Merline Healthcare Ltd

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment, recruitment and staffing.

This service scored 50 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Learning from incidents and complaints was not always embedded. Incident logs and action plans were in place, but there was limited evidence that themes, such as repeated late visits or medication issues, had been analysed and used to improve practice or prevent recurrence.

There were systems in place to support learning, improvement and reflection; however, these were not consistently effective in identifying risks or driving improvement.

The provider told us they were “open to learning,” had engaged a consultant and begun developing improvement plans following our assessment feedback.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Processes to support coordination of care, including recording systems and task monitoring, were in place but not always used effectively to ensure ensuring safe and consistent outcomes for people.For example, the provider had an electronic system where care tasks were set, and staff had to record when these were completed; however, some tasks were not specific enough to provide assurance that care had been delivered as required.

There was insufficient clarity and management oversight regarding delegated clinical tasks. Documentation did not clearly evidence which tasks staff were responsible for, or how clinical oversight was maintained and reviewed, particularly where care was shared with other providers.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems were in place to safeguard people from abuse and staff demonstrated an understanding of safeguarding processes. Staff were able to describe types of abuse and the actions they would take, including escalation to management, local authority safeguarding teams or emergency services where required.

The registered manager understood safeguarding responsibilities and there were systems for recording and responding to concerns. They maintained safeguarding records and liaised with external agencies, such as the police and safeguarding teams when risks were identified.

Relatives told us they felt care was safe and did not raise any safeguarding concerns.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider described a personalised approach to assessing risk, including visiting people prior to starting care and involving family members and professionals where appropriate. However, systems to ensure risk management plans were consistently followed were not always effective. Risks linked to people who were receiving clinical care were described in their care plans, however care notes did not always evidence care was being provided as planned. There was a lack of evidence that staff had their competency assessed to complete clinical care. There was no evidence of regular reviews of care completed by those with responsibility for clinical oversight.

We found examples of risk assessments which lacked sufficient detail to guide staff in safe practice.

We did not find evidence that these risk management issues were having a detrimental impact on people’s health, but there was a risk of this happening. Some assurances were provided by the registered manager and some actions taken, in response to our assessment findings.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

People were supported in their own homes and environmental risks were assessed. However, the provider could not demonstrate they had an appropriate oversight of the equipment used by staff to complete moving and handling manoeuvres. This information was requested during our site visit and was only provided after our third request. We were able to confirm the equipment was safe to use, however the lack of management oversight meant we could not be assured that any issues would be timely identified and acted upon.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support. They did not work together well to provide safe care that met people’s individual needs.

There were significant concerns regarding staffing, recruitment and deployment which impacted the safety of the service.

Recruitment processes were not consistently safe or in line with the provider’s own policy. We found incomplete application forms, gaps in employment history not explored, and references not always obtained from the most recent employer.

Staffing deployment was not effective. Rotas did not always allocate travel time between visits and staff sometimes worked consecutive shifts without adequate rest, including examples of reduced rest periods below expected standards.

Call monitoring systems were not used effectively. There were multiple accidents, complaints and recordsshowing late visits, but no evidence that this information had been used to improve the service.

There was insufficient assurance that staff were competent to deliver clinical care. Competency checks lacked detail and did not evidence robust assessment of staff skills.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff received training in infection prevention and control (IPC), including safe practices when supporting people with clinical interventions such as having their meals through a feeding tube called PEG, catheter care and stoma care.

Staff were able to describe appropriate IPC procedures, including the use of personal protective equipment (PPE), maintaining hygiene, and identifying signs of infection.

The provider ensured PPE was available and staff followed standard precautions when delivering care.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines were not always managed safely, and systems in place were not effective in identifying and addressing risks.

We found examples where protocols for ‘as and when required’ medicines were not sufficiently detailed, meaning staff did not have clear guidance on when these medicines should be administered.

There was a lack of evidence that prescribed creams were consistently administered.

Medicine audits and oversight was not effective. We found gaps and inconsistency in medicine administration records, which had not been identified through audits. Medication audits were limited and did not cover other aspects of medicines management, in line with best practice guidance.

Staff’s competency to administer medication had been assessed and staff could describe safe practice.

The registered manager took actions to address the issues found during our assessment and we did not find evidence that these recording and quality assurance issues had had a negative impact on people. However, the issues created a potential risk of harm to people.