Archived: Scotland Road Branch

Scotland Road Branch provides personal care to people in their own homes. At the time of our inspection, the service was supporting 413 people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Medicines were not always managed safely. Medication administration records (MAR) were not completed consistently to a high standard. There were no recent records of competency assessments for existing staff to ensure they were able to safely administer medicines.

Not all risks were assessed and mitigated to keep people safe from harm. Some risk assessments had not been completed and some were not detailed enough to guide staff to support people safely. This placed people at avoidable risk of harm.

Systems in place to monitor the quality and safety of the service were not always effective. Some of the recording issues found during this inspection had been identified by the providers systems. However, this had not always resulted in a sufficient and timely response to keep people safe.

Oversight of the safety and quality of the service was not always effective. There was no system in place to monitor staff’s completion of COVID-19 tests. This meant that the provider failed to identify that staff were not completing weekly COVID-19 tests in line with best practice guidance.

Staff followed good infection control practices and used PPE (personal protective equipment) to help prevent the spread of healthcare related infections. One person told us, “[Staff] always come in with masks, gloves and aprons.”

Staff were safely recruited and deployed in sufficient numbers to meet peoples care needs. A dedicated team monitored people’s call times and took action to follow up on late call alerts to ensure peoples care needs were met.

Staff were aware of procedures to follow if they had any safeguarding concerns. The registered manager had oversight of detailed records relating to safeguarding actions and outcomes.

Staff completed regular telephone reviews with people to gather feedback about the care provided. People also told us they received questionnaires. We received mixed feedback from staff in relation to engagement and the support they received. However, we saw evidence of regular staff engagement through team meetings, telephone job chats and appraisals.

The service worked with the local authority to coordinate the care and support people needed. Professionals who work with the service spoke positively about the working relationship and told us staff "try to work with us to get the best outcomes for members of the community." The registered manager acted in accordance with their duty and shared information in an open, honest and timely manner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 4 January 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider responded to the concerns we raised during and after the inspection. They provided evidence of immediate improvements to their governance systems and updated risk assessments to mitigate the risks to people’s health and safety.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of medicines and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Scotland Road offices are the Liverpool branch of ‘Local Solutions’. Local Solutions are a not for profit social enterprise, predominantly operating across Liverpool and North Wales. The organisation is a registered charity and provides personal care to people living in their own homes throughout Liverpool. At the time of our inspection the service supported approximately 770 people in the community and employed over 370 care staff.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in their community.

There was a registered manager in post at the time of our inspection. 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 completed on 27 January 2017, we found that the registered provider was in breach of Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment) and Regulation 18 (Staffing). We also made recommendations in relation to governance and leadership. Following the last inspection, we asked the provider to complete an action plan to tell us what they would do and by when to improve. At this inspection, we found that improvements had been made and the provider was no longer in breach of regulation.

At the last inspection on 27 January 2017 we identified a breach of regulation in relation to safe care and treatment. This was because people did not have support plans in place around as and when required medication (PRN). At this inspection, we found that the registered provider had taken action and ensured that the relevant plans were in place around PRN medication to guide staff on safe administration.

At the last inspection on 27 January 2017 we identified a breach of regulation in relation to person centred care. This was because risks had not always been identified for people who needed support around pressure care and manual handling. At this inspection, we found that risks were assessed and the associated care plans in respect of pressure care and manual handling were personalised and sufficiently detailed.

At the last inspection on 27 January 2017, we identified a breach of regulation in relation to staffing. This was because not all staff had undergone appropriate training to ensure they were competent and updated to train others. At this inspection we found the registered provider had taken action to update the training programme for quality officers to ensure those members of staff had the up to date skills and knowledge to support people effectively.

People who used the service told us they felt safe when receiving care and support.

Systems were in place to support people with their prescribed medicines. Staff received medicine training to ensure they had the skills and knowledge to safely administer medicines.

People were supported by sufficient numbers of staff. The majority of people told us that staff arrived when they should, were on time and stayed the correct amount of time.

We saw some people had experienced missed visits. The registered provider had taken appropriate responsive action and had analysed this information for possible trends or themes to help reduce the risk of reoccurrence.

People were protected from the risk of harm because staff could identify the potential signs of abuse and knew who to report any concerns to. Staff followed local safeguarding protocols if someone was deemed to have suffered harm.

The service operated within the principles of the Mental Capacity Act 2005 (MCA). Records demonstrated that processes were in place to assess people’s capacity and make decisions in their best interests. Decisions that were made were thoroughly assessed to ensure the least restrictive option was chosen.

Staff were assisted in their role through induction, observations, supervisions and an annual appraisal and staff told us they felt well supported in their role.

Care records showed that people's health care needs were addressed with appropriate referral and liaison with external health care professionals when needed.

People were supported by staff in respect of their nutritional needs. People’s records contained information relating to their individual dietary needs.

