Disability care service put in special measures after critical report

The Care Quality Commission (CQC) inspected the West Bromwich-based Sandwell Community Caring Trust, run by a charity, in June.

Concerns were raised that the service was not always obtaining people's consent for care and treatment, which is required by law – and the inspection substantiated these concerns.

Following the inspection, Sandwell Community Caring Trust was rated inadequate overall and for being effective and well-led. It was rated as requires improvement for being safe. The service had previously been rated as good overall.

The CQC also placed the service into special measures – which will see it inspected again within six months. If fundamental improvements have not been made by the time of the next inspection, CQC will take further enforcement action to ensure people are not exposed to a service which does not meet standards they have a right to expect.

However, a spokesman for the Sandwell Community Caring Trust said the organisation was left "devastated by the findings" in the report – adding that areas where they received the "fiercest criticism" they had been commended for in a previous report. The spokesman added that they were taking urgent steps to address concerns raised in the report with an action plan in place.

The inspection found the trust made decision about people's care without involving them and where it had no legal authority to do so – including administering their medicines covertly and using surveillance equipment, which did not follow the principles of the Mental Capacity Act (MCA). The report stated that the situation had developed because the service's senior leaders had not ensured staff received the right training. Leaders had also not taken all reasonable steps to ensure national guidelines were followed.

Inspectors also found the service had not mitigated all restrictions affecting people that it could address. This included failing to explore all options to ensure people could move freely around their homes.

However, people did provide positive feedback about the service and they reported having good relationships with staff providing their care. The service did not use agency workers, so people benefited from consistency.

The report stated: "We found decisions had been made on behalf of people who lacked capacity without the principles of the MCA having been followed. This included using surveillance equipment and administering medicines covertly. The management team had limited knowledge of MCA and the process of how decisions should be made for people who lacked capacity.

"Most staff hadn't received any recent training in relation to MCA and some staff had never received training. Staff knowledge was limited."

Debbie Ivanova, CQC deputy chief inspector for people with a learning disability and autistic people, said: "Our inspection of Sandwell Community Caring Trust found the service did not always involve people in important decisions about their care. People should always be supported to have as much choice and control over their lives as possible, so this is unacceptable.

“We also had concerns about how the service managed its safeguarding responsibilities, people’s records and staff training. Behind this was a lack of oversight from its leadership to ensure best practice was followed and to support staff to provide good care.

“However, people and their relatives said they felt safe using the service. We also found it took steps to manage the risk of infection, including for Covid-19, and it sought positive outcomes for people’s overall physical health.

“We continue to monitor the service closely and will take further action if we are not assured it is making necessary improvements.”

A spokesman for the Sandwell Community Caring Trust said: "Sandwell Community Caring Trust has been providing care and support to adults with learning disabilities for almost 25 years and the rating of our services has always been good.

"Our primary focus has always been on providing high quality services valued by the people we care for and their families.

"Our organisation is therefore devastated by the findings in our report and the language used in the press release. We would like to point out that some of the areas for which we received the fiercest criticism in our report, we were commended for in our previous report in 2019.

"The decisions which were made regarding the people we care for and support were always made openly and transparently and with the knowledge and support of the other external professionals and their families.

"It is important to understand that the criticism in the report is almost exclusively concerned with the way in which decisions were recorded because they did not clearly show the decision making process.

"In 25 years our record of safeguarding and keeping people safe has been exemplary.

"Our organisation has taken urgent steps to address the concerns highlighted by our regulator. We already have an action plan in place which has been accepted by our regulator and in a recent email they stated they were assured by our prompt and comprehensive response.

"We are pleased that the regulator acknowledged that the people we care for and support and their families were happy with the service they received and felt safe being cared for by our organisation.

"The report also acknowledges that we have a very stable staff team who know and understand the people they care for very well and that we have managed to keep them safe during the Covid-19 pandemic.

"We look forward to continuing our work with our regulator and an early re inspection so that we can demonstrate that we have listened and learned and are continuing to deliver the high standards of care for which we have always been known."

The trust cared for 150 people across 66 supported-living settings at the time of the inspection.