The inspection took place on 14 November 2018 and was unannounced. The previous inspection took place on 5 April 2016 when it was rated as ‘Good.’
Mermaid Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation, for up to 10 people under the age of 65 years with a range of mental health needs including substance misuse. On the day of our inspection there were seven people living at the home. The home is converted from two residential properties and overlooks the seafront at Lancing. The home has 10 single bedrooms, each with its own en suite bathroom. There was a communal lounge and dining room as well as a room which people could smoke in.
The service had a registered manager, who was also the provider. 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 premises were generally well maintained, but there were exceptions to this. A first-floor bathroom had recently been refurbished but the ceramic floor tiles had cracked into pieces with sharp edges which raised from the floor when walked on. There was a risk people could cut their feet on the broken tiles. The provider had not taken steps to assess or mitigate the risks of legionnaires’ disease. Legionnaires’ disease is a potentially harmful type of pneumonia contracted by inhaling airborne water droplets. The provider did not know this needed to be assessed and had not carried out checks on the water system as advised by the Health and Safety Executive (HSE) Health and Safety in Care Homes. Arrangements for maintaining adequate fire safety had not been taken. The weekly test of the fire alarms had not taken place since 18 October 2018 and the provider had not completed personal emergency evacuation plans for each person. The home was inspected by the fire and rescue service on 1 November 2018 who issued a letter for eight areas in need of improvement.
Risks to people were assessed and plans in place to mitigate these. However, one person’s risk of going out unsupervised had not been assessed when an external professional had assessed the person as being in need of constant supervision. The provider agreed this needed to be clarified.
Improvements were needed regarding the system for ensuring the service complied with the Health and Social Care Act 2008. For example, the Commission asked the provider to complete a Provider Information Return (PIR) to give us information about the service. This was not responded to. Whilst people’s communication needs were assessed the provider did not know about the Accessible Information Standard (AIS) guidance, which requires service providers to ensure those people with disability, impairment and/or sensory loss have information provided in an accessible format and are supported with communication. The provider was aware of the General Data Protection Regulation (GDPR), which was effective from 25 May 2018, but had not yet considered this for the service’s record keeping.
Records of staff supervision were maintained until 2015 and 2016 but had then stopped; the provider said informal supervision took place. The provider stated staff were observed and assessed in their work, but this was not recorded; this included the assessment of staff as being competent in the safe management of medicines. Records were not readily available and the provider had to access several records from their mobile phone such as maintenance service records and correspondence with health and social care professionals about people’s care.
The process of audits and checks on the quality and safety of the service had not identified and acted where we found attention was needed. The provider had not kept up to date with current guidance on record keeping and it was evident that a number of systems for monitoring the service had ceased since the last inspection on 5 April 2016.
The provider had not taken appropriate steps when one was assessed as not having capacity. The provider did not have a system or toolkit for assessing the mental capacity of people. and we found he provider had not taken appropriate steps to follow up i . We have made a recommendation about this.
People said they felt safe at the home. Staff had a good awareness of the principles and procedures for safeguarding people in their care.
Sufficient numbers of care staff were employed to ensure people were looked after well.
Medicines were safely managed.
There were systems to review people’s care and when incidents or accidents had occurred.
Staff were well qualified and were trained, or studying, the Diploma in Health and Social Care. People described the staff as helpful. People were provided with nutritious meals and said their individual preferences for food were catered for.
People said they received care from kind and caring staff. People were consulted about their care and their rights to privacy was promoted. The provider supported people to maintain and develop their independence. People told us they were able to choose how they spent their time.
People received personalised care that was responsive to their needs. Care plans reflected people’s needs and preferences. Activities were provider for people based on what they wanted. The provider had a complaints procedure and people said they were able to raise any issues if they needed to. There have been no complaints made to the provider.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.