Archived: Comfort Call (Liverpool- Latham Court)

A previous inspection had taken place in October 2016, and breaches of the health and social care act 2008 were found which meant that some of the people living at Latham Court were at risk of harm. The service was rated as ‘inadequate’ and placed into special measures.

We asked the provider to take action following our inspection. The provider sent us an action plan following the inspection setting out what improvements needed to be made. Furthermore, we requested that the provider updated us weekly of any incidents or accidents at the service.

This inspection was to check that the provider’s action plan had been implemented and to review their evidence. This inspection only looks at the serious concerns we found on our inspection in October 2016 and whether the provider had completed the actions required to ensure these breaches were met. This means we have only looked at four out of the five inspection domains, whether the service is ‘safe’ ‘effective’ ‘responsive’ and ‘well-led.’

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Latham Court' on our website at www.cqc.org.uk.

The service was an Extra Care Living Scheme. A housing association held the tenancy agreements with the people who lived there, some of whom were being provided with care by Comfort Call Limited. At the time of our inspection there were 33 people receiving care packages from the service. There was one staff member present at night time and an alarm system in place for people to raise the alarm if they needed emergency assistance.

There was a registered manager in place at the time of the 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. Since the inspection we had been informed they have left their position.

During our inspection in October, we found concerns regarding the safeguarding of some of the vulnerable people who lived at the scheme. We found that some people were at risk of self-neglect and this was not always documented appropriately by the staff on shift. The provider was in breach of regulations associated to this. We asked the provider to send us an action plan detailing the action they were going to take The provider had detailed in their action plan what action they had taken to address these concerns, which we checked during this inspection. We saw during this inspection that new paperwork and risk assessments had been introduced for the people identified as being at risk, and the provider showed us how they had adopted this approach into their documentation for the future. We saw that adequate steps had been taken to ensure staff complete records appropriately, and all incidents had been reported as requested. The provider had adhered to their action plan and were no longer in breach of regulation.

During our inspection in October we found that incidents and accidents were not always being recorded appropriately by staff and analysed by the registered manager, which meant that this information was not able to be analysed for any emerging patterns or trends. We asked the provider to send us an action plan detailing the action they were going to take The provider had detailed in their action plan the action they were going to take and we checked this as part of this inspection. We saw during this inspection that the provider had re-evaluated their approach to incident reporting. We had been updated regarding any recent incidents and accidents at the service, and saw the provider had taken the correct action. The provider had adhered to their action plan.

We found during our last inspection that risk assessments were not always being reviewed. We identified the provider was in breach of regulation associated to this. We asked the provider to take action this to ensure that all risk assessments were reviewed in a timely manner, and in accordance with any changing needs that the person had. We asked the provider to send us an action plan detailing the action they were going to take. The provider had detailed in their action plan the action they had taken and we checked this during this inspection and found that people’s risk assessments had been reviewed and re-written to encompass any changing need. The provider had adhered to their action plan and were no longer in breach of this regulation.

We found during our inspection in October 2016 that the service was not always applying the principles of the Mental Capacity Act 2005, (MCA). We identified the service was in breach of regulation associated to this. We asked the provider to provide us with an action plan of how they were going to ensure the principles of the MCA were applied to people living at scheme who lacked capacity to make their own decisions. We saw during this inspection that the provider had addressed capacity and consent with everyone living at the scheme and had devised new paperwork in each person’s care plan to determine what decisions people could make for themselves, and where best interests decisions would have to be applied, specifically with regards to medical conditions and potential safeguarding concerns. We found some inconsistencies in one of the care plans we viewed, which we highlighted to the registered manager, and they addressed this straight away. The provider had adhered to their action plan, and they were no longer in breach of this regulation.

We found during our inspection in October 2016 that there was not always detailed information in people’s care files concerning their backgrounds, personal care needs and choices. We identified that the provider was in breach of regulation associated to this. We asked the provider to send us an action plan detailing the action they were going to take. The provider’s action plan detailed the action they had taken to address this, and we checked it as part of this inspection. We saw that the provider had taken action the address the issues that we found, and care plans contained more person centred information, such as people’s likes, dislikes and their backgrounds. We also saw that the provider had included in people’s care plans whether they wished to be supported by a male or female carer. We found during our inspection in October people were not always given this choice. The provider had adhered to their action plan and they were no longer in breach.

We found during our last inspection in October 2016, staff did not always have the correct skills and knowledge to support to support people around their mental capacity, best interests and safeguarding. We identified a breach of regulation associated to this. We asked the provider to send us an action plan detailing what action they were going to take. The provider’s action plan described the action they had taken between October 2016 and this inspection, and we checked this as part of this inspection. We found that the provider had adhered to their action plan and staff had completed ‘themed’ training and supervision with particular emphasis on the Mental Capacity Act 2005 and safeguarding.

During our last inspection in October 2016 we raised some concerns regarding the management structure at Latham court as the registered manager was not always on site, and we were concerned that the scheme manager was not adequately supported and did not have a good enough oversight of the scheme. We identified a breach of regulation associated to this. We asked the provider to send us an action plan detailing the action they were going to take. The provider discussed a new management structure with us during this inspection, which included a new management post created specifically to support the scheme manager.

