Merlin's Barrow

We found the following examples of good practice.

The service had been proactive at supporting people to understand how to keep themselves safe.

People were supported to maintain relationships with family and friends. The service had explored varied ways of keeping people entertained and in touch with other people using video services.

The service had introduced measures to prevent visitors from catching and spreading infections. Visitors were screened for COVID-19 and were provided with personal protective equipment (PPE).

Staff had received training on infection prevention and control measures and how to use PPE safely. PPE was available to staff throughout the service and staff were seen using it effectively. Staff competence and knowledge was regularly assessed.

Additional cleaning measures of frequent touch points had been introduced in the home. All areas of the home were clean.

COVID-19 testing was being carried out for people using the service and staff in line with the latest guidance.

The provider had effective systems in place to check staff and professional visitors were vaccinated against COVID-19.

Merlin’s Barrow 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 is part of Innovations Wiltshire Limited and is located in the town of Marlborough. It is registered to provide personal care for up to four people with a learning disability. The home is a detached house situated in a residential area. At the time of the inspection four people were living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good in all five domains of safe, effective, caring, responsive and well-led. At this inspection we continued to rate the service as good overall. However, the service’s rating for one key question, ‘Is the service safe?’ had deteriorated from good to requires improvement. This is because following a fire safety inspection during November 2017 the provider had received a recommendation that all staff should be trained in the use of fire extinguishers. When we asked for evidence of this, the provider was unable to demonstrate this had taken place. Instead, we were sent confirmation that training had been arranged for July 2018. We asked one member of staff if they knew how to use the extinguishers and they said, “I’ve had fire training, but I’ve never had actual extinguisher training. I know you pull the pin out, but that’s all.” This meant that for a seven month period staff were not trained to use fire extinguishers.

Some areas of the stair carpet were worn and there was a risk these could be a trip hazard. Also, there were worn areas in people’s bedroom carpets caused by fire door safety mechanisms. These issues had been highlighted in the provider’s audits as far back as September 2017. The house manager said the carpets were due to be replaced when people went on holiday, but no holiday dates had been set which meant there was no set date for when this would be completed.

Staff knew how to keep people safe. Risk assessments were in place and care plans contained clear guidance on how to keep people safe whilst maximising their independence.

Medicines were managed safely. People received their medicines as prescribed. Medicines were stored safely.

Incidents and accidents had been reported.

With the exception of extinguisher training, staff were trained to carry out their roles and had regular supervisions with a line manager.

People’s nutritional needs were met and people were involved in meal planning and preparation.

People were supported to access ongoing health care. Examples included doctor, dentist and optician appointments. The service worked closely with the community learning disabilities team.

Consent to care was sought in line with legislation and guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We saw and heard many positive interactions between people using the service and staff. People told us the staff were “very kind” and “nice.”

Care plans were person centred and people were actively involved in their plans. People and their families were asked for feedback about the service.

There was a complaints procedure in place. This, and other written information provided to people was in an easy read format to aid understanding.

There was a positive open culture at the service. People and relatives spoke highly of the management team. Staff said they felt well supported.

The inspection took place over two days and was announced a day before the inspection. The provider was given 24 hours’ notice because the location was a small care home for adults with learning disabilities who are often out during the day; we needed to be sure that someone would be in.

The service 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 registered manager told us they neither worked at nor managed the service because the service was managed by a home manager. The home manager was in the process of applying to be the registered manager.

People living at Merlin’s Barrow described it as their home and each person’s bedroom was decorated to their own taste. The home had a busy, happy atmosphere with people helping out in the household, for example laying and clearing the dining table.

People were able to tell us about their care and said how happy they were with the staff. People told us they felt safe living at Merlin’s Barrow. We saw people were well cared for and relaxed in the home. They were confident to ask staff for help and staff responded with kindness, humour and warmth. Everyone at Merlin’s Barrow spoke positively about the staff and living at the home.

Staff had a good understanding of how to keep people safe and was aware of their safeguarding responsibilities and showed positive attitude towards this.

Peoples’ medicines were managed and administered safely. Medicines were stored safely in a locked cabinet in each person’s bedroom. The premises were clean, tidy and well maintained.

People were assisted to go out into the community to enjoy leisure time and also to attend health

appointments. Some people told us they did voluntary work locally. People had their own personalised care plans with associated risk assessments and positive behaviour plans were in place where needed.

We observed that people were given choices and consulted about their care. Relatives said they were kept informed by staff and felt welcome at the home.

There was a complaints procedure in place. The service had not received any complaints since the last inspection on 3 January 2014. Management completed monthly audits to identify any issues or learning needs, which required improvement.

Staff members said they were well supported and felt valued by the management team. There was a sufficient number of staff to meet people’s individual needs.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were provided with a choice of suitable and nutritious food and drink. One person living at the home said that the food was 'good'.

There were enough qualified, skilled and experienced staff to meet people's needs. One person said 'there are enough staff to help me'.

There was an effective complaints system available.

The two people we talked with told us they were happy living at the home. They said they liked the staff and they were looked after well. They were able to make their own minds up, were treated with respect, and able to live their lives as independently as possible.

We observed care delivered with kindness and patience. People appeared happy and settled in the home and able to be part of how the home was run. People were supported by staff who were well trained and supported to carry out their roles safely. Their care plans were well written and produced for each person as an individual. People's records and those to run the home were kept confidential and held securely.