Meritum Integrated Care LLP (Folkestone)

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• 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

People were protected from the risk of potential abuse. Staff had appropriate skills and experience and knew how to report any concerns and who to report them to. Any potential concerns had been appropriately reported and investigated. The management team worked in partnership with external health care professionals to ensure people remained as healthy as possible and protected from the potential risk of harm. Potential risks to people’s health care and environment had been assessed and mitigated. Staff had received training to meet people’s needs including any specialist needs. Staff had been recruited safely. People were provided with consistency and continuity of care by staff who knew them well. Staff had been trained and followed guidance to reduce the risk of infection. People received their medicines safely as prescribed by staff who had been trained and had their competency assessed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a culture of learning and continually improving the service. People spoke positively about the staff who said they were well trained and knew how to meet their needs. Comments from people included, “I give them (staff) top marks. They come in and say good morning, smiling. I feel safe with them around me” and “They come in and they do what they do every day, and I feel safe with them doing it.” The management team were committed to promoting a positive open culture where lessons were acted on when things went wrong to prevent a reoccurrence. The registered manager gave examples of changes that had been made following incidents and complaints. For example, as a result of the latest incidents, the importance of clear documentation, clear communication and having a robust audit trail was discussed with the care team. Staff knew how to report and escalate concerns and where to find the organisations policies. Staff felt confident that the management team would deal with any concerns raised in a timely and appropriate manner. Accidents and incidents were reported and reviewed. One staff member told us, “I would report to the office, we complete incident and accidents forms, they would then be picked up by management who would take it from there. If there is an incident or accident that is time critical, they are handled straight away.” Health care professionals spoke positively about the joined up working with the management team following any identified concern. One health care professional said, “Meritum has been a very responsive, proactive and flexible provider, always trying to find solutions and they communicate any issues or concerns that need to be resolved.”

The management team worked closely and collaboratively with health care professionals, to solve identified concerns and make improvements to people’s health and wellbeing. An external health care professional told us they worked in partnership and had regular communication with the management team. People’s needs were assessed with them to ensure staff had the skills and knowledge to meet these needs. The registered manager told us that any recommendations or action plans from external healthcare professionals were uploaded onto the person’s care plan and hard copies were kept within the persons’ own home. Staff were aware of how to support people when their needs changed, or they had an accident. Comments from staff included, “If I need to report anything I just call the office and the emergency services (if required)” and “I would go to my manager (Name) and explain everything. I would complete an incident form.”

People felt safe with the care staff, comments included, “They’re very good carers. They give me confidence and they’re always cheery”, “They’re all nice girls, they make sure they hold onto me, and they wash my back” and “Absolutely (safe). They are just comforting and welcoming. To be fair every single member of staff I have had has been exceptional.” Staff had been trained, understood the potential signs of abuse and knew the action to take if they had any concerns. One member of staff said, “I understand safeguarding, it’s about protecting people. If I was concerned, I would the call office or emergency services.” Staff felt confident that any concerns would be taken seriously and acted on. The registered manager said, “All safeguarding concerns and complaints give us an opportunity to improve, to communicate better, better communication from carers to us, us with health colleagues, families, etc. Better communication leads to better education.” Records showed concerns had been reported to the local authority, investigations had taken place, and any actions had been completed. Staff had access to the providers policy and procedure in relation to safeguarding and whistleblowing.

People and their loved ones had been involved in the development and review of their risk assessments. One person spoke about how staff supported them to move safely to reduce the risk of any pressure damage to their skin. People’s care records were reviewed with them on a regular basis with any changes being made as required. Staff knew the triggers for poor health and recognised the signs of people’s health risks. Staff told us that people’s care plans and risk assessments were clear and easy to understand to keep people safe. The registered manager emphasised the importance of keeping people involved at all stages of their care and supporting people to take positive risks. They said, “The care plans and risk assessments were bespoke to the needs of the person.” This was evident within the care records we viewed which were outcome focused and were person centred.

The internal and external environment of a person’s house had been assessed with any additional measures put in place to reduce potential risks. The registered manager told us a member of the management team completed an environmental assessment which included things such as, access to the property, the fire alarm system and any lighting. A process was in place for the event that care staff were running late or were poorly. One person said, “They either ring me or I wait, and they apologise when they come in. It’s either traffic or they run over with someone else.” Regular spot checks of care staff were completed by a member of the management team to ensure for example, people’s choices were followed and respected, monitoring timekeeping and toe ensure all care records were followed.

People spoke highly of the staff saying staff arrived on time and that they never felt rushed. Comments included, “The staff are very nice. I’ve got to know them”, “Very friendly. I just get on with them really well” and “Well, they know everything I like to drink and how I like my tea.” Staff told us they were given enough travel time between care calls and that their calls were clustered together as much as possible. People confirmed they had a team of care staff who they knew well, providing consistency and continuity of care. The registered manager told us, that staff working in rural locations were given additional paid travel time. The registered manager completed a monthly audit of the electronic call monitoring system to ensure people received the care and support they had commissioned. This gave the management team assurances that care staff had attended and completed the required care tasks The electronic call monitoring system sent an alert to the management team if a care call was late or an allocated care task was not signed as completed such as, to ensure fluids had been checked and left available. Systems were in place for the event an alarm went off this included, calls to the care staff to ensure all allocated care tasks were completed and to check the care call had been attended by staff. Staff told us they received a comprehensive induction including working alongside experienced staff and undertaking essential training before working on their own. Staff felt the training they had received covered their role and people’s needs. Staff had been recruited safely; recruitment files contained the necessary documents to reduce the risk of unsuitable staff being employed. Records showed investigations had taken place when required following the providers disciplinary procedure.

People did not comment on infection prevention and control (IPC) specifically or the use of personal protective equipment (PPE) however, no concerns were raised or identified. Staff had been trained in IPC and were familiar with the processes to mitigate infection risks. Staff were given a supply of PPE such as, gloves, hand gel, masks and aprons. The management team completed regular spot checks of care staff working within people’s own homes to ensure IPC policies and processes were followed and actions taken if any issues were found.

People told us that if it was required, staff administered their medicines safely. People’s care plans included information about any health professional’s involvement, medication prescribed and the use of any ‘As and When Required’ (PRN) medication. Staff had been trained and had their competency assessed by a member of the management team to support safe administration of medicines. The registered manager said, “When there has been a medication error, we undertake an investigation, facilitate reflective practice, look for patterns, trends and lessons learned.” A monthly medication audit took place which included reviewing the electronic medication administration record for each person being supported by the agency to take their medication. Any medication errors were investigated and discussed during staff meetings to identify any changes that could be made.