Unicorn Healthcare Services

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Consent was not always sought for the care and treatment of people. Capacity assessments had not always been completed if a person’s capacity was doubted and where a person lacked capacity the provider did not always act in accordance with the Mental Capacity Act (2005). For example, best interest meeting were not held for people who had restrictions placed on them for medicines, leaving their house and supervision in the community. This was a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The service did not promote evidence based practice and staff lacked training and knowledge to support people. Action plans were not always delivered in the time frame agreed and actions were not adequately completed. We saw no evidence the provider or registered manager had been involved in multi-disciplinary meetings or care reviews, which meant any changes in peoples needs was not always updated and current in support plans. We saw no evidence regular reviews of people’s care had taken place.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not always have the right information in the care records to give staff direction to care for them safely. One person record stated he had a stoma fitted and the registered manger confirmed this was not correct.

Staff we spoke to said they could meet the needs of the people they looked after because they knew them well but there was no guidance in the form of updated care plans or risk assessments to give them any direction.

Although people’s needs were identified at their initial assessment, they did not have adequate support plans and risk assessments in place to support staff to care for people safely. People’s support plans and risk assessments were not routinely reviewed which meant people did not always receive care which met their current needs.

People were not always involved in the monitoring of their care to support and improve their outcomes. Some people told us they had never seen a care plan or risk assessment. However, some relatives we spoke with told us they were involved in the initial assessment and support plans.

The registered manager told us all monitoring tools for pressure care, food and fluid, etc were kept in a person’s home. However, the registered manager did not review them to ensure people were receiving care and support as required. One staff member said, “We only do on-line training the company don’t want you to do anything else.”

The provider did not always offer care and treatment that was evidence based and in line with good practice guidance. Monitoring tools gave conflicting information which meant people were not always provided with the right support for their assessed needs. The provider and registered manager did not have a process in place whereby they could detect changes in a person’s presentation and adjust care accordingly or refer on to other agencies.

People told us staff give them information about their care. However, if different carers came to support them, they did not provide care as consistently as the regular carers.

Staff told us they do not work well with other professionals as they do not receive any information from them. If people’s needs change the carer would inform the registered manager, however nothing would not get updated.

The provider did not always submit safeguarding concerns and follow support and guidance from external agencies. Action plans required were not always delivered on time or the actions within them were not always adequately completed.

We saw no evidence of the provider being involved in multi-disciplinary meetings or care reviews. Support plans did not include any recommendations from other professionals such as district nurses and social workers. One person was subject to 117 reviews, and we saw no evidence this had taken place even though the family informed us the carer was present for the review.

People were not involved in regular reviews about their health. However, relatives told us carers would contact them if they had any concerns about the person they were caring for.

Staff told us they would encourage people to make healthy choices but there was no guidance or support to improve outcomes for people.

There was no process in place to complete regular reviews of people’s care. We saw no evidence of annual reviews or health checks. We requested the registered manager send us copies of annual reviews they have completed, none were provided to us.

Care was not always reviewed for people to improve their outcomes. One relative said, “I had to initiate a care review so we could see how to improve things for [Person’s name] otherwise they would have never had one.”

We were unable to review any monitoring charts due to them not been provided by the registered manager, we could not be assured people were receiving care in line with their needs.

The provider had not completed any audits to capture the experiences of people to improve the quality of care delivered and the outcomes for people.

People had restrictions placed on them without their capacity been assessed or any best interest meeting held. It stated on one person’s initial assessment they did not have capacity, however there was no documentation in place on how they had come to this decision.

Some staff lacked understanding around the implications of the Mental Capacity Act (200). The registered manager accepted restrictions which were placed on people by relatives who did not hold a Lasting Power of Attorney for health and no capacity assessment was completed.

We found the service was not always working within the principles of the Mental Capacity Act (2005). People were not always involved in decisions about their care and best interest decision were not in place to support the least restrictive practices. Some people had medication in locked cupboards, however there was no consent gained or capacity assessment and best interest meeting to support this decision.