Julee Care Limited was rated Requires Improvement overall following a focused inspection in October–November 2022, with regulatory breaches identified across safe care and treatment, staffing, consent, and good governance. Key failures included incomplete risk assessments, unsafe medicines management, persistent late calls, poor application of the Mental Capacity Act, and ineffective auditing that had failed to drive improvement since the previous Good rating in 2019.
Concerns (10)
criticalCare planning: “People's care plans included a list of healthcare conditions. The provider had assessed and planned for some, but not all of these.”
critical
Medication management
: “Some put them in a tumbler and I try to get them out with my fingers...they don't make sure I am ok, some are better than others and I need more help than just popping them on the table.”
criticalMissed or late visits: “I expect them at 5pm and they turn up at 6pm...Sometimes I can end up with a wet bed and that is not good.”
criticalConsent / capacity: “They continued to apply a blanket assessment to people who had capacity to make their own decisions...had not completed these at the time of the inspection.”
criticalGovernance: “Audits in place to assess the quality and safety of the care provided were not effective in identifying improvements.”
moderateStaff training: “Staff had not completed training in other areas...These included risks of choking, diabetes and skin integrity.”
moderateIncident learning: “Procedures to learn and develop staff practise when things went wrong were not in place...meetings with staff did not discuss any concerns, accidents or incidents.”
moderateRecord keeping: “Some daily logs of the care provided were ineligible and could not be read.”
moderateStaff competency: “The registered manager was not aware of the differences between prompting or administering medicines...Staff were equally unaware of the difference.”
moderateCommunication with families: “Staff shared intimate information relating to people's choices and care with family and friends...no discussions with people to ensure they were happy to share their information.”
Strengths
· People told us they felt safe with the care provided.
· Staff were clear on infection prevention and control requirements including PPE use and hand washing.
· The provider undertook appropriate pre-employment checks including DBS and right to work documentation.
· Staff supported people with meal preparation based on individual needs and preferences, placing drinks and snacks within reach.
· The registered manager was open and honest throughout the inspection and responded immediately to concerns raised.
Quality-Statement breakdown (12)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Working in partnership with othersRequires improvement
Julee Care Limited improved from Requires Improvement to Good overall, having remedied prior regulatory breaches in safe care, staffing, safeguarding and governance. The service remains Requires Improvement for well-led due to gaps in person-centred care record detail, incomplete end-of-life documentation, training shortfalls, and insufficiently structured team meetings.
Concerns (5)
moderateRecord keeping: “auditors had not identified care records lacked detail relating to supporting people in a person centred manner. For example where people identify they may need help when anxious, the record does not instruct staff how to specifically support this person.”
minorEnd-of-life care: “Care records also did not always record that conversations had taken place around people's wishes for end of life care.”
minorStaff training: “we found shortfalls in some areas of training around end of life and diabetes. Subsequent to the inspection the registered manager informed us this training had been arranged.”
minorGovernance: “Actions from previous meetings were not reviewed, and key agenda items required for discussion at each meeting were not identified.”
minorConsent / capacity: “the registered manager had assessed capacity regardless of considering if this applied. This is not in line with the principles of the MCA 2005.”
Strengths
· People felt safe and risks were clearly identified, assessed and mitigated in care records.
· Staffing levels were sufficient and consistent, with electronic monitoring introduced to track timeliness.
· Staff demonstrated kindness, built meaningful relationships, and respected people's dignity and independence.
· People were involved in care planning and reviews; their views and preferences were listened to and acted upon.
· The registered manager was responsive, sought external mentoring, and implemented auditing and quality assurance systems.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
Julee Care Limited received a Requires Improvement rating across all five key questions at its first CQC inspection, with five regulatory breaches identified covering safe care and treatment, safeguarding, staffing, fit and proper persons employed, and good governance. Widespread failures in risk assessment, staff training, recruitment robustness, management oversight, and care plan personalisation placed people at risk and demonstrated an immature governance framework.
Concerns (14)
criticalSafeguarding: “Staff had little knowledge about safeguarding, what constituted abuse and what the reporting process was. One staff member told us, "You need to make sure everyone is ok"”
criticalStaff training: “The provider did not have adequate training or systems in place to ensure staff had the skills and knowledge to enable them to provide safe and effective care. This was a breach of Regulation 18.”
criticalStaff competency: “Not all staff had effective moving and handling training before supporting people who required to be transferred with the use of hoists and sling. This put people at risk of unsafe care.”
criticalGovernance: “The provider did not have adequate systems and processes in place to monitor the quality and safety of the service. This was a breach of Regulation 17 HSCA RA Regulations 2014 Good governance.”
criticalStaffing levels: “One staff member was covering all the visits for all people using the service and working seven days a week without adequate rest periods.”
moderateCare planning: “Peoples care plans were pre-populated and did not always relate to the needs of the individual. This was confusing for staff especially new staff who were not familiar with peoples assessed needs.”
moderateRecord keeping: “Care plan and recruitment files audits that had been completed had not identified the lack of missing information, missing dates in risk assessments and missing signatures.”
moderateSupervision / appraisal: “Staff received some formal support from the registered manager but there was no schedule to show the frequency or agenda of discussions held. Two of the three meetings were terminated prematurely.”
moderateConsent / capacity: “People were asked for consent to care and support but the process was inconsistent. The consent policy had not been reviewed since 2015.”
moderatePerson-centred care: “"My visit is often provided much later than I would like. I asked them if I could change the time... but was told 'Your slot is [time] and that is all we can do.'"”
moderateIncident learning: “There was no follow up or investigation by the registered manager to determine the cause of the skin damage and no measures were put in place to prevent further deterioration.”
moderateLeadership: “The registered manager was unable to demonstrate they fully understood their individual responsibilities to providing a service under the Health and Social Care Act 2008.”
minorMissed or late visits: “Three people we spoke with told us that they had experienced late calls on occasions.”
minorComplaints handling: “There was a complaints policy in place however this had not been reviewed since June 2012 so we could not be assured it was still current.”
Strengths
· Peoples dignity was respected and maintained; people felt staff were respectful when supporting them.
· People were supported by a small and consistent team, providing continuity of care.
· Staff were aware of the need to wear gloves when providing personal care to reduce the risk and spread of infection.
· No safeguarding concerns had been recorded and people did not raise concerns about their safety.
· People and relatives were confident the registered manager would act on any complaints raised.
Quality-Statement breakdown (18)
safe: Risk assessment and risk managementRequires improvement
safe: Safeguarding training and awarenessRequires improvement
safe: Recruitment and pre-employment checksRequires improvement
safe: Medicines managementNot rated
safe: Infection controlGood
effective: Staff training and competencyRequires improvement
effective: Staffing and visit managementRequires improvement
effective: Consent and Mental Capacity Act complianceRequires improvement
Good
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: How the provider understands and acts on the duty of candour; Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Continuous learning and improving careRequires improvement
well-led: Working in partnership with othersGood
effective: Staff supervision and supportRequires improvement
caring: Kindness, compassion and personalised careRequires improvement
caring: Involvement in care planningRequires improvement
caring: Dignity and respectGood
responsive: Care plan responsiveness to changing needsRequires improvement