Merline Healthcare Ltd

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.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 39 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

Leaders described a strong intention to provide compassionate, community‑based care and spoke openly about wanting to learn and improve. Staff meetings were taking place and leaders described using these forums to discuss safeguarding concerns and operational issues. However, this vision was not consistently translated into practice. There was limited evidence that feedback from people, relatives and staff was routinely captured, analysed and used to drive improvement and to build an improved culture of safely and person centred care.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

The management team were not always effective in providing consistent oversight and assurance, despite being visible and approachable. They were involved in care delivery, spot checks and supervision, and staff told us management were available for support. However, leadership systems did not ensure safe, effective and inclusive management. There were significant gaps in oversight of delegated clinical tasks, staff competencies, recruitment processes and care documentation, including PEG care and medicines management.

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

The provider partly supported an open culture where concerns could be raised, but arrangements were not consistently effective. Staff were aware of safeguarding responsibilities and whistleblowing procedures, and leaders described encouraging staff to contact them at any time with concerns. Safeguarding incidents had been reported appropriately, including escalation to external agencies when required. However, there was limited evidence that concerns raised by staff, people or relatives were systematically analysed or used to improve the service. For example, recurring issues with late calls and rota pressures had resulted in complaints, but these were not always used to prevent reoccurrence. This meant people and staff could not be assured that speaking up consistently led to learning and improvement.

The provider did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider recognised the importance of equality and inclusion, and leaders described fair recruitment processes and support for international staff, including visa sponsorship arrangements. Staff were supported through supervision and were able to request additional training or support. However, systems did not consistently ensure equitable and safe working conditions. We found examples of staff working long consecutive periods without adequate breaks, and travel time was not always built into rotas. There was limited evidence that leaders routinely assessed the impact of these arrangements on staff wellbeing or equality of experience. This reduced assurance that workforce equality and inclusion were fully embedded across the service.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems were not effective in ensuring the safe and sustainable running of the service. Although the provider had audits and monitoring processes in place, these had not identified key risks, including gaps in medicines management, incomplete care records and weaknesses in recruitment and competency checks. Medication and care plan audits had failed to highlight issues found during our assessment, which meant we could not be assured that people were protected from harm. The provider was not always meeting working time regulations.

Leaders acknowledged that systems were still being developed. They had recently engaged external support to improve compliance, but these arrangements were not yet embedded or effective. As a result, governance arrangements did not provide sufficient assurance of quality or sustainability.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider worked with some external professionals, particularly in relation to end‑of‑life care, district nursing and safeguarding. There was evidence the provider liaised with health professionals for people with complex needs, including escalating concerns and joint working where risks were identified.

However, partnership working was not consistently well‑coordinated or clearly documented. For people receiving care from multiple providers, roles and responsibilities were not always clearly recorded, and there was limited evidence of structured information sharing or learning across organisations. This reduced assurance that partnerships were consistently supporting safe, joined‑up care for people in the community.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Leaders described a willingness to learn and had recently commissioned external compliance support and an improvement plan. However, these actions were reactive and had not yet resulted in sustained improvement.

There was limited evidence that learning from incidents, audits, complaints or feedback was systematically captured, analysed and shared with staff. Repeated issues, such as late visits or medicines recording gaps indicated that lessons were not consistently embedded into practice. As a result, innovation and improvement were not driving safer or more effective care.