We carried out an inspection of Merseycare Julie Ann on 31 October and 2 November 2016. The inspection was unannounced.Merseycare Julie Ann provides domiciliary care services to approximately 700 people living in their own homes.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
The majority of the people that we spoke with told us that they felt the service they received was safe. Only two people who used the service responded to our questionnaire, but both said that the service made them feel safe.
The care files that we saw showed evidence risk had been assessed and reviewed regularly. Risk assessment was undertaken at the initial assessment phase and reviewed regularly once the service had started. However, we found examples where risk could not be safely managed because the risk management plans were lacking in detail.
You can see what action we told the provider to the back of the full version of this report.
Prior to the inspection we had received information of concern relating to allegations of abuse and neglect. We spoke with the registered manager about some of the more serious concerns relating to late or missed calls and thefts. After reviewing the relevant records we were satisfied that the provider had acted in a professional and timely manner to address each of the concerns.
The majority of care records that we saw were reliant on pre-admission information provided by the local authority. It was sufficiently detailed and contained some personal information. However, Merseycare Julie Ann had not consistently reviewed its own care records to ensure that the information had been transferred, or that personal information had been included.
We have made a recommendation regarding this.
We noted from our pre-inspection information that no notifications of deaths had been submitted recently. We spoke with the registered manager about this who confirmed that other notifications had been submitted as required and we saw evidence of this. However, they were unsure about notifying the CQC about deaths because of the nature of the service. The relevant notifications were submitted after the inspection.
Incidents and accidents were subject to a formal review process by the registered manager. We saw that these reports were sufficiently detailed and recorded where actions had been completed.
The service had sufficient staff to cover its responsibilities. Staff were recruited following a process which included individual interviews and shadow shifts. Each offer of employment was made subject to the receipt of two satisfactory references and a Disclosure and Barring Service (DBS) check. The staff records relating to people who had transferred from another provider were lacking in critical detail although Merseycare Julie Ann had requested the information.
Each of the staff that we spoke with confirmed that they had completed training in the administration of medicines and felt confident in their abilities. The records that we saw and the comments that we received indicated that medicines were administered safely.
The majority of staff were supported by the organisation through supervision and appraisal. However, some staff reported that they had not received regular, formal supervision.
We have made a recommendation regarding this.
Staff had been recruited and trained to ensure that they had the rights skills and experience to meet people’s needs. New staff were required to complete an induction programme which was aligned to the Care Certificate.
The majority of people spoke positively about the way in which care was delivered. Comments included, “Very friendly”, “Polite, lovely girls”, “Thank goodness for them”, “They are nice people” and “We are more like friends.”
The staff that we spoke with knew the people that they cared for and their needs in detail. Staff told us that they usually had sufficient time to focus on the person and not the task. We saw that care plans were not always sufficiently detailed to inform new carers and good care practice sometimes relied on the carer’s knowledge of the people concerned.
The care records that we saw used language which was respectful when describing people and the care provided. In response to our questionnaire 100% of people using the service and their relatives said that they were treated with respect and dignity.
People using the service and their relatives were encouraged to provide feedback to the organisation through informal and formal mechanisms. Monthly telephone service reviews were completed with a selection of service users which covered a range of topics and gave people the opportunity to provide feedback and raise concerns. The majority of people that we spoke with were satisfied with the service and had no complaints.
The service had a clear set of values and expected behaviours which were clearly defined in policies, staff information and the service user guide. There was a focus on holistic care, independence, maximising people’s quality of life and treating people with respect. These values were consistently evident in conversations with care staff and managers.
The staff that we spoke with were motivated to provide high quality care and understood what was expected of them. They spoke with enthusiasm about the people that they supported and their job roles. One member of staff said, “I feel happy in my job. It gives me satisfaction.” Another member of staff told us, “I love my job. I will go the extra mile for them [people using the service].”
The registered manager and director were aware of the day to day culture and issues within the service. The scale of the service made it difficult for them to know the people that received care and their staff in any detail, but they were able to provide examples of good practice when required and were able to respond to specific issues raised during the inspection.
Audit processes had failed to identify issues and concerns relating to the quality and completeness of care plans and risk assessments.
We have made a recommendation regarding this.