The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: LANCuk Heywood

Overall: Inadequate read more about inspection ratings

Independence House, Adelaide Street, Heywood, Lancashire, OL10 4HF (01403) 240002

Provided and run by:
Learning Assessment and Neurocare Centre Limited

All Inspections

1 November 2022

During an inspection looking at part of the service

LANCuk (Learning Assessment and Neurocare Centre) provides assessment and treatment for both children and adults for attention deficit hyperactivity disorder (ADHD) and autism.

At the last inspection, we imposed conditions on the provider for failing to comply with Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance. We found during this inspection that insufficient improvements had been made.

However, oversight of the prescribing process had improved by arranging for all prescriptions to be sent to nominated pharmacies rather than the individual patient, to reduce risk of the prescriptions going missing and there was oversight of the prescription numbers too.

Staff records now included health screening.

Our rating of this location stayed the same. We rated it as inadequate because:

  • The service had not made significant improvements to the oversight of the prescribing of medicines. The service still did not have robust systems and processes in place for managing prescriptions and monitoring patients prior to repeat prescribing.
  • Records were not complete and contemporaneous.
  • Staff files had gaps, including gaps in work history and supervision.
  • The registered manager had been absent from work since 6 January 2022, the interim manager had applied to be the registered manager, however, withdrew their application on 18 October 2022 following their interview. This meant there is not a registered manager providing leadership at the service and the interim arrangements did not include oversight of patients treated under a private arrangement.
  • There were four mandatory training course with compliance levels below 70%.

However:

  • Staff files now had health screening in place.
  • Prescriptions were now sent directly to the pharmacies to reduce the risk of missed and lost prescriptions.

29 and 30 March 2022, 5, 6 and 7 April 2022.

During a routine inspection

LANCuk (Learning Assessment and Neurocare Centre) provides assessment and treatment for both children and adults for attention deficit hyperactivity disorder (ADHD) and autism.

Following this inspection, we took urgent action and served a Notice of Decision which placed conditions on the providers registration. The Notice of Decision prevented them from accepting any new or repeat patients to the medicine prescribing service without the prior written agreement of the Care Quality Commission. We also instructed the provider to:

  • implement an effective system for recording all future reviews of patients’ prescription needs including details of clinical observations and decision making and minutes of prescription meetings by 26 April 2022
  • review all treatment plans for all patients currently prescribed medicines and any patients who have been accepted for prescription service and awaiting their treatment to commence by 12 May 2022
  • develop and implement an effective system for the oversight of dispensing prescriptions to ensure medicines are provided to patients securely and within the time period specified within treatment plans and complete an audit of the system on a monthly basis by 11 May 2022.

Our rating of this location stayed the same. We rated it as inadequate because:

  • The service did not provide safe care. The service did not have oversight of the prescription management process to mitigate the possible misuse of prescriptions and ensure it was safe or appropriate to increase the dose of the medicine before prescribing or continuing to prescribe for patients when clinically appropriate to do so.
  • The registered manager had not taken sufficient action to remedy the concerns we raised at the last inspection.
  • Multidisciplinary meetings had not taken place and information had not been shared with clinicians. This meant staff were not given the opportunity as a team to discuss the service, receive feedback from incidents, complaints and updates about the service.
  • There was no information provided to patients regarding the service including what to expect and timescales.
  • Staff records did not include all required documentation and checks.
  • The service was not well led, and the governance processes did not ensure that procedures relating to the work of the service ran smoothly. Staff did not engage in clinical audit to evaluate the quality of care they provided.

However:

  • Clinical premises where patients were seen were safe and clean. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff provided a range of assessments and treatments that were informed by best-practice guidance and suitable to the needs of the patients.
  • The service included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training and supervision.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.
  • The service had introduced the oversight of incidents and complaints, with a database and clear investigations with records to support the decision making.

08 and 13 October 2021

During an inspection looking at part of the service

Our rating of this location went down. We rated it as inadequate because:

  • The registered manager had not taken sufficient action to remedy the concerns we raised at the last inspection. Patient records were not current, complete and contemporaneous and staff were not receiving supervision in line with the supervision policy.
  • Staff did not assess and managed risk well. Risk was not considered and recorded at each appointment. There was no oversight of incidents within the service.
  • The service did not have robust systems and processes in place for managing prescriptions.
  • Staff records did not include all required documentation and checks.
  • We did not find sufficient arrangements in place for the provider to determine the quality of the service provided and make improvements.
  • The service was not well led, and the governance processes did not ensure that procedures relating to the work of the service ran smoothly.

However:

  • Following the last inspection, patient records now included documentation and responses to complaints patients had raised.

As a result of this inspection, we used our enforcement powers to serve a Warning Notice to the provider under section 29 of the Health and Social Care Act 2008. This was served for failing to comply with Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance.

We are placing the service into special measures. 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 overall or for any key question or core service, 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.

16 July 2019

During an inspection looking at part of the service

We undertook this unannounced inspection to find out if LANCuk had made the improvements we told it that must be made following our last inspection in January 2019. At that inspection we rated the well led key question as inadequate and made the decision to place the service in special measures.

At this inspection we saw that some significant improvements had been made but there were still some further improvements required. In light of the improvements made, we have removed LANCuk from special measures.

We rated LANCuk as requires improvement because:

  • The service did not always complete risk screening for each patient and therefore did not fully consider any potential risks of working with each patient on an individual basis.
  • Staff were not receiving one to one supervision. The registered manager was not based at Heywood and did not see the majority of staff on a regular basis. The registered manager was therefore unaware of the quality of their practice and the service they provided to patients. The provider’s policy stated that staff should receive one to one supervision from the registered manager.
  • There were a high number of patients waiting to be assessed by the service. Some patients waited over a year for their face to face assessment.
  • Some governance arrangements were still not fully embedded. Staff were not following some of the provider’s policies to ensure the safety of patients and learning from complaints was not shared across the whole team.