People told us they were happy with the care received and that staff supported them in a respectful manner. Staff spoken with demonstrated a clear understanding of their responsibilities and gave examples of how people's privacy and dignity was promoted and maintained.

People's care plans were person centred. Information we looked at described what the person liked to do and how they liked their routine to be followed.

People and relatives we spoke with said they were consulted about their care and we saw evidence of their input in care planning documentation.

Opportunities were provided for people, their relatives and staff to comment on their experiences and the quality of service provided.

Complaints were well managed and documented in accordance with the registered provider’s complaints policy. The complaints policy contained contact details for the local authorities and Local Government Ombudsman (LGO). People felt confident to raise any concerns and trusted that these would be responded to.

People, staff and relatives spoke positively about the organisation in general. People described the company as ‘fantastic’.

The registered provider had sought new and innovative ways of improving service delivery such as the development of a pilot scheme entitled ‘Cluster’ and the acquisition of new electronic databases to improve operational efficiency.

The registered provider had a number of different systems in place to assess and monitor the quality of the service, ensuring that people were receiving safe, compassionate and effective care. Such systems included regular audits, analysis of complaints and missed visits and trend analysis in accordance with key performance indicators.

Staff meetings were held regularly and staff felt valued. This was promoted through initiatives such as ‘Carer of the quarter’ awards for staff, an employee recognition scheme which celebrated and rewarded good practice.

There were a range of policies and procedures in place to guide staff in their roles and these were updated regularly.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred at the service in accordance with our statutory requirements. This meant that CQC were able to monitor risks and information regarding the service.

On this inspection we found the service had improved and was no longer in special measures. However, some improvements where still required and the service remained in breach of regulations 12 safe care and treatment, 18 Staff training and 9 Person Centred Care. We also made recommendations in relation to governance and leadership.

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.'

'Local Solutions' Scotland Road Branch is a not for profit social enterprise, predominantly operating across the North West of England. The organisation is a registered charity and it does not recruit nurses. The organisation provides personal care and support for people living in their own homes. At the time of our inspection there were 681people using the service and 331care staff.

Since our previous inspection in March 2016 there were changes within the management of the service including a newly appointed registered manager. The service had changed their referral procedure and had worked towards improvements set out in their action plan which we requested from them. They had sourced agency quality officers to drive improvements within the service some of whom were being employed by the service.

On our last inspection we found there were not enough staff to provide care when people needed their care. Staff were not provided with travel time in between calls and were call cramming. We checked this during our inspection and found not everyone we spoke with was receiving their care at the time they needed it. We were informed by the provider travel time was now incorporated into the rotas for staff. The provider had made improvments since our last inspection and were no longer on breach of the regulation related to staffing levels. However, there were still some concerns raised during this inspection of staff not always being able to provide care at the time specified on the rota.

We recommended that the provider undertook a staffing analysis to ensure there are enough staff to provide care for people when they need their care.

We found during our last inspection that people were not always safeguarded from abuse. This was because not all reportable incidents had been reported to the local authority. The provider was in breach of regulations in relation to this. We found during this inspection that there was a clear system of reporting safeguarding concerns and staff were aware of the signs of abuse. Staff were also aware of whistleblowing and what to do if they wanted to raise concerns.

The provider was no longer in breach of these regulations in relation to safeguarding.

At our last inspection in March 2016, we saw that consent was not always being sought in line with legislation. The service was in breach of this regulation. We saw during this inspection that consent was being sought in line with the Mental Capacity Act 2005 and the care plans we viewed contained information regarding the person’s mental capacity with evidence they had followed a best interest’s assessment.

The provider was no longer in breach of this regulation related to consent.

During our last inspection in March 2016, we found that staff were not always trained to provide the care they were delivering for people. We saw during this inspection this was improved, however some staff had not always received the appropriate training to be able to deliver effective care for people such as stoma care and enough practical manual handling training and experience to be able to use a hoist. The staff member who was responsible for assessing and writing manual handling risk assessments and care plans had completed the mandatory manual handling training but they had last undertaken manual handling risk assessment training in 2009.

The care provider remained in breach of the regulation related to staff training.

There was a staff supervision structure in place. However, some staff had only received supervision annually. Some staff told us they were receiving supervision once each year. Appraisals were being undertaken .There was an induction and the staff files we viewed demonstrated safe recruitment practices were in place.

Fluid and nutrition balance charts were being recorded when appropriate and staff were supporting people with food preparation and eating/drinking.

People and their relatives told us they were not always being listened to.

Staff we observed who were speaking with people spoke to them in a respectful manner. We were present whilst a staff member was talking with one person during a care call and they spoke with them in a gentle and calm manner and asked them if it was alright for them to support them before they provided care.

