HF Trust Cheshire and Merseyside

The provider had not ensured there was an effective system in place to ensure people’s risks were managed effectively. Care and risk management plans were not always put in place to mitigate these risks and to ensure they received the required care and support. Provider oversight was not effective with safeguarding process within services. Safeguarding incidents and concerns had gone unreported. There were missed opportunities for lessons to be learnt. The provider had not ensured effective oversight and management of medicines. We identified a breach of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) as people in some of the services were under constant supervision and did not have a DoLS authorisation in place. In one instance a Court of Protection DoLS had expired. There was a significant use of agency staff due to the lack of permanent staff, although, wherever possible, the same agency staff were used. We found low staff training compliance in key mandatory training and risk-based topics. Staff competencies were not checked for moving and handling of people in between their allocated 3 yearly practical course.

The provider had failed to ensure all people using the service and those lawfully acting on their behalf, had given consent before any care or treatment was provided. We observed capacity assessments were out of date. People and their relatives were not involved in assessments around their care, meaning their contribution could be missed. People were not put at the heart of every decision relating to them; therefore, their rights were not protected due to staff not understanding the principles of the Mental Capacity Act (2005). Records around mental capacity and best interests were not present, out of date or had only just been created. Staff lacked training to be able to fully communicate with people especially when they were non-verbal, not all staff were using peoples i pad devices to aid in communication and lacked training in using Makaton which is a communication method that uses signs, symbols, and speech to help people with disabilities or learning disabilities express their wants and needs.

The recruitment needs in the service impacted on some people not being able to have their allocated 1:1 with care staff and plans being cancelled. Care plans were not always reflecting peoples current care and support needs. People were not always participating in regular reviews of their care and support to also include family members. The feedback from staff was mixed, some staff being positive about the recent changes and the changes in management, however there was a high volume of feedback where staff were not feeling valued, supported and not listened to by the management team.

There was a lack of involvement with people and relatives around the care and support they received, what they wanted and their experiences. A person-centred care planning and goal setting training roll out plan had commenced during the assessment process. This was to be delivered to deputy managers, then to team leaders and the teams in services, following on from this training people were going to be involved in person centred care reviews and have involvement from their support staff and family members. Managers and staff acted on what they believed to be the best for people without any consultation or involvement with them which has resulted in people not being treated as individuals.

The provider did not ensure there were effective governance oversight and the processes in place were effective, as well as the service being in a turnaround process, the volume of turnaround and changes with the leadership and recent restructures had destabilised the workforce. Right support, right care, right culture principles were not always meet. Quality governance systems and management structures were not effective in identifying and addressing shortfalls to ensure good quality, safe care and support was always being provided and ensuring oversight of staff through effective regular team meetings, regular supervisions and appraisal processes, they were not being completed to ensure staff had the training, supervision and feeling supported by their peers to deliver the care people required. The service was not well-led and did not have clear processes for learning and driving improvement. These concerns found resulted in a breach of Regulation 17.