However:

  • The service had made a number of improvements since our last inspection and the commissioners of the service were positive about the service delivery and progress made.
  • Staff had had improved the safety of the environment and equipment since the last inspection.
  • Patients now knew how to complain, and complaints were managed appropriately.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training and appraisal. The provider now had oversight of staff training and ensured staff were allocated appropriately to provide the service to patients. Staff felt respected, supported and valued. They felt able to raise concerns without fear of retribution. Staff provided a range of treatments that were informed by National Institute for Health and Care Excellence Guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

15 January 2019

During a routine inspection

We are placing the service into special measures. 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 overall or for any key question or core service, 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.

We rated LANCuk as requires improvement because:

  • The registered manager had not taken sufficient action to remedy the concerns we raised at the last inspection. Patient records were not current and there were many sessions where records had not been completed. The registered manager had not taken action in relation to the provision of alarms in the interview rooms, providing a height measure in the Heywood base nor advising patients how to complain about the service.
  • Risk assessments were not completed for all patients. The registered manager did not have oversight of safeguarding alerts or concerns.
  • Several improvements were at an early stage including the introduction of senior management team meetings, appraisals and supervision for staff.
  • Policies did not reflect the nature of the service. Mandatory training was not identified in the training and development policy. The duty of candour policy did not fully reflect the regulation. The calibration of equipment had not been identified as a requirement.
  • The registered manager had not been proactive in communicating with the CQC in relation to requests for information, submitting statutory notifications and meeting the regulations of displaying the rating.

However:

  • Patients feedback about the service was positive. Patients told us staff were very helpful and respectful, they were given information about their treatment and understood this.
  • Staff had a good understanding of patients’ needs and respected their confidentiality.

15 January 2019

During a routine inspection

We are placing the service into special measures. 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 overall or for any key question or core service, 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.

We rated LANCuk as requires improvement because:

• The registered manager had not taken sufficient action to remedy the concerns we raised at the last inspection. Patient records were not current and there were many sessions where records had not been completed. The registered manager had not taken action in relation to the provision of alarms in the interview rooms, providing a height measure in the Heywood base nor advising patients how to complain about the service.

• Risk assessments were not completed for all patients. The registered manager did not have oversight of safeguarding alerts or concerns.

• Several improvements were at an early stage including the introduction of senior management team meetings, appraisals and supervision for staff.

• Policies did not reflect the nature of the service. Mandatory training was not identified in the training and development policy. The duty of candour policy did not fully reflect the regulation. The calibration of equipment had not been identified as a requirement.

• The registered manager had not been proactive in communicating with the CQC in relation to requests for information, submitting statutory notifications and meeting the regulations of displaying the rating.

However:

• Patients feedback about the service was positive. Patients told us staff were very helpful and respectful, they were given information about their treatment and understood this.

• Staff had a good understanding of patients’ needs and respected their confidentiality.

Tuesday 17 July 2018

During a routine inspection

We rated Learning Assessment and Neurocare Centre Limited as inadequate because:

  • There was no training that was determined mandatory for staff in order for them to have the skills they needed for their job roles. There were no records of training for sessional staff available.

  • Safeguarding training was not completed for staff and the policy gave limited direction to support staff. There was no system for staff to alert others if there was an incident whilst seeing a patient alone.

  • The duty of candour policy did not identify what level of harm would need a duty of candour response.

  • We were not assured the provider had good oversight of risks of people waiting to be seen because contact from patients were not recorded.

  • Staff were not receiving supervision or appraisal.

  • Patient records were not contemporaneous and incomplete.

  • There were limited records that appropriate checks on staff suitability had been carried out.

  • All patients we spoke to told us they were not given information on how to complain.

  • We did not find sufficient arrangements in place for the provider to determine the quality of the service provided and make improvements.

  • Staff had not received appropriate checks prior to commencing their role. The provider could not evidence that appropriate checks had been carried out prior to staff commencing in their role. In ten staff files we reviewed there were no application forms, curriculum vitae, references or DBS checks. In addition, there was no evidence of staff training either at LANCuk Ltd or at sessional workers permanent roles.

However:

  • The premises were visibly clean, tidy and were suitable for patients.

  • Staff at the service had reported no serious incidents in the twelve months leading up to our inspection. However, it was difficult to know if there had been any due to the lack of documentation at the service. We did not find any evidence on the day of our inspection that any serious incidents had occurred.

  • All records we reviewed contained a full assessment.

  • The service liaised well with others such as GPs. were good examples of shared care agreement with patients GPs.

  • The provider followed national institute of health and care excellence guidance for assessment, diagnosis and prescribing of medication.

  • There was an effective multidisciplinary team approach.

  • Staff told us they were supported and could approach colleagues for advice with complex cases.

  • All patients we spoke to told us that staff treated them with dignity and respect. Carers we spoke to told us that staff involved them in decisions about their loved ones care and

    felt they genuinely took an interest in their problems. Patients told us they were consulted about their treatment options and given information to help them make an informed decision. The rooms that were used for patient appointments were adequately soundproofed for confidentiality. Information about advocacy services were displayed for patient to use. Patients could give feedback via surveys and comment boxes.

  • The provider was meeting targets for referral to assessment time. Patients were able to access staff quickly via telephone or email. There was a full range of rooms to provide treatment and care. The premises were accessible for people requiring disabled access via a ramp. Interpreters were available for patients whose first language was not English.

  • Staff morale was high and staff felt empowered in their roles. There was an open and honest culture at the service.