Merseycare Julie Ann Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.The provider was in legal breach of the regulation, good governance.

This service scored 36 (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 inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Governance systems were not robust or used effectively. The quality assurance systems in place were underdeveloped, limited in scope and where audits and checks were completed, these were ineffective. During discussions with the provider’s management team, they failed to demonstrate a clear understanding or recognition of the seriousness of the shortfalls in service delivery and their regulatory responsibilities.

A service improvement plan was in place, but this plan failed to identify some of the shortfalls we identified at this assessment or the severity of risk these shortfalls posed to people. At times, the management team did not demonstrate they were open or responsive to constructive feedback or understood the context of care and its impact on people’s experience. This made discussions about service improvements challenging.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

Governance systems were not robust or used effectively. The quality assurance systems in place were underdeveloped, limited in scope and where audits and checks were completed, these were ineffective. During discussions with the provider’s management team, they failed to demonstrate a clear understanding or recognition of the seriousness of the shortfalls in service delivery and their regulatory responsibilities.

A service improvement plan was in place, but this plan failed to identify some of the shortfalls we identified at this assessment or the severity of risk these shortfalls posed to people. At times, the management team did not demonstrate they were open or responsive to constructive feedback or understood the context of care and its impact on people’s experience. This made discussions about service improvements challenging.

People did not always feel they could speak up and that their voice would be heard.

People’s felt able to speak up about any concerns they had but had mixed opinions on whether they were actively listened to. For example, one person said they had raised concerns about a member of staff, he said “I rang the office and told them I didn’t want him coming back again and he hasn’t been sent again”. Other people also confirmed prompt action was taken when any concerns were reported about the staff team. This was good practice

However, people who raised concerns about late or too early visits or the skills of some staff felt they were not always listened to. One person said they had called the office staff “Quite a few times” to report late visits but nothing changed. Another person said, “Some of the carers come and they can’t cook…I have spoken to the office about this issue although I haven’t made a formal complaint I’ve just pointed it out. They say., ‘We will look into it for you and thank you for pointing it out’ but then nothing actually changes or happens”.

Most staff felt listened to by the provider. One staff member told us it was difficult to be heard and listened to in staff meetings but all staff felt confident raising concerns with the management team. The provider had whistleblowing and safeguarding policies in place to guide staff practice.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Most staff felt valued by the provider and equality and diversity was reflected in the workforce. However, one staff member mentioned it was sometimes difficult to get annual leave approved and another said, “Only issue is having time off with childcare/sickness and you lose a week’s work”.

The provider had policies and procedures in place to promote workforce equality, diversity and inclusion. This included ensuring staff with protected characteristics under the Equality Act 2010 had equal opportunity and equity in their working life”.

There was an employee assistance programme in place to support staff wellbeing. Staff told us they felt supported by the provider.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did have not systems in place to analyse, learn or share robust information about the service with partners to collaborate for improvement.

The service worked in partnership with the Local Authority, hospitals and other community partners to accept referrals into the service for people who required support in their own homes. Feedback from partners in respect of the referral process was positive.

It was not always clear however how the provider engaged with others involved in people’s ongoing care, to promote their care, safety and independence. There was limited evidence in people’s feedback and in their care records to demonstrate how the provider worked in partnership with other health and social care professionals. A relative told us an occupational therapist was helping the person improve their mobility. They told us, “I am not aware of any communication between the therapists and the agency staff but that doesn’t mean there hasn’t been”. Information about people’s needs and risks was also not always up to date to ensure people received seamless care when they needed support from partners.

There was no effective system in place to schedule and monitor people’s visits, staff attendance and time keeping. The provider had not ensured they had the capacity or skills within the organisation to efficiently analyse and share information about the service with partners. During our assessment, we had concerns about the provider’s ability to meet contractual agreements with partners such as the Local Authority. Following the assessment, we shared information about our concerns with them.

We saw that the provider had various initiatives to engage with the local community which was good practice.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did have not systems in place to analyse, learn or share robust information about the service with partners to collaborate for improvement.

The service worked in partnership with the Local Authority, hospitals and other community partners to accept referrals into the service for people who required support in their own homes. Feedback from partners in respect of the referral process was positive.

It was not always clear however how the provider engaged with others involved in people’s ongoing care, to promote their care, safety and independence. There was limited evidence in people’s feedback and in their care records to demonstrate how the provider worked in partnership with other health and social care professionals. A relative told us an occupational therapist was helping the person improve their mobility. They told us, “I am not aware of any communication between the therapists and the agency staff but that doesn’t mean there hasn’t been”. Information about people’s needs and risks was also not always up to date to ensure people received seamless care when they needed support from partners.

There was no effective system in place to schedule and monitor people’s visits, staff attendance and time keeping. The provider had not ensured they had the capacity or skills within the organisation to efficiently analyse and share information about the service with partners. During our assessment, we had concerns about the provider’s ability to meet contractual agreements with partners such as the Local Authority. Following the assessment, we shared information about our concerns with them.

We saw that the provider had various initiatives to engage with the local community which was good practice.

The provider had some processes in place to share learning and improvements ideas across the organisation. These systems were not effective and did not demonstrate a focus on continuous learning or that robust action was taken to drive up improvements. They did not actively contribute to safe, effective practice and research.

People’s feedback on the service and their experience of care was not used to learn from and continuously improve the service. Trends and themes in incidents, concerns, complaints and safeguarding events were responded to on an individual basis. We saw some evidence information about accidents and incidents were shared at staff meetings but there was limited evidence this was used to effectively to drive up improvements in the experience, outcome and quality of life for people.

There was a lack of effective audits in place to schedule, track and monitor people’s visits to ensure they were completed appropriately. There was limited evidence the provider has used visit data from their electronic care planning system to identify where improvements were needed or to ensure robust action was taken as required.

Some learning bulletins were shared across the provider’s services when critical incidents occurred. Staff meetings took place to discuss staff practice and other issues associated with the service. Regular management meetings took place to discuss service improvements, but we found these failed to recognise the level of risk associated with the widespread shortfalls identified at this service.

The provider’s service improvement plan did not fully identify the concerns we identified at this assessment. This raised concerns about the systems in place to identify where improvements were needed and the provider’s oversight of the service.

The outcome of CQC’s assessment was discussed with the management team but they were not always receptive or open to feedback from the inspection team where improvements were required. This raised concerns about the provider’s ability to listen, learn and continuously improve.