This inspection of Local Solutions, Scotland Road branch took place on 7 and 8 December 2017 and was unannounced.

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

This announced inspection took place on 13, 14, 15, 16, 19, 20 December 2016 and 27 January 2017. The service was last inspected in in March 2016 and was found to be in breach of six regulations. These were in relation to regulation 9 person centred care, 11 consent, 12 safe care and treatment, 13 safeguarding, 17 governance and 18 staffing. The overall rating of the service was inadequate resulting in the service being placed in special measures.

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 d

This announced inspection took place between 14 and 22 March 2016. The previous inspection in October 2013 found the service to be compliant under our old methodology for inspection.

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

We met or spoke with nine people who used the service or their relatives. Each person gave us good feedback about the support they had received from the agency. People told us staff were reliable and that most of the time they were supported by the same carers who knew their needs well. People said the only time they saw other carers was if their main carer or carers were off work. However, they told us that all staff were good. People told us staff were respectful towards them and protected their privacy and dignity. People said they had been asked how they wanted their support to be provided and that the service they received was as they had requested. People’s comments about the service included the following: “It’s excellent I’m very happy with it.”, “I can’t fault them it’s very good and always has been.” and “The carers are lovely, kind and considerate."

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.

During our inspection we spoke with three people who used the service and four people’s relatives. People we spoke with were positive about the care and support they received from staff at Scotland Road Branch. Comments we received from people included:

“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.

On the day of the site visit to the service we conducted two visits to people who use the service and receive support. In addition we spoke with people by phone. All people spoken with confirmed that they were encouraged to express their views openly. They were of the opinion that these views were being taken into account by Local Solutions in the decision making for the care and support they received.

People told us that Local Solutions were very good at keeping them informed about their care and this was regularly discussed. People said that staff were generally very consistent and tried to ensure that care was delivered at times they had chosen. One said, ''Staff are always on time and they are very good.'' All people spoken with expressed the view that they felt they were treated with respect and dignity.

The level of dependency of people varies but those needing some degree of personal care said they felt comfortable with staff who were, ‘’Very patient and kind.’’ All spoken with said that the staff were both competent and respectful in terms of promoting their privacy and dignity. We spoke with one person who said, ''The staff look after me very well. They are always on time and are not rushed.''

Another person told us about recent treatment and visits from the district nurse. The care staff at the agency had liaised well to support the person with any issues arising from this. We spoke with a visiting district nurse who told us that the staff were very proactive and will refer through any health care issues they identified.

This shows that Local Solutions were responsive to people’s care needs and have liaised when necessary to support people’s health care needs.

Other comments received were also very positive:

‘’The staff and managers are very good and everything is well organised.’’

‘’Staff are marvellous and are always cheerful.’’

‘’We have experience of another care agency and Local Solutions are much better organised and overall give very good care.’’

When asked people said that they felt ‘safe’ and they were confident that any concerns would be listened to and addressed. They had a say in how they were supported and were asked their opinions at various times such as reviews carried out by the care coordinators and also through surveys conducted by the agency. All people we spoke with said that the agency was well run.