in relation to medicines, risk management and the recruitment of staff. The scores for these areas have been combined with scores based on the rating from the last inspection, which was rated as good. Peoples care records did not always contain detailed information to guide and direct staff on the delivery of care. Medicines were not always stored or managed safely. Staff were not always recruited safely. Systems were in place to safeguard people from abuse, and staff had received training. However, these systems had not always been followed to safeguard people. People were supported by the required number of staff who knew how to meet their needs. Most of the staff had received core training to enable them to fulfil their role. Systems were not in place to record and learn from safeguarding’s, incident and accidents.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us they felt their loved ones were safe. However, one relative said, “There have been times where I have visited [person] and they have had a bruise or scratch or something and staff have not always been able to tell me how this was sustained. They don’t always call me and tell me either.” Relatives told us the communication between them and staff and management could be improved. A relative said, “The communication is not always good I don’t always get feedback about [person] wellbeing, and I am unsure who the manager is.” We observed people appeared to be comfortable in staff presence and people were able to move freely around most parts of their home.

Staff confirmed they had received training in how to safeguard people from potential abuse. A staff member said, “I would report any concerns to my manager or go higher if needed.” However, we found not all concerns such as bodily markings had been fully recorded and escalated. The management team told us they were aware of their responsibilities in relation to safeguarding people. However, the management team had not always taken the appropriate action in relation to responding to potential incidents. For example, in relation to maintaining oversight of bruising or bodily markings identified on people.

Safeguarding procedures were in place; however, these were not always followed. We found a safeguarding referral had been submitted to the local authority. However, the provider had failed to ensure this was also submitted to CQC. This was addressed when raised. The registered manager did not follow their own policy to ensure all bodily markings such as bruises were fully recorded, and reviewed to ensure a rationale had been provided to how these may have been sustained. Records lacked detail and there was no management oversight of these. Audits were not completed to identify any potential patterns or trends or to address the shortfalls we found in the records.

Relatives told us they thought the current staff team knew their relative well and about the risks associated with supporting them to keep them safe. A relative said, “The current staff know [person] well, they know what to look out for, the risks and the action they need to take in event of [person] becoming unwell or anxious.” However, relatives did raise concerns about the previous inconsistencies with the staff team supporting their relatives and the impact this had on their care and their knowledge of risks. A relative told us, “The staff team has not always been consistent, there have been lots of staff changes, different staff supporting each time I call or visit. This has not given me the confidence staff know [person] well. I had to constantly remind them about things. I hope the current staff team stay and [person] continues to be supported by the same staff.”

Discussions with staff demonstrated their knowledge of any potential risks when supporting people. A staff member said, “We discuss people’s needs at handover and information is available electronically on our devices. I routinely work with [person], so I have got to know their needs and what signs to look out for to know if they are unhappy or in pain.” The management team told us people’s needs were assessed and care plans and risk assessments were implemented and reviewed regularly. However, there was limited evidence to support the involvement of people’s relatives in the development of their care plans and risk assessments.

Although care plans and risk assessments were in place, these did not cover all of people’s needs. Some risk assessments lacked detailed information to direct staff on how to mitigate some of the risks identified. For example, for one person all their medical needs had not been assessed and planned for. One person had a medical condition but the type of condition they had was not clear in their care records and the action staff should take should the person become unwell. Where people used equipment to support their mobility detailed procedures where not in place for staff to follow. Systems were not in place to maintain oversight of incidents that occurred to ensure these were reviewed and action taken to mitigate future risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives told us they were happier now their loved ones appeared to have a stable consistent staff team who knew them well and recognised risk. They had concerns previously due to staff turnover and staff not knowing people well. Relatives thought staff had the skills for their role. One relative said, “The staff appear to know what they are doing, and I presume they have received all the required training they need.” Relatives said their loved ones were supported by the required number of staff for their safety. Relatives told us about the management changes, and lack of communication from managers. One relative told us, “There have been lots of management changes in the last year and we have not always been sure who is managing the service.” Although relatives knew who the operations manager was, they were unaware who the registered manager was for the service. Relatives told us they had little contact with the registered manager and most communication was with the operations manager or support staff.

Staff confirmed there was enough staff to meet people’s needs. A staff member told us, “We are allocated to people at the start of our shift. I then work solely with that person and meet their needs.” Staff confirmed they felt supported in their roles. Staff confirmed they had employment checks completed before they commenced employment and had received an induction and training for their role. A staff member said, “I completed an induction and training is always ongoing. The training provides me with the skills for my role.” Discussions with staff demonstrated they had not completed training applicable to the needs of the people they were supporting. For example, not all staff had completed the required training in communicating with people with a learning disability and autistic people. Staff were also not familiar with current methodology for supporting people to live independently in their own home. Action was taken to address this after our site visit. The management team told us about the training they had completed for their role, and how they monitored the training needs of staff. The management team acknowledged training was not currently provided for all service user bands they were registered for. For example, people with an eating disorder. However, they were not supporting people with these needs at the time.

Recruitment procedures were in place however these were not always followed to ensure all required checks were completed before staff worked with people. We found gaps in employment for 2 staff which had not been explored with them and a rationale provided. Disclosure and Barring Service (DBS) checks were not available for 2 staff to support these had been completed prior to staff commencing employment. A reference for 1 staff member did not match their employment history. The providers training matrix indicated some areas of core training had not been completed by all staff. This included awareness of current methodology for supporting people with learning disabilities and autistic people to live independently. Action was taken to address this during the assessment. Systems were in place to ensure sufficient staff were on duty to meet the needs of people. Records showed staff received supervision and had regular meetings where they were able to discuss their roles.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff did not always follow safe medicines practices. We found staff continued administering a short- term medicine before seeking clarification from their GP. Staff were able to explain how they supported people to take their medicines safely. One staff member said, “I take the tablet to the [person] and once they have swallowed it, I then sign the medication record.” The management team told us they monitored staff practices and completed observations. However, medicine discrepancies were not always identified in a timely way.

Medicines were not always stored in accordance with manufacturers instructions. We found the temperature of the storage unit some medicines were stored in was not monitored. Stock balances of medicines were not always accurate with what had been administered. Codes that were used on the medicine record where not always explained to state why a person may not have been administered their medicines. Some people required ‘as needed’ medicine but staff did not always have clear written guidance on how this should be administered. For example, guidance on how someone would indicate they were in pain. Although checks were undertaken on a weekly and monthly basis these did not identify the shortfalls we found. There were body maps in place to guide staff on where prescribed creams should be applied. These creams and bottled medicines were dated when these were opened for use in accordance with good practice.