Merit Care 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. At our last assessment we rated this key question good. At this assessment the rating has changed to 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 the safe management of people’s medicines and the safe recruitment of staff.

This service scored 56 (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 mainly had a proactive approach and a positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and staff told us they felt able to raise concerns and were confident anything raised would be acted upon. Staff understood the importance of recording and reporting incidents to the managers. They told us regular staff meetings were held to discuss and learn from any incidents. One staff member said, “Yes we are always learning in the organisation, and we share information in staff meetings.”

A tracker system was used to log all incidents and monitor the progress of any actions needed. Whilst, we found incidents had been reported to relevant authorities and professionals; there was not a consistent approach in notifying CQC. We found a small number of significant incidents had not been reported. We raised this with the provider, who agreed to extend their tracker system to include notifying CQC to ensure there was a consistent approach in the provider’s legal requirements.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Assessments of people’s need and associated risks were completed during the initial assessment of care to ensure safe and effective support. This assessment informed people’s care plans and risk assessments. However, it was unclear how people’s consent to care was documented. We requested the provider considers how they lawfully recorded people’s consent to care, particularly when assessing people who live with a cognitive impairment.

When people’s needs had changed, timely referrals were made and tracked to ensure the correct care and support was in place, such as referrals to an occupational therapist for specialised equipment. People and their relatives told us they had been involved in their initial assessment. One relative said, “Mum had a very in-depth assessment. I had not experienced being part of one before and I was very impressed.”

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.

Staff were aware of the importance of reporting any safeguarding concerns and provided examples of when they had become concerned about people’s safety and possible abuse. They were confident the management team would take the appropriate actions. A safeguarding tracker was in place to provide oversight of safeguarding concerns. The provider shared concerns appropriately and in a timely manner to the relevant safeguarding agencies. However, there was not a consistent approach in notifying CQC of all safeguarding concerns.

Staff and managers had been trained in safeguarding for adults and children. However, it was difficult to assess if staff and managers had received the level of safeguarding training appropriate to their role.

People raised no concerns about their safety while being supported by staff. One relative said, “What the carers give, they are all lovely they think the world of her, they have never treated her badly. Credit to them they are all good They do all the lifting and intimate stuff. They are very polite, very professional, very kind and very chatty.”

People received a copy of the providers service user guide which explained the provider’s complaints and safeguarding processes.

The provider was not consistent in their approach to understand and manage people’s risks. Recorded guidance on how staff should support people to help reduce their personal risks were not always detailed.

People’s care records and risk assessment and management plans did not always reflect in detail the recommendations made by health care professionals. For example, the care plans of people who were at risk of skin breakdown did not fully describe the management of their skin to help prevent skin breakdown. The agreed resuscitation status of people and their priority of care in the event of adverse weather conditions or in an emergency was not always recorded. This meant people may not receive personalised care in line with their support and health needs.

However, people spoke positively about the support they received. We received comments from people such as, “When I came out of hospital I had bedsores. They cleared them up and I haven’t had one since they have been attending to them” and “They will do anything I ask. I couldn’t do without them. I am in a wheelchair 14 hours a day. They always check me over to make sure everything is OK and then they put cream on my legs and feet before they put socks on for me.”

Staff were knowledgeable about people’s care needs and risks and knew the importance of escalating any concerns about changes in people’s well-being to the managers of the service. Staff were aware of the actions they should take if people didn’t answer their doors or refused care. One staff member said, “We take time to explore the reasons behind their refusal, offering encouragement and allowing space for reconsideration. We report any concerns to the care coordinator and document it in their care notes.”

The provider was in the process of implementing an electronic care management system which would assist staff and managers to comprehensively record and monitor people’s personal information, care and risks. Further time was needed to assess if the system would be effective.

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

We reviewed 5 staff recruitment files and found employment and criminal checks had been completed. However, we found there was limited evidence that the provider had explored staff’s health history and reason for leaving and gaps in their previous employment. This meant the registered manager could not be fully assured about the suitability and safety of conduct of staff. The provider had acted on feedback about recruitment at our last inspection; however, these improvements had not been sustained.

Staff said they felt supported and trained in their role. One staff member said, “Yes, we are well-trained and supported. If I raise a concern, they [managers] are quick to respond to the challenge and solve the problem.” A training matrix was in place to help the registered manager to monitor staff training.

Systems were in place to plan and monitor staff call times. People and their relatives raised no concerns about the reliability and punctuality of staff to deliver their care. They told us they were mainly supported by regular staff members who arrived on time, and they were informed if staff were running late. Staff told us their rotas were issued weekly and could also be accessed online.

Staff told us they received regular supervisions, and their practices were checked by senior staff. The provider acknowledged their records of staff probation records, supervisions, competencies and observations of staff practices required more detail. This would assist managers in monitoring the conduct and skills of staff and to demonstrate their understanding of the required practices. For example, staff’s infection control practices were checked but there were limited records of the different aspects of good infection control practices.

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 infection, prevention and control (IPC) training. Staff confirmed they had completed training and had access to supplies of personal protective equipment (PPE). There were no concerns raised by people or staff about the availability and use of PPE.

One relative said, “Everything they do is done with total cleanliness their basic job is treating sores and putting barrier cream on. They change the gloves between various jobs, after changing the catheter, after washing my wife down.”

Whilst people raised no concerns about the management of their medicines; the provider had not always ensured there were detailed medicines records for staff to follow. Clear medicines records help to reduce the risk of mismanagement of people’s medicines and reflect their needs, capacities and preferences.

People's medicines plans did not consistently detail the shared responsibilities of people’s medicines and how they preferred to take their medicines including clear protocols for medicines to be administered 'as and when' needed and topical creams. Information about the dose, route and frequency of people’s medicines were not explicitly recorded. This meant staff did not always have access to recorded guidance on how to safely administer people’s medicines.

People raised no concerns about the management of their medicines. We received comments such as, “They come twice a day and oversee my medication and rub cream on my back. It is so painful, my spine is absolute agony all the time. One of the care workers pops back in her own time in lunchtime to rub some cream on again it is just lovely of her.”

However, the provider was responsive to our feedback and started to make improvements to people’s medicine records. The provider was in the process of implementing an electronic care management system which will assist them to comprehensively record and monitor the administration of people’s medicines.