Archived: Meridian Health and Social Care - Lincoln

Meridian Health and Social Care – Lincoln provides care for people in their own homes. The service can provide care for adults of all ages. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs and or a physical disability.

At the time of our inspection the service was providing care for approximately 141 people most of whom were older people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

The provider had a quality assurance policy in place. However, the policy did not describe a clear scheme of delegation for undertaking audits to ensure regulatory compliance. There was insufficient detail regarding monitoring timeframes and who was responsible for the quality assurance process.

There was a lack of quality assurance processes in place to monitor the quality of the service and address shortfalls. For example, the provider did not audit planned hours against actual hours delivered.

People did not always receive their visits at the times they expected, people did not always receive their hours of care in line with their care plan and planned hours of care. Staff were not deployed effectively in order to meet people’s needs.

Medicine records had a lack of guidance and information for staff to safely administer prescribed medication. Medicine records were not consistently completed to show that people had received their medicines.

Communication with the office was not always effective. People told us when they raised issues, there was no evidence of action taken to resolve issues.

The care plans we reviewed contained conflicting information relating to people’s needs and were not always in line with other documentation.

People did not always receive care and support in line with their preferences. There was a lack of information and guidance for staff to understand conditions associated with people’s health.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 14 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and quality assurance. A decision was made for us to inspect and examine those risks.

We received concerns in relation to the deployment of staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements.

Please see the Safe and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 Safe Care and Treatment, Regulation 18 Staffing, Regulation 17 Good Governance and Regulation 9 Person Centred Care at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

This was the second comprehensive inspection for this location. The service was previously rated overall ‘Requires Improvement’. At this inspection the service remained ‘requires improvement’. Although improvements had been made there remained issues relating to the consistency of staff and times of calls. Support was not always provided at the times people expected.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. Staff had been helped to understand their responsibilities and to speak out if they had any concerns. There were arrangements for working in partnership with other agencies to support the provision of quality care.

There were sufficient staff to safely meet people’s needs. Background checks had been consistently completed before all new staff had been appointed. A process for checking the quality of care people received was in place. People told us that they received person-centred care according to their wishes. Staff had received training and regular supervision and appraisal.

There were processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their independence was respected.

Medicines were managed safely.

Arrangements to prevent and control infection were in place.

Staff had been supported to deliver care in line with current best practice guidance. Records were not always clear about people’s ability to consent to care.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive ways possible. People were helped to eat and drink enough to maintain a balanced diet. People were supported to access healthcare services so that they received on-going healthcare support.

People were treated with kindness, respect and compassion. They had also been supported to express their views and be involved in making decisions about their care. In addition, confidential information was kept private.

Information was provided to people in an accessible manner. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care.

Further information is in the detailed findings below.

At our previous inspection on 31 January 2017 we found that the provider did not have effective and safe systems in place for the allocation of staff. A breach of legal requirements was found.

After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sevacare-Lincoln on our website at www.cqc.org.uk”

At this inspection we found the provider had made the necessary improvements.

Arrangements were in place to monitor the times of visits and ensure people received their visits in a timely manner. People received their visits at the times they expected. Sufficient staff were deployed in order to meet people’s needs.

There was a registered manager 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. Communication with the local office was effective.

Sevacare (Lincoln) provides care for people in their own homes. The service can provide care for adults of all ages. It can assist people who live with dementia or who have mental health needs. It can also support people who have a learning disability, special sensory needs and or a physical disability. At the time of our inspection the service was providing care for approximately 320 people most of whom were older people. The service covered the Lincolnshire LN6 area which included Hykeham, Birchwood, Skellingthorpe, Hartsholme and also Eagle, Whisby and Witham St Hughes.

People did not always receive their visits at the times they expected. Sufficient staff were not deployed in order to meet people’s needs. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager 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.

Communication with the office was not always effective.

Medicine records were not consistently completed to show that people had received their medicines.

Possible risks to people’s health and safety had been managed. Risk assessments and plans to manage the risks were usually in place.

Staff had the knowledge and skills they needed in order to care for people in the right way. They did not always have appropriate information to assist them to provide people's care. A process was in place to monitor training and ensure staff were kept updated.

The registered persons and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

People were treated with kindness, compassion and respect.

People had been consulted about the care they wanted to receive. Care was planned, delivered and assessed in a consistent way.

People had been consulted about the development of the service. Staff were able to speak out if they had any concerns about poor practice.