Mermaid Lodge

Mermaid Lodge is a residential care home providing accommodation and personal care to up to nine people in one adapted building. The service provides support to people who have mental health needs. Some people required support with addictions and substance misuse. Mermaid Lodge provides people with a safe place to live and promotes people’s independence and rehabilitation. At the time of our inspection there were six people using the service.

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

People told us that they felt safe. Risks to people had been identified and assessed. There was a flexible approach to risk management which promoted people’s independence. Staff were recruited safely and there were enough staff to meet people’s needs. Medicines were managed safely. Infection prevention and control processes protected people from the risk of infections.

Systems and process were in place to monitor the quality of the service being delivered. The culture of the service was positive, and people and staff were complementary of the management. People were treated with dignity and compassion by a kind, caring staff and management team who understood people's individual needs, choices and preferences well. People and staff told us that they felt supported and valued.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 December 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 12 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mermaid Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service is located in Lancing and can accommodate up to nine people in one adapted building. The service provides people with a safe place to live and support to make healthy lifestyle choices.

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

There was not an adequate process for assessing and monitoring the quality of the services provided and ensuring that records were accurate and complete. Health and safety checks were not routinely taking place and risks to people had not always been assessed and monitored.

People lived independent lifestyles and they told us they were happy with the care they received. People said the service provided them with a safe place to live and positive environmental experiences. People were protected from the risk of abuse and harm by staff who knew what action to take if they had any concerns. Some people required staff to administer or prompt them to take their medicines; this was completed in a safe way. People’s needs were regularly reviewed to ensure the service they received was suitable.

There were sufficient numbers of staff to ensure people received support when they needed it. People had direct access to staff at all times. People spoke positively about the staff and supportive and caring relationships had been developed between staff and people. People were treated with kindness and compassion and staff were friendly and respectful. People benefited from having support from a consistent staff team.

Before people received support from the service, the registered manager undertook assessments of people’s needs. People and their relatives were involved in discussions about their support and people’s life stories were captured. This information was used to develop care plans that enabled people to be supported in a person centred way.

People's privacy and dignity was respected, and people's diverse needs were supported. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 12 December 2018) and there were two breaches of regulation. The provider failed to complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection not, enough improvements had been made and

the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. 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.

Enforcement

We have identified two continued breaches of regulation. Quality assurance processes were not in place to

assess, monitor and improve the quality and safety of the service. Risks to people had not always been identified to ensure people’s safety, this included ensuring the premises and equipment were safe. You can see what action we have asked the provider to take at the end of this full report.

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.

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.

Mermaid Lodge is registered to provide care for up to 10 people. The home provides support to people with a range of mental health needs. On the day of the inspection nine people were living at the service.

The home had a registered manager. 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 experiences of people were positive. People told us they felt safe living at the service, staff were kind and compassionate and the care they received was good. One person told us “The reason I’m so happy here is that I feel so safe, there is no aggression to deal with so you can just live your life in peace”.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate the risks. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff on duty at all times to meet people’s individual care needs. When new staff were employed at the home the registered manager followed safe recruitment practices.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed.

Care and support provided was personalised and based on the identified needs of each individual. People were supported to develop their life skills and increase their independence. People’s care and support plans and risk assessments were detailed and reviewed regularly.

Support staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Staff attended refresher training to meet the provider’s requirements and had access to further qualifications in health and social care. One member of staff told us “We have regular training and updates and it’s great we get to be able to get a qualification in what we do. I am about to start my diploma”.

The home considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care and support tasks before they proceeded.

People were supported and encouraged to eat a healthy and nutritious diet. People had access to health care professionals. They had been supported to have an annual healthcare review. All appointments with, or visits by, health care professionals were recorded in individual support plans.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. They told us that communication throughout the service was good and included handovers at the beginning of each shift and through staff meetings. They confirmed that they felt valued and supported by the registered manager who they described as very approachable.

People, relatives and staff told us the service was well led. One person told us ”Her [the manager] door is always open if you have a problem. She runs a good ship here”. The registered manager told us they carried out a range of internal audits to review the quality of the care provided, and records confirmed this. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.

People and relatives told us they would raise any worries, concerns or complaints they may have to the registered manager and would get a positive response. One person told us “I have never had to complain but have had discussions when I’m a bit worried or upset and then I felt better”

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe receiving care from staff employed by Mermaid Lodge. One person said, 'I can trust the staff to help me when I need it. They make me feel safe when I have concerns about my mental health.'

Staff had completed training in the safeguarding of vulnerable adults. Information about reporting safeguarding concerns was displayed in prominent areas of the home. Risks to people's health and safety in the home had been assessed and management plans were in place to reduce these risks. Appropriate checks were carried out on staff before they began working with people.

We found the provider had effective systems in place concerning the administration of medicines. Medicines were stored safely and in the correct environment. Records concerning medication administration were completed appropriately. Staff had received suitable training to administer medicines.

The home had appropriate policies and procedures in relation to the Mental capacity act and Deprivation of Liberty Safeguards, although no applications have been made. The service had an open front door policy and people could walk in and out of the home whenever they wished to.

Is the service effective?

People we spoke with told us they were involved in planning their care. One person said, 'I think I am involved in my care plan. I talk to staff regularly about my health concerns and how I am managing to look after myself and they write it down.' Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills to care for people living in the home. Where appropriate, the service sought advice from appropriate professionals to assist with the care provided for people. People's needs were assessed and the care plans reflected those identified needs.

Is the service caring?

People were supported by staff who were aware of their needs and how they wished to be supported. One person told us 'the staff always have time to talk to me. They help me to do more things for myself but aren't pushy about it.' We saw people were asked by staff how they wished to be supported and waited for a response before delivering care. The provider told us of a person who had left the service for another placement with minimal staff support. Staff from the service visited the person regularly in their new setting to offer support and help to the person.

Is the service responsive?

An assessment of needs was carried out before people began to receive support from the service. The care records contained details of how each person wished to be supported, including their personal likes and dislikes. These were reviewed every month by the provider or when required to meet the changing needs of people who used the service. People told us they could change some aspects of their care and could discuss this with staff or the manager. One person told us, 'One night I was in a lot of pain and called out to the staff. They came immediately and called the ambulance out. The next day I had my appendix removed and the doctor told me they had just caught it at the right time.'

Is the service well-led?

Quality assurance systems were in place. The provider carried out regular audits which looked at the care and support people received along with checks of people's care plans. Annual questionnaires had not been done for two years. The provider told us they were developing a new one and would send it out when it was ready. Staff told us the management team were supportive and always available for advice and help. The provider was always available to support staff and people who used the service.

Meals were flexible and food was well balanced and varied. People were encouraged to give feedback which was reflected in adjustments to the menu.

The complaints procedure was accessible but difficulties were dealt with through regular dialogue and a constructive response.

The home was clean and tidy and appropriate precautions were taken to prevent the spread of infection and promote health and wellbeing.

Staff and people who used the service appreciated the therapeutic effect of the seafront location.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs. Care plans held information on all aspects of a person's care needs.

People using the service were protected from abuse as they were supported by staff who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to one of the providers or the staff member.

We looked around the location and saw bedrooms, communal areas, bathrooms and toilets were clean and well maintained.

We spoke to one of the care co-ordinators following the visit who was really positive about the service and how they support the people there.