Lloyds Clinical

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.