Unicorn Healthcare Services

On this page

• 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

People’s needs were not always reflected in their support plans and did not give direction for staff to follow and mitigate the risks. Monitoring forms were not available to review on either day of the assessment. The provider did not provide staff with the correct personal protective equipment (PPE) and there was no evidence of competencies assessed for correct donning and doffing and wearing PPE. Medication was not administered safely. There were no ‘as and when required’ (PRN) protocols in place and staff did not sign to say they had administered topical creams. Not all staff had received medication competency assessments or refresher training for medication. People did not have medication support plans or risk assessments in place to give guidance to staff on administering and people’s preferences. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider failed to operate robust systems and processes for the safe recruitment of staff, including undertaking relevant checks and ensuring staff were of good character. The provider did not have an appropriate process in place to assess the competencies of staff before they worked unsupervised in a role. Some staff did not have an up-to-date record from the disclosure and barring service (DBS). This is a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe cared for by Unicorn Healthcare Services, however there were mixed messages from relatives, one relative said “[Person’s name] does not always get the standard of care that is required, and some carers don’t have the right training and lack knowledge.”

Staff told us they did not have team meetings and were not involved in any lessons learned.

There was no evidence of learning from safeguarding incidents or accident and incidents. The registered manager acknowledged they needed to improve in this area.

People were not asked for their views about the service and there was a lack of consistency with some carers. People told us they were not always notified if carers were not turning up, one person said, “I am given a rota, but it never works there are always changes.”

Staff told us they would involve people in changes in their care, however the management are not involved in anything and once they have done the initial assessment they do not engage or see people. A staff member said, “the company know nothing about the people we care for they do not even come out and do care reviews.”

The local authority were engaging with the service and had produced action plans to support the service in providing safe, streamlined care, however the service had not shared this with staff to enable shared learning and drive improvements.

Although initial assessments had been completed, support plans did not provide enough information to ensure people’s care was streamlined and there was no evidence of involvement from other professionals and risks to people was not always monitored.

People told us they felt safe, and the carers provided good care. Comments from people included “I have no concerns about my care when the carers are here”, and “[Relative] is always happy with their care.”

Staff had good relationships with people they cared for and knew them well. Staff had completed online safeguarding training, however some staff lacked awareness of what they would report as a safeguarding. For example, we found several safeguarding incidents in care records which had not been reported to safeguarding.

Not all safeguarding’s had been reported and there were limited systems in place as to who would or was investigating safeguarding concerns. We discussed one safeguarding incident with the registered manager who was unaware of the outcome as she did not investigate it. There was limited evidence of learning from investigations.

People and their families were not involved in developing support plans or risk assessments. People told us they only saw the mangers for their first assessment, and they had not been visited them since to review or update any care.

Although staff knew people well, the staff we spoke to told us they had never seen a risk assessment for the people they cared for.

People did not have appropriate support plans or risk assessments in place to guide and support staff to keep people safe and mitigate any risks. We found people who were a risk of falls, required support to transfer, had complex health issues, were a risk of pressure sores and mental health had no adequate support plan or risk assessment in place. This placed people at increased risk of harm.

People told us they felt safe with their regular carers, however sometimes different staff came, and they did not know what to do which made them feel unsafe.

Staff told us they did not check equipment was safe to use and there was nothing in place to say it was safe.

The provider kept no records in relation to the servicing of people’s equipment to ensure it was safe to use and properly maintained and staff had checked the equipment was safe to use. However, the provider has now developed an audit tool so staff and mangers can be assured the equipment is safe.

People gave mixed messages about staffing; it appeared people who had regular staff were happy with the support they received and told us staff were on time, however, some people told us staff were late, did not always stay for their full call time or the service did not notify them if a carer was not going to turn up. One person said, “When they send different carers, I spend most of the time telling them what to do and where everything is.”

Staff told us they only did e-learning and had never completed any face-to-face training including for moving and handling. Staff did not have an appropriate induction when they started working for the service. Staff told us they had not had an appraisal and did not have regular supervision. Comments from staff included, “Sometimes the managers fetch staff in from out of area and people don’t know them, and “I have never had any supervision while I have worked her.”

Systems and processes were not robust to ensure the safe recruitment of staff. We identified 7 people who were currently working without a Disclosure and Barring Service (DBS) in place, some records did not have any references in and there were gaps in people’s application forms which had not been followed up. The registered manager did not complete any risk assessments to ensure it was safe for staff to work while waiting for checks to come back. The provider has now got an action plan to ensure they can monitor DBS checks for staff and are developing a system to monitor recruitment records.

People told us staff do not always turn up to calls with gloves. A relative told us they often supply staff with gloves as they do not have any.

Staff told us they do not always have gloves and at times have had to buy their own. When speaking to staff they told us they have never had their competencies assessed for donning and doffing.

Staff had not completed any competencies to ensure they were donning and doffing personal protective equipment (PPE) correctly. There was no system in place to ensure staff had received all the necessary PPE to care for someone safely and minimise the risk of transferring infections.

People did not always receive their medication as prescribed. People who were administered medication had no support plans or risk assessments in place to ensure they received their medication safely and as they preferred.

Staff told us they did not know if people were getting the right support when they were administering medication as there was no support plans or risk assessments in place for people who were administered medication.

The provider and registered manager did not complete regular audits of medication. There was no process in place for the management of controlled drugs. We saw poor recording on medication administration records. People who required ‘as and when’ medication had no protocols in place. The registered manager did not know how many people had medication administered as part of a regulated activity.