This unannounced comprehensive inspection was carried out on 11, 12, 13 and 14 December 2017.

Merseycare Julie Ann is a domiciliary care agency. It provides personal care to approximately 700 people living in their own homes across Liverpool.

A registered manager, who had worked for the organisation for many years, 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.

We last inspected the service in October 2016 and gave it an overall rating of ‘requires improvement’. On that inspection we a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that risk management plans in people’s care files were not sufficiently detailed to inform staff and some files contained conflicting information about risk.

During this inspection we found that the service had improved in this area and was no longer in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We saw that people’s risk assessments were reviewed regularly and care files contained the information staff needed to safely manage these risks.

Medication was correctly administered and recorded by staff who had appropriate training and experience. The staff we spoke with told us that they were confident managing people’s medication and people received the right medication at the right times. The people we spoke with told us that they received their medication correctly and when they needed it.

The service had robust systems in place to protect people from abuse and staff demonstrated a good understanding of this when we spoke with them. They were able to demonstrate the actions they would take in the event of a person being at risk of harm. We saw that safeguarding concerns were promptly and effectively managed by the Safeguarding and Complaints Manager, with oversight from the registered manager.

Staff were safely recruited and were supported with an induction process. Criminal records checks, known as Disclosure and Barring Service (DBS) records, were carried out. We also saw that official identification, such as a passport or driving licence and verified references from the most recent employers were also kept in staff files.

Staff training records were up-to-date and there was a clear system to document and plan staff training. We saw that all staff had received training relevant to their roles.

All new staff took part in an induction process. This included a period of office-based training and shadowing an experienced member of staff. During the induction process staff were introduced to the people they would be visiting regularly and they were not allowed to start working on their own until their mentor had assessed them as competent to do so.

The majority of staff had received timely supervisions and appraisals. A small number of staff were not up-to-date with their supervisions but the registered manager had a plan in place to address this. We were also reassured by the fact that all staff, including staff whose supervisions were overdue, told us that they felt well-supported working for the service. They received an appropriate level of supervision and had regular contact with their line managers.

People we spoke with told us that they received care from regular staff who were caring, knew them well and whom they trusted. Some people said that sometimes alternative carers attended when their regular carers were unable to do so. They said that they preferred their regular carers but the standard of care remained good.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and to report on what we find. We saw t

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

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who used the service, four carers, and five other office based staff including the risk assessment officer. The service employed over two hundred staff. The registered manager was on leave when we visited but we later spoke to them by telephone. We reviewed records relating to staff training and supervision, complaints, care files and quality audits.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Care had been planned for each person after an assessment of needs. We saw that a risk assessment had taken place before people had received care in their home. These included environmental risks and mobility assessments. The service employed a moving and handling risk assessor who had visited every person who used equipment. They also delivered training to all carers so that they could use the equipment safely. Equipment in people’s homes had been well maintained and serviced regularly. There were enough staff to meet the needs of the people cared for by the service.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. During the visits that we made to two people’s homes, we observed the interaction between people and the care staff. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us that the staff were, “All very good.” We saw from the results of a survey that nearly all people who responded said that they had a good or excellent relationship with their carers. Nearly everyone said they would recommend the service to others. There were enough carers to meet the needs of people using the service. Carers had received training to meet most of the needs of people using the service.

Is the service caring?

The service was caring. We spoke with carers who knew people’s needs and we observed them interact with people in a pleasant and caring way. We saw that staff were patient and gentle when helping people. The manner in which carers talked about the people that they supported showed us that they cared about their wellbeing. Not all staff received regular supervision. In particular several carers who were new to the service had not met formally with their manager since starting some months previously. This meant that the provider could not demonstrate that carers were appropriately supported to deliver care to people safely. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service responsive?

We saw that a duty team answered telephone calls to the service office promptly. Calls were logged and included details of the response made. Care coordinators were available at all times to support the duty team and their names appeared in the log when a call had been passed to them.

People’s needs had been assessed before they received care and support from the service. This was reviewed after six weeks and then every six months. However the main carer was not involved in care reviews. This meant that other carers did not have access to all the information relevant to caring for people.

The manager responded to the results of surveys and audits with action plans and meetings with staff.

Is the service well led?

The service was led by a registered manager. They were supported by a development manager, a complaints manager, a quality manager and care co-ordinators. Carers were supported by the coordinators. The service had a system in place to monitor and assess the quality of the service. An analysis of care reviews up to January 2014 showed that 20% of people did not know how to make a complaint. The manager told us that they had later met with staff in order to co-ordinate a response.

Although the service had a robust policy for dealing with complaints, two complaints had not been dealt with according to the company policy. This meant that complaints were not all dealt with appropriately. A compliance action has been set for this and the provider must tell us how they plan to improve.

We spoke with ten people who used the service and/or their carers, who were happy with the care and support provided by Merseycare Julie Ann Limited (MCJA). One person told us “Mum is quite happy, the regular carer knows her ways”, and other said “They are always on time; if the usual lady doesn’t come we get another in their place”. We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do.

The people who accessed the service provided by MCJA were cared for by staff that were appropriated recruited, well trained and experienced at supporting them. The organisation had systems in place to keep the people who used the service safe and monitored the quality of the service provided on a regular basis.

People who used the service told us they were happy with the service provided and the standard of support and care they received. Some comments made were:

"I don't think of them as carers, they are more like friends"

"They are always cheerful"

"I am well looked after"

"If I ring up the office the action is instant"

The people we spoke with knew who to contact if they wished to discuss their care and would feel comfortable raising concerns with the manager.