We are 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.

We rated LANCuk as requires improvement because:

• The registered manager had not taken sufficient action to remedy the concerns we raised at the last inspection. Patient records were not current and there were many sessions where records had not been completed. The registered manager had not taken action in relation to the provision of alarms in the interview rooms, providing a height measure in the Heywood base nor advising patients how to complain about the service.
• Risk assessments were not completed for all patients. The registered manager did not have oversight of safeguarding alerts or concerns.
• Several improvements were at an early stage including the introduction of senior management team meetings, appraisals and supervision for staff.
• Policies did not reflect the nature of the service. Mandatory training was not identified in the training and development policy. The duty of candour policy did not fully reflect the regulation. The calibration of equipment had not been identified as a requirement.
• The registered manager had not been proactive in communicating with the CQC in relation to requests for information, submitting statutory notifications and meeting the regulations of displaying the rating.

However:

• Patients feedback about the service was positive. Patients told us staff were very helpful and respectful, they were given information about their treatment and understood this.

• Staff had a good understanding of patients’ needs and respected their confidentiality.

We rated Learning Assessment and Neurocare Centre Limited as inadequate because:

• There was no training that was determined mandatory for staff in order for them to have the skills they needed for their job roles. There were no records of training for sessional staff available.

• Safeguarding training was not completed for staff and the policy gave limited direction to support staff. There was no system for staff to alert others if there was an incident whilst seeing a patient alone.

• The duty of candour policy did not identify what level of harm would need a duty of candour response.

• We were not assured the provider had good oversight of risks of people waiting to be seen because contact from patients were not recorded.

• Staff were not receiving supervision or appraisal.

• Patient records were not contemporaneous and incomplete.

• There were limited records that appropriate checks on staff suitability had been carried out.

• All patients we spoke to told us they were not given information on how to complain.

• We did not find sufficient arrangements in place for the provider to determine the quality of the service provided and make improvements.

• Staff had not received appropriate checks prior to commencing their role. The provider could not evidence that appropriate checks had been carried out prior to staff commencing in their role. In ten staff files we reviewed there were no application forms, curriculum vitae, references or DBS checks. In addition, there was no evidence of staff training either at LANCuk Ltd or at sessional workers permanent roles.

However:

• The premises were visibly clean, tidy and were suitable for patients.

• Staff at the service had reported no serious incidents in the twelve months leading up to our inspection. However, it was difficult to know if there had been any due to the lack of documentation at the service. We did not find any evidence on the day of our inspection that any serious incidents had occurred.

• All records we reviewed contained a full assessment.

• The service liaised well with others such as GPs. were good examples of shared care agreement with patients GPs.

• The provider followed national institute of health and care excellence guidance for assessment, diagnosis and prescribing of medication.

• There was an effective multidisciplinary team approach.

• Staff told us they were supported and could approach colleagues for advice with complex cases.

• All patients we spoke to told us that staff treated them with dignity and respect. Carers we spoke to told us that staff involved them in decisions about their loved ones care and

  felt they genuinely took an interest in their problems. Patients told us they were consulted about their treatment options and given information to help them make an informed decision. The rooms that were used for patient appointments were adequately soundproofed for confidentiality. Information about advocacy services were displayed for patient to use. Patients could give feedback via surveys and comment boxes.

• The provider was meeting targets for referral to assessment time. Patients were able to access staff quickly via telephone or email. There was a full range of rooms to provide treatment and care. The premises were accessible for people requiring disabled access via a ramp. Interpreters were available for patients whose first language was not English.

• Staff morale was high and staff felt empowered in their roles. There was an open and honest culture at the service.