• Community
  • Community healthcare service

Lloyds Pharmacy Clinical Homecare

Overall: Good read more about inspection ratings

Unit 4, Scimitar Park, Roydon Road, Harlow, Essex, CM19 5GU (01279) 456789

Provided and run by:
Lloyds Pharmacy Clinical Homecare Limited

Important: We are carrying out a review of quality at Lloyds Pharmacy Clinical Homecare. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

10, 11, 12 October 2022

During a routine inspection

We last inspected this service in November and December 2021. Following this inspection, we took enforcement action against the provider due to the concerns we identified during the inspection. We issued the provider with 2 warning notices for breaches of regulation 17 and regulation 18 of the Health and Social Care Act 2014. The service was subsequently rated as inadequate and was placed into special measures by the Chief Inspector of Hospitals.

At this inspection in October 2022, we found that the service had made significant improvements.

Our rating of this location improved. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well on home visits. Staff assessed risks to patients, acted on them and kept good care records. Nursing staff worked within their working hours to deliver effective care at home including good Personal Protective Equipment and hand hygiene. The patient services department responded promptly to calls, the performance on the number of calls answered had improved with an average call wait time of 5 minutes. The patient support programme coordinators supported patients to administer specialist medicines safely at home
  • Managers ensured that staff completed all mandatory and specialist training relevant to their roles, and had regular team meetings, supervision and appraisals. Patient facing staff completed safeguarding training. Nurses referred safeguarding incidents to the Local authority via an NHS safeguarding application on their smartphones. Managers made sure staff were competent. Incidents at home and safeguarding incidents were well reported and escalated. Outcomes of incidents were shared with commissioners such as the NHS trust, and lessons learned were shared through ‘head of nursing town hall meetings’.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff reported the warehouse safety hazards via smart survey scan and actioned by senior leadership team. The service had a robust governance process and monitored its performance and risks regularly. The corporate and clinical risk registers included relevant risks and were monitored and managed effectively.

However:

  • The patient’s satisfaction survey was last done in 2020.This meant that the service had not captured recent views from patients.

The service had closed other registered locations in 2022 and brought all activities to the registered location in Harlow, Essex. However, there remained in Surrey, a Mobile unit, infusion centre and the healthcare centre. There was also the Patient support programme in Derby.

This report describes our judgement of the quality of care by the provider from this location. It is based on a combination of what we found when we inspected and a review of all information available to the Care Quality Commission including information given to us from patients, the public and other organisations. For this inspection, we looked at the 5 domains of safe, effective, caring, responsive and well led, and have applied ratings to each domain and an overall rating.

9, 10 November 2021 and 1, 2, 16 December 2021

During a routine inspection

Lloyds Pharmacy Clinical Homecare provided care to more than 100,000 patients, throughout the United Kingdom, in their own homes, places of work or in the community. Approximately 5,000 patients received nursing care from the service.

The Care Quality Commission completed an inspection of the services provided by Lloyds Pharmacy Clinical Homecare as part of our inspection methodology. For this inspection we looked at the registered location in Harlow, Essex, which covers the South East of England. The provider has three other registered locations in the West Midlands, South West and the North West of England. This inspection was unannounced, meaning the provider did not have advanced notice of the inspection.

This report describes our judgement of the quality of care at this location. It is based on a combination of what we found when we inspected and a review of all information available to CQC including information given to us from patients, the public and other organisations. For this inspection, we looked at all domains, and have applied ratings to each domain and an overall rating.

Due to the concerns identified during the inspection, we served the provider with a Warning Notice in respect of regulation Regulation 17, good governance and Regulation 18, staffing. A Warning Notice requires the provider to make immediate improvements to ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Chief Inspector of Hospitals is 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

This was the first time we have rated this service. We rated it as inadequate because:

  • The patient services department did not respond to contacts promptly and within the service’s policy timeframe.
  • Nursing staff were working in excess of their working hours to deliver effective care.
  • Managers did not ensure staff completed all mandatory or specialist training relevant to their roles, have regular team meetings or supervision and appraisals. Staff did not always feel respected or valued.
  • Although nursing staff were aware of and understood how to protect patients from abuse, managers had not ensured staff were reporting safeguarding concerns in relation to omissions of care and neglect. Patient service staff did not complete safeguarding training.
  • Managers did not ensure improvements were made following patient and staff surveys. Action plans from patient and staff surveys were incomplete, out of date and did not demonstrate on going monitoring or how improvements were being made.
  • The service did not have robust governance processes and did not monitor or update their performance and risks regularly.
  • The service did not complete regular clinical audits to monitor their performance and improvements over time.
  • The service did not ensure their corporate and clinical risk registers included all risks, were being monitored and being managed effectively.
  • The service did not ensure there were clear records to demonstrate how decisions to categorise and investigate incidents and complaints were determined.
  • The service did not ensure they notified the Care Quality Commission of events that stop, or may stop, the registered person from running the service safely and properly.

However:

  • Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from investigations.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • Managers worked hard to recover their position following a number of issues that led to a backlog of nurse visits and delays to responding to patients and referrers. The performance on number of calls answered had improved to 75% with an average call wait time of 6 minutes.

28 October 2013

During a routine inspection

We sent out questionnaires to 60 people who used the service and also enclosed a separate questionnaire for their relatives or advocates. We received 10 completed replies from people who used the service and six from their relatives or advocates. During our inspection we spoke with 12 people who received care from this agency and with the relatives of two people. We also spoke with four staff members.

People experienced care and treatment that met their needs and protected their rights. The majority of the people who responded to our survey told us the service they received was 'excellent' with the remainder of people rating it as 'good'. This view was reflected by most of the people we spoke with. One person told us, 'I am 100% happy with the service I get.' Another person said, 'Oh yes, they're very good, I get lots of different people but they are all excellent.' One person's relative said, 'They're brilliant with my [relative], they come every day and they only ever let us down once, but they sorted that.' However, three people expressed concern that they had seen a very recent increase in the number of staff who provided their care and treatment. These people also said the staff timekeeping had deteriorated.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found people receiving a service were protected by the recruitment checks that the provider carried out. This ensured only suitable staff were appointed to provide care and treatment.

There were effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and to assess and monitor the quality of service that people received.

There was an effective complaints system available and we found complaints were appropriately investigated.

2 January 2013

During a routine inspection

We spoke with the relatives of six people who used the service. They told us that they and their relative had been fully involved in the discussions to develop the care plan prior to the service being started. One of the relatives we spoke with told us that they were always involved when there were discussions to review the care provided. One told us, "They are fantastic. They are always on time and just get on with it."

We looked at the electronic copies of the care plans for five people. These were very detailed and included needs and risk assessments for every area affecting the care of the person. We spoke with six relatives of people who used the service. All told us that they felt that their relative was safe and protected by the care workers.

We looked at the training records for each of the regions and specialist areas of the organisation. These showed that the majority of staff had received updated training in safeguarding procedures within the last twelve months.

We looked at the records of four new staff members. Two had started work only after a full and satisfactory Criminal Records Bureau (CRB) check had been received. However the other two checks were still outstanding at the time of the inspection.

Documents that we saw showed the provider had regard to the comments and complaints made by people.