Archived: Liverpool Mental Health Services

Liverpool Mental Health Services provided support to people primarily with mental health support needs. They supported 37 people living in their own homes. 31 people were supported at five locations across Liverpool, these were small blocks of flats ranging from 13 to 4 flats in each block. Six people were supported by community based floating support. Liverpool Mental Health Services provided people with care and support. They did not provide people with accommodation.

A person was in the process of applying to be the registered manager. At the time we visited there was no registered manager in place. 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 number of breaches relating to safe administration of medication, assessment of risks, staffing, consent in relation to the Mental Capacity Act (2005) and lack of good governance.

You can see what action we told the provider to take at the back of the full version of the report.

We found that people’s medication was not stored, documented or administered safely. There was an excess of old medication stored. There were examples of incomplete records and inaccurate guidelines for support staff. There had been times when people had not been administered their medication or had been administered a discontinued medication. One person had incomplete records and the provider was unable to tell us what medication they had taken.

We observed that risk assessments were inconsistent. We observed examples of effective and ineffective risk assessments. Assessments had not been effective in keeping people support and staff safe. Staff had not been training in deescalating situations despite the provider being aware of incidents.

There was an inexperienced staff team and a recent overreliance on temporary staff. The newer staff members had not received appropriate training or effective documented induction. At times inexperienced staff were inducting new staff members.

The provider was recruiting more staff. They had organised the role of tenant representative for a person supported. They were involved in interviewing and choosing new support staff.

We found that the provider did not meet the requirements of the Mental Capacity Act 2005 (MCA). They had not assessed a person’s fluctuating capacity in relation to the refusal of their medication or taken into account what effect this decision would have on a person’s capacity.

Many people told us they were happy with their care and were supported in their health needs. The staff interaction we observed was caring and we observed a recent change in practice that ensured that staff had the time to sit, chat and get to know people better. People had been supported to socialise and efforts had been made by support staff to reduce social isolation. Recent communal events had been a success.

People’s files contained a lot of information about people. They were written in a person centred way and had been updated recently. We saw examples of how these had been effective in guiding the support of some people and times when they had not been effective in responding to people’s needs.

The management of the service was described by some staff and people supported as confusing. The manager had not taken the lead in the induction of new staff members or influencing the practice and developing culture of newer staff.

Information from incidents was gathered and stored in an organised way. There was no evidence that this information had been used to improve the support provided to people or to mitigate future risks.

Medication audits had been ineffective in improving medication practice and had not picked up errors and bad practice. Records of support provided were of a poor quality and could be contradictory.

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.