We carried out a review of the data available to us about Merry Den on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Merry Den, you can give feedback on this service.
Merry Den is a supported living service providing personal care and support to 15 people at the time of the inspection. People live in single or small multi occupancy homes.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Since our last inspection, improvements had been made to the development and support of staff and the management of people’s risks and quality of care.
The new registered manager had been instrumental in implementing new systems and directing the quality of care being provided to achieve positive outcomes for people.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were involved in decisions about their care and supported to make choices about their day to day living. The culture of the service promoted independence, choices and empowerment for all people who received a service from Merry Den. People’s care was focused around their needs and wishes.
People’s needs had been assessed and were being met in line with current guidance. People’s individual risks and medicines requirements were comprehensively recorded, monitored and known by staff.
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. They were supported to make choices about their lives such as activities and were encouraged to have a healthy and balance diet. Staff monitored people’s well-being and supported people to access health care services as required.
Systems were in place to ensure people continually received their funded support hours.
People were empowered to raised concerns and discuss their views with staff. Staff were aware of their responsibilities to report any allegations of abuse or concerns. Relatives praised the caring nature and approach of staff. One relative said, “We have absolutely no concerns and are very happy with how they [staff] managed throughout the pandemic.”
Effective infection control practices and extra measures had been implemented to prevent the spread of infection and to assist people in understanding the restrictions related to COVID-19.
Staff had been safely recruited. They confirmed and records demonstrated that staff had received the training and support they required to meet people’s individual needs.
The registered manager and provider were committed to improving the service and learning from any incidents. Effective operational quality monitoring systems and policies were in place which enabled the registered manager to evaluate the service being delivered and to direct staff in good practices
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 23 April 2019). 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 was a planned inspection based on the previous rating.
We carried out an announced comprehensive inspection of this service on 29 March 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 in areas relating to staff development and support and the quality monitoring systems to manage and monitor people’s risks.
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 of Safe, Effective and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merry Den on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service: The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:
• People were supported to have meaningful opportunities and activities.
• Staff supported people to access mainstream services and specialist health and social care support.
Improvements were needed to ensure people’s medicine would always be managed in accordance with current best practice guidance.
The provider’s quality assurances processes had not always been effective in identifying shortfalls in the service. Where shortfalls had been identified plans were not always in place to manage the risks these could pose to people till the required improvements were completed.
Staff had not always received regular supervision and timely refresher training to support their professional development and ensure they remained up to date with current practice.
People told us they were supported by a team of caring staff who knew them well. We saw staff were kind and respectful towards people.
There was an open culture where staff and people could raise concerns or issues. People told us they felt safe at the service and felt happy to speak up. People’s views were sought and were used to improve aspects of the service.
Rating at last inspection: The last comprehensive inspection rating was Good (This report was published on 14 September 2016). A follow up responsive inspection took place on 26 January 2017 and the rating was Good. The service is now rated Requires Improvement.
Why we inspected: This was a planned inspection based on the previous rating.
Action we told