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Archived: Merryhill House Requires improvement


Inspection carried out on 07 August 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced, which meant the staff and provider did not know that an inspection was planned on that day.

This provider is registered to provide personal care and accommodation for up to 35 people. At the time of our inspection 26 people lived at the home. Ten people were provided with personal care and accommodation on a permanent basis. Sixteen people were provided with a respite and rehabilitation service on a short stay basis.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The registered manager told us that the service had been in transition over the last twelve months. The service was moving from a residential care home to promoting short stays to enable people to have respite and rehabilitation before returning to the community.

Some people’s diverse language needs had not been fully considered prior to admission to the home. Some people wished to undertake activities and trips which could not be achieved due to a lack of funding. The provider had not ensured consistent planning and delivery of care to meet people’s individual needs.

There was enough staff to meet the needs of people who used the service. A high percentage of staff were sourced from external agencies. The provider used additional agency staff to complement its existing workforce to ensure it met the needs of people admitted on a short stay basis, with high dependency needs

Staff received on-going supervision and appraisals to monitor their performance and development needs. One member of staff told us that they had not received regular supervision.

Staff were kind, caring and respectful to people when providing support and in their daily interactions with them. We observed several areas where dignity awareness could be improved for staff.

There were processes in place intended to drive service improvements. The registered manager could not always ensure service delivery improvements due to funding constraints.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints.

We discussed the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) with the registered manager. The MCA and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. No-one who used the service was subject to a DoLS application at the point of our inspection. The staff and registered manager had received training to enable them to follow the legal requirements of the MCA and the DoLS.

Records showed that we, the Care Quality Commission (CQC), had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 5 July 2013

During a routine inspection

During our inspection we spoke with eight people, two visitors, three members of staff and the manager. We looked at seven people’s care records.

We found that people were supported in making day to day decisions about the care they received. People’s values and diversity were respected and promoted.

Care records had improved since our last visit and provided information which reflected people's health and care needs. One person told us, “I love it here”.

Arrangements were in place to ensure that people were protected from harm. Staff were clear about how they would identify abuse and their responsibility for reporting suspected abuse. A relative told us, “I do feel he’s safe here”.

The service carried out a number of audits to ensure people’s safety and standards of care. Action was taken where issues were identified by audits.

We found improvements in record keeping. Records were kept securely but were accessible to staff.

Inspection carried out on 10 January 2013

During an inspection to make sure that the improvements required had been made

During our inspection we spoke with six people, a visitor, five staff, the Acting Care Manager and the Community Resource Manager. We looked at seven people’s care records.

A temporary management team had been put in place in late October 2012. We found that the action plan to address the issues we found in June 2012 had not been fully implemented, but the new management team were progressing this. We saw that some improvements had been made to the quality of the service provided.

We found that people were supported in making day to day decisions about the care they received. We saw that not all care records were personalised or reflected people’s own choices.

The care people received was not always reflected in their care plans, although some plans had improved since our last visit. We found that some people’s health needs were not being promoted. One person told us, “They look after me, to an extent”.

Procedures for recording people’s finances were not being consistently applied. We found improved reporting of safeguarding issues.

We found that correct staff checks were carried out to ensure their suitability to care for people. We saw that staff were receiving improved supervision, which meant that issues with performance could be identified. One person told us, “Staff are kind”.

The home was recording complaints and we saw evidence of action being taken to address issues. There was improvement in audits and record keeping in some areas.

Inspection carried out on 11 June 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people using the service. On the day of the inspection there were 30 people using the service. The home had four different units with people who went to live at the home on a long-term basis or a short-term basis. We spoke to nine people, two relatives, one visiting health professional, four staff, and the manager.

In one unit we saw that staff offered people adequate support, choice, and involvement. However, staff interactions with people were minimal on three units in the home. This meant that staff did not interact with people consistently throughout the home.

Systems were not in place to ensure that people and their finances were appropriately safeguarded. We found that allegations of abuse were not always reported to the local authority for investigation and to us.

We found that staff training was not completed regularly to ensure that staff were confident and competent at looking after people’s needs. Supervision for staff was not taking place. This meant that arrangements were not in place to ensure staff received adequate support to carry out their role.

The arrangements in place to assess and monitor the safety and quality of care need to be improved. Our visit identified issues in the home that had not been identified and addressed by the registered manager or registered provider. The quality and accuracy of records also needed to be improved.