Southport’s Community Care Direct – Inadequate says CQC

Following the latest CQC inspection report Southport’s Community Care Direct is still rated as inadequate says CQC.

Updated 16 August 2016

This comprehensive inspection took place on 19, 20 and 23 May 2016 and was announced. At the previous inspection in November 2015 the service were rated inadequate and placed in special measures with breaches of regulations 9, 10, 11, 12, 13, 16, 17, 18 and 19. Enforcement action was taken and we served a notice that restricted the service from accepting any new service users until the necessary improvements had been made. We found that the agency had adhered to this legal requirement at the time of our inspection.

The agency provides care to people who have complex care needs such as palliative/end of life care, spinal injury and neurological conditions such as Parkinsons Disease and Multiple Sclerosis. At the time of our inspection there were 35 people using the service and 44 staff employed.

We found despite some improvements being made since our last inspection, such as an improved recording of messages in the communication book, we remained concerned that the service delivery was to suit the service and not the people receiving the service. We were also concerned that the registered manager had failed to demonstrate that they had actively listened to people and done everything possible to improve the care for people. People were still at risk of harm.

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.

We found a system in place whereby the registered manager was visiting people to review their care but we did not see a system of transferring that information in the care plans to ensure the information in the care plans was up to date. We found care plans were also not being reviewed when changes occurred. Therefore, we could not be sure the information was up to date. We found that although new processes had been implemented, the information was not always being recorded appropriately.

We found the service were still not reviewing people’s mental capacity.

A new on-call system had been put in place since our last inspection and a more thorough recording system of any messages received however, it was not always clear what action had been taken.

Staff told us that they have an online system in place to complete training in addition to their classroom training. Staff we spoke with told us they had received supervision in the last six months.

The registered manager had implemented new policies such as the Quality Control/Assurance Audit Record and Policy and completed survey questionnaires with staff and people who use the service. Of those returned, we could not see any evidence of learning from the comments or answers being given. We also did not see any evidence of learning from complaints, safeguarding’s or accidents.

An incident logging system had been put in place however it was not robust enough to ensure information was being recorded appropriately.

There had been an improvement to staff rotas as staff were now receiving them a week in advance. However there was still not enough staff to ensure people were safe and their needs were met in a timely way.

We looked in staff recruitment files and found there were systems in place for recruiting staff. Some people we spoke with were unhappy with the delivery of care in relation to the timings and duration of their calls.

We viewed MARS (Medication Administration Record Sheets) sheets and they were being signed when medication was administered. However, we found for one person there were gaps on occasions where the person required prescribed creams to be applied.

Staff were able to tell us what they would do in the event that they were concerned about abuse and how they would report it. Safeguarding training was being provided and the registered manager was sending in Statutory Notifications when appropriate. However, we received information of concern from the Local Authority and from another source.

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.

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