We received mixed views regarding whether staff always treated people with respect and dignity. Staff told us they wanted to do the right thing for people they were caring for.

People were being involved in the planning of their care and relatives were also being consulted with.

The complaints policy and complaints procedure were not consistent for people to be clear what they needed to do to make a formal complaint.

Communication systems were not always effective which were impacting on people. Computerised records were incomplete with no system of checking what was being entered onto the system.

The service were not making their complaints process clear for people using the service for them to ensure they were always learning from concerns people had.

Audits had been completed with trends analysis and action plans. This demonstrated they were driven to improve and act on the information from the audits undertaken. However, they didn’t always pick up on the concerns we found. Further work was required to ensure an effective system of quality assurance was in place.

We recommend that the provider continues to review their approach to quality assurance and takes action accordingly.

The service had strong links within the community and was seeking guidance outside the organisation to ensure they were aware of best practice.

Following our inspection the registered manager provided us with an action plan of further improvements required.

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.’

‘Local Solutions’ Scotland Road Branch is a not for profit social enterprise, predominantly operating across the North West of England. The organisation is a registered charity and it does not recruit nurses. The organisation provides personal care and support for people living in their own homes.

At the time of our inspection there were 892 people using the service and 349 care staff.

We saw the service had implemented a robust recruitment system. Disclosure Barring Service [DBS] checks were undertaken on staff to ensure they were able to work with vulnerable people. Staff had an induction programme in place.

Most staff members we spoke with had heard of the term Safeguarding and described how they would report an incident but only one staff member we spoke to mentioned abuse when asked about Safeguarding. Therefore, we were concerned staff only had a basic awareness of Safeguarding. For example, one staff member told us Safeguarding is “Making sure vulnerable adults are safe as possible in my care and respecting them and everything”.

Staff were receiving supervision but not consistently to demonstrate continuous on-going improvements and developments were being made. There was an appraisal system in place. We received information from a staff member who informed us that they were, at times sent to deliver care without having the appropriate information about the person to be able to deliver care.

We looked at the care records and found risk assessments were either absent or did not contain detailed enough information to keep people safe. Staff who were providing care to people with complex needs had not been trained adequately. We could not find medication risk assessments or medication care plans.

Care plans were not being reviewed according to the changing needs of people and checks were not in place to ensure people were receiving care for the duration of their calls. We found there was no system in place for checking if incidents reported by staff were then dealt with and reported to the Local Authority. During the inspection, we found examples of incidents which had not been reported.

Staff we spoke with demonstrated a caring approach and were observed interacting with people in a caring manner. Most people we spoke with provided positive feedback about the manner in which they were spoken to and felt listened to.

People were not always receiving care at a time which suited them and told us they fitted around the needs of the service. We found the system of care delivery did not allow staff travel time in between their calls which meant staff were either having to leave early to enable them to arrive at their next call on time, or be late for their next call. This was impacting on people who received the care as they were not receiving care for the duration of the call.

We could not find a system in place which ensured people who lacked Mental Capacity to consent or make decisions were supported through the Best Interests process. Staff across the service from management to staff delivering care, were unable to demonstrate a thorough understanding of the Mental Capacity Act and associated legislation to be able to implement good practice across the service. There was no consent documented in the care records and the service did not have a consent policy.

Policies were not always being followed and documentation was incomplete. We were informed that the Registered Manager was on site on average twice each month and in view of the issues highlighted as part of the inspection did not have a full oversight of the day to day running of the service. The systems in place to document information were not robust. We found pertinent information had not always been entered into the documentation and at times was missing. This precluded accurate and thorough investigations of events. We found a list of 10 complaints within a year and evidence of them being looked into and an outcome, however, three relatives we spoke to told us they had made complaints and no action was taken.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

You can see what action we told the provider to take at the back of the full version of the report. The concerns we identified are being followed up and we will report on any action when it is completed.

Each of the people who used the service had a care plan and we saw that these had been reviewed on a regular basis. Risks to people's safety had been assessed and plans were in place to minimise risks.

Systems were in place to protect people from the risk of abuse. Staff had undergone training in safeguarding and they were clear in their responsibilities to report concerns.

Staff felt well supported and appropriately skilled and trained. Staff were provided with regular training and regular supervision. Staff team meetings also took place on a regular basis.

The provider had a system in place for monitoring the quality of the service and this included asking people who used the service for their views. People told us they would feel confident to raise any concerns or complaints about the agency and they felt confident that these would be addressed.

'They make you feel comfortable, really make you feel at ease, I trust them to look after me'.

'The carer reminds me of the things I forget, it is good to have her around'.

'They're always respectful'.

Staff are 'well trained in what they do'.

We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do.

The people who accessed the service provided by Scotland Road Branch were supported by staff who were appropriately recruited, well trained and experienced at supporting them. An effective complaints system was in place and comments and complaints people made were responded to appropriately.