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 that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not safe and were at risk of avoidable harm. The provider was in breach of the legal regulation, safe care and treatment.

This service scored 38 (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 have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

A review of the provider’s systems and processes highlighted shortfalls in visit monitoring, the prevention of risk and incident reporting. There were a lack of managerial oversight and a significant number of missed opportunities to review and learn from the systems in place to plan track and monitor people’s visits including the deployment of staff. As a result, a cycle of poor visit punctuality and continuity was repeated with little consideration given to the impact on people’s welfare.

Provider led best practice meetings took place to discuss areas for improvement across all of the provider’s services. For example, in respect of medication practice, care plans and staff rotas. Information about accident and incidents was also discussed. The provider however did not use these meetings effectively to help identify and drive improvements at this service in respect of visit scheduling, monitoring and delivery.

Individual accidents and incidents were recorded and investigated, but it was unclear how this information was collated and used to make overall improvements to the service people received.

There was little evidence accident and incidents were analysed regularly at the service to identify recurring themes or trends. Learning in how, when and why accidents and incidents occurred at the service was not productively shared or analysed to embed good practice.

The provider did not establish and maintain safe systems of care in order to ensure people’s safety was managed and monitored. They did not make sure there was continuity of care, including when people moved between different services or needed support from different health care partners.

People’s needs, risks and care were not adequately assessed when they first started to receive support or through regular reviews. Records maintained in relation to people’s needs, risks and care were not accurate or up to date to ensure a safe and positive transition to other services if needed.

There was also no effective system in place to ensure people going to hospital were reviewed on their return home to ensure their support remained safe and appropriate. One person was admitted to and remained in hospital for over a week. No information on the reasons why the person was admitted, their diagnosis, the treatment they received or the care they required post discharge had been obtained by the service prior to, or on their return home.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People said the majority of staff were kind and respectful. Some people felt safe with the support they received, whereas other raised concerns over visit punctuality and reliability which impacted on their wellbeing. One relative reported on one occasion due to staff being late, they found the person lying in their own faeces. They told us they had raised numerous concerns with the provider about the punctuality of visits. Another person said they only felt safe with certain staff helping her with a shower, and other staff they only allowed them to assist her with a wash.

Some people told us they did not receive a telephone call from office staff to advise when staff were going to be late for their visit. Some people also said it was difficult to get in touch with the office by phone, which worried them if there was an emergency.

We reviewed information relating to people’s visit times. A significant number of visits were either late or much earlier than planned. Some people experienced visits over 2 hours late or 2 hours early. Some people’s visit to support them for bed were being provided much earlier than planned, which meant they went a significant period of time before their morning visit.

This was not good or safe practice. Late and irregular visits expose people to the risk of avoidable harm, neglect and distress.

We reviewed a sample of safeguarding incidents and concerns. Some incidents were repetitive in a nature for example, visits incorrectly cancelled or amended by office staff leading to missed visits. Some incidents had not been identified as a safeguarding concern appropriately.

Records showed investigations into incidents took place but records were not always fully completed to show the action taken. Some safeguarding events had also not been reported to the Care Quality Commission in accordance with regulatory requirements for us to assess whether appropriate action to protect people had been taken.

The provider did not work well with people to understand and manage risks. Staff did not have adequate information on people risks or guidance to ensure people’s care was safe, supportive and enabled people to do the things that mattered to them.

People were exposed to the risk of harm, as people’s needs and risks were not adequately assessed and staff lacked guidance on how to mitigate risks to their health and welfare.

Some people lived with complex health conditions. Staff lacked information on these conditions, how they impacted on people’s lives, the signs and symptoms to spot in the event of ill-health and the action to take. For example, one person lived with epilepsy. There was no epilepsy risk assessment or management plan in place. This meant staff lacked critical information on the type of epilepsy the person lived with, the frequency and duration of a usual seizure, potential seizure, the early warning signs of a potential seizure to spot and the action to take to in the event of a seizure to prevent avoidable harm.