The service was managed day to day by a scheme manager and a registered manager who was responsible for undertaking supervisions with staff, overseeing the care delivery and reporting to an Area Manager. The provider had adhered to their action plan and were no longer in breach of this regulation.

The rating for the service was no longer inadequate. This was because the provider adhered to the action plan in respect of the serious concerns identified at the last inspection. We will review the rating for the service in full at the next comprehensive inspection.

The service was an Extra Care Living Scheme. A housing association held the tenancy agreements with the people who lived there, some of whom were being provided with care by Comfort Call Limited. At the time of our inspection there were 33 people receiving care packages from the service. There was one staff member present at night time and a Tunstall Alarm system in place for people to raise the alarm if they needed emergency assistance.

There was a registered manager in place at the time of the inspection however, we were concerned they did not have oversight of the service. Another registered manager was in attendance on the 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.

The service was managed day to day by a Scheme Manager who was responsible for undertaking supervisions with staff, overseeing the care delivery and reporting to the registered manager and Area Manager. We found that the registered manager and scheme manager, who were relatively new to Latham Court, did not know the people who were receiving care well and relied upon staff for information about them.

We were informed by the provider that they had no choice over who they provided care for and decisions were made as to who required care without consultation with Comfort Call Limited. We were also informed by the provider that they were only provided with basic information about people who they were asked to deliver care to. This meant the assessment process for people being accepted into the extra care living scheme at Latham Court was not robust. We were informed by the provider there were no people with complex care needs living at Latham Court. However, we found during our inspection the staff were delivering care to people with complex care needs. We were therefore concerned that the care provider did not have a full oversight of the dependency levels and complex needs of some of the people who lived at Latham Court.

We found staff were able to describe different types of abuse and what they would do to report alleged abuse but we found the system in place to safeguard people who lived there and associated documentation were not robust. The documentation did not provide a detailed account of the events of an incident and staff were not reporting all incidents/safeguarding concerns in a timely manner. We highlighted this to the service who then put a new handover sheet in place for staff to relay any concerns. However, when we returned to check the effectiveness of the new handover sheet we found that people were still not being safeguarded in a timely manner or with a detailed record of events.

The Mental Capacity Act 2005 legislation had not been implemented within the day to day delivery of care for people. It was unclear from the care plans if people had mental capacity to make all decisions or some decisions as there were no details about which decisions were difficult for the person and no record of a named person who was best to consult with as part of a best interest’s process. Staff who wrote care plans and risk assessments were not knowledgeable about decision specific mental capacity questions. The service acknowledged this and had planned Mental Capacity Act training for all staff to be completed by the end of November 2016.

Care plans did not provide enough detail about people for staff to know what their background was or their likes or dislikes to be able to support them effectively. There were no care call times specified in the plan of care or evidence family members/next of kin were being consulted in the process of writing the care plan. People didn’t always have a choice of male/female carers.

Risks were not being managed effectively with some risk assessments not being updated when needed or in some instances there were no risk assessment at all for staff to follow. Incidents were not always being recorded and staff were not always acting in people's best interests. The daily records did not include whether a person had the mental capacity at the time of declining care or food with poor recording of information.

Staffing levels were not sufficient to allow time for staff to always provide care for the duration of the call times specified in the Local Authority support plan. We viewed in the daily records carers were leaving a person’s home earlier than they were required to provide care according to the Local Authority support plan. There was no documentary evidence why the call time was shorter than specified on the rota. Therefore, some people were not receiving the amount of care hours as stated on their Local Authority Support Plan agreed on admission. We were also made aware of this by the Local Authority who had raised this issue with the care provider.

Recruitment systems were in place however, not all staff were being provided with an induction to ensure all staff including staff who have been transferred from another care provider received an induction. The registered manager agreed to address this. Staff training was extensive however we were concerned staff were not always implementing and consolidating it. For example, staff had received training in Safeguarding however we found staff were not always documenting safeguarding concerns effectively or safeguarding people in a timely manner.

There were safe systems in place for administration of medication including a medication risk assessment seen in the care plans.

Information regarding how staff were to support people with nutritional needs was not detailed enough and people who were declining to eat were not always being supported effectively. For example, we found one person who had declined to eat over a period of time had not been referred to health care professionals or the Local Authority with concerns regards self-neglect.

People told us they were not always being supported to access the healthcare they needed to access such as the Dentist and Opticians. We received information from social care and health care professionals raising concerns some people were not receiving effective support or support for the duration of time needed. One healthcare professional told us that staff were not always supporting people as requested by the healthcare professionals and in one instance a person was admitted to hospital due to this. However, one healthcare professional also told us they had no concerns regarding the care being provided.

The service was not caring. People’s dignity was not always being upheld when staff spoke with them and people with complex family backgrounds with no next of kin were not being referred for advocacy services.

Staff were not being provided with enough detailed information in the care plans for them to know how to encourage people to be as independent as possible.

We viewed the quality assurance forms completed with people which were not tailored to the communication needs of some people with learning difficulties. Therefore, we did not consider that the service were doing all that was possible to obtain the views of all the people who were receiving care in the best way to meet their needs.

The service was not being well-led as the system failures identified during the inspection had not been identified through the audit systems and quality control systems in place.

The overall rating for this service is inadequate and the service is therefore in special measures.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.