Merseycare Julie Ann Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure records demonstrated a positive culture of safety. There was a system in place to record accident and incidents. While we were assured the necessary action was taken immediately following incidents to ensure people’s safety, we found not all follow up actions were recorded in a timely manner. For example, the follow up actions were not completed for 6 falls until several weeks after the incident. This increased the risk leaders would not have oversight of all actions taken which could impact the overall reliability of timely incident analysis.

However, the provider had made some improvements to learning culture following our last assessment. Accident and incident analysis was undertaken and there was a greater focus on managing staff performance issues. A reflective practice was completed with staff when things went wrong, and issue specific supervisions were carried out to reduce the likelihood of incidents recurring.

People, relatives and staff told us the provider had learned lessons following our last assessment and they described improvements to the overall quality and safety of the service. Comments included, “It’s been excellent since the middle of last year” and “There’s been the most remarkable improvement since about eight weeks ago."

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. Effective systems were in place to ensure people could transition to the service safely. Care plans were developed in a timely manner which took into account information shared by external professionals such as people’s health conditions and the risks associated with these.

Safe systems were in place to ensure continuity of care. The provider employed emergency responders who were able to respond to staffing emergencies when needed. Continuity of care was considered and planned for in a business continuity plan.

Staff described effective systems of communication about people’s needs prior to them receiving care. Most staff told us they were provided with an overview of the persons needs before the calls took place. A staff member told us, “The office do tell us things. They say you’ve got this new call and give us a bit of information. We always make sure we read the care plan before we go into a new call. We wouldn’t go into a call without reading the care plan."

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Effective systems were in place to respond to and report safeguarding concerns. The provider shared concerns quickly and appropriately.

Staff understood their safeguarding responsibilities and described the action they would take if they felt someone was at risk of abuse or harm.Staff described how improvements to initial assessments was key in identifying any safeguarding concerns early on. For example, we saw evidence how the provider took responsive action when a person was discharged from hospital unsafely.

People told us they felt safe in the care of staff. Comments included, “At no time have I felt unsafe or unconfident”, and “[Person] is safe. It’s like we have known [Staff member] all our life."

The provider did not always ensure staff were provided with detailed guidance to mitigate risks. Individual risks including risks associated with people's health conditions were assessed and mitigated. However, some further improvement was needed to ensure all records were sufficiently detailed to effectively guide staff in reducing the risk of harm. For example, where people had risks associated with health conditions such as diabetes, we found risk assessments were not always fully descriptive about the signs and symptoms staff should look out for that may indicate the person was unwell. Although we identified shortfalls in relation to the detail in some risk assessments, our conversations with staff found they knew people well and they could confidently describe the action they took to reduce the risk of harm when delivering care.

The provider was responsive to the feedback and took action to improve records during the assessment process and shared their ongoing action plan which detailed the work they were already undertaking to improve the quality of the records.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental risks were assessed and mitigated. Staff understood the need to escalate any environmental concerns to the provider for action.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff were safely recruited. The required background checks, induction, training and shadowing opportunities were completed before staff started working independently.

At our last assessment, we found concerns with people’s call times, the duration of the calls and a lack of continuity of people’s staff teams. At this assessment, the provider demonstrated the hard work they had undertaken to improve, and we identified improvements across all areas.

People, relatives and staff reported improvements in their care calls. A relative told us, “[Person] had different carers all the time, but in the last 8 weeks it has improved dramatically and now [Person] is having the same carer morning and early afternoon and the same carer evening and late evening and is now familiar with their faces and is building a rapport with them, and I am very pleased now with how it has progressed since 12 months ago.” A person told us, “It’s got more regular now, a lot better. One time they would be coming after 4pm, but it’s very regular now. I have a good idea to within five minutes when they are going to be here. I would say in the last month or two months, it’s got more organised."

The provider assessed and managed the risk of infection. Individual risk assessments were completed to assess and reduce infection control related risks. Guidance was provided in people’s care plans on how staff should dispose of waste and carry out domestic tasks to ensure the cleanliness of the environment. The provider completed regular spot checks and staff were assessed on their effective use of PPE.

People told us staff followed good hygiene practices. Comments included, “My routine is for personal care and then breakfast, and they do change their gloves from one task to the other” and “They wear gloves all the time and nice clean uniforms."

Systems and processes to ensure the safe management of medicines were not always operated effectively. While staff told us they had received medicines training and had their competency checked, the provider was unable to produce records to show all staff had received a competency assessment to ensure they could administer medicines safely. Records showed most medicines were given appropriately however, we identified inconsistencies in some people’s medicines records. For example, not all prescribed medicines were included on some people’s individual medication administration records. We followed up on this and gained assurance people had generally received their medicines as prescribed however, a failure to maintain accurate records of medicines increases the risk of medicines related harm.

The provider was responsive to our feedback and took immediate action to reduce the risk of harm such as completing medicines competency assessments and taking action to strengthen medicines auditing processes.