Some people had individual risks associated with falls, skin integrity, nutrition, moving and handling, the self-administration of medicines and the safety of the equipment which had not been properly assessed. This meant staff lacked adequate guidance on how to mitigate these risks during the delivery of personal care. For example, one person had a history of falls and injury, but no falls risk assessment or management plan was in place. Another person had a pressure wound, but no skin integrity risk assessment or adequate management plan was in place to advise staff how to mitigate the risk of decline or further pressure sore development

The provider failed to carry out regular environmental risk assessments of people’s homes to ensure the equipment in use during the delivery of person care was safe and fit for purpose. Where risks were identified these were not always followed up to ensure risks were addressed.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always make sure there were enough qualified, skilled and experienced staff deployed effectively across the service. Staff did not always work together well to provide safe care that met people’s individual needs. The provider has systems in place to ensure staff received supervision and support from their line manager.

Staff deployment required improvement along with the scheduling of people’s visits. People’s scheduled visits did not always correspond with the time agreed in their care plan. Staff were given a rota which specified the dates, times and duration of people’s visits. Staff did not always follow the rota, completing visits in a different order and time than scheduled. This meant people experienced visits that were often late or too early which placed them at risk of avoidable harm.

The provider had not identified or addressed poor visit punctuality and failed to monitor and address staff practice to ensure risks to people’s health, safety and welfare were mitigated.

Staff were recruited safely to ensure persons employed were safe to work with vulnerable people. The provider had a mandatory training and induction programme for all staff to complete. Training was refreshed at specified intervals. We saw that all 265 members of staff on the provider training matrix had completed the required training. 29% (77 staff) needed to refresh some areas of their training to ensure their knowledge was up to date.

Staff told us they felt trained and supported in their job role. They confirmed they had an induction when they first started working for the provider. One staff member told us, “My induction was over 4-5 days. It included mandatory training and shadow sessions” with more experienced members of staff. Ongoing spot checks were completed on staff practice and staff members had regular supervision meeting with the line manager. Some staff told us they had had an appraisal, other staff told us they had not.

People had mixed opinions on the skills and experience of staff. Comments included, “I think the staff are well trained. They are able to use the hoist safely”, “Trained good”, “No, (younger carers) can’t do practical things, no idea how to prepare food like egg on toast or how to put the cooker on” and “I don’t think they get enough training, for example, some carers come, and they can’t cook”. A relative also felt staff needed more specific training or knowledge of the person’s specific health condition so they could appropriately support their loved one.

We saw the provider had received compliments from some people using the service or their relatives on how kind some of the staff were.

The provider did not have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

A review of the provider’s systems and processes highlighted shortfalls in visit monitoring, the prevention of risk and incident reporting. There were a lack of managerial oversight and a significant number of missed opportunities to review and learn from the systems in place to plan track and monitor people’s visits including the deployment of staff. As a result, a cycle of poor visit punctuality and continuity was repeated with little consideration given to the impact on people’s welfare.

Provider led best practice meetings took place to discuss areas for improvement across all of the provider’s services. For example, in respect of medication practice, care plans and staff rotas. Information about accident and incidents was also discussed. The provider however did not use these meetings effectively to help identify and drive improvements at this service in respect of visit scheduling, monitoring and delivery.

Individual accidents and incidents were recorded and investigated, but it was unclear how this information was collated and used to make overall improvements to the service people received.

There was little evidence accident and incidents were analysed regularly at the service to identify recurring themes or trends. Learning in how, when and why accidents and incidents occurred at the service was not productively shared or analysed to embed good practice.

Staff made sure people’s medicines were administered appropriately and met people’s needs, capacities and preferences. The provider involved people in planning, including when medicine changes happened. However, documentation did not always reflect this accurately.

We saw staff administering medicines in a kind and caring way. Staff knew people well knew and how they liked to take their medicines. Staff recorded when medicines were given, and records showed most medicines were given appropriately. Most people who were prescribed time critical medicines which needed to be given at a set time had the time of their visits co-ordinated with this, so they received their medicines at the right time. A relative of one person who required time critical medicines however told us the person did not always get their visit or their medicines at the right time.

We checked the medicine records for 17 people. Records in relation to people’s medicines were not always accurate. For example, one person’s medicine record listed the same medicine twice, another did not explain a personal preference to manage some medicines but not others. One person was at times, self-administering their own medicines without an appropriate risk assessment or management plan in place to check they were capable or safe to do so.

A system for auditing medicines administration was in place, however the system did not ensure records in relation to medicines were regularly reviewed to ensure they were correct.

The management team were aware improvements to the management of medicines were needed and already had a plan in place. Additional medicines training and induction processes had also recently been introduced. This had a positive impact on the number of medicine errors made in the last 6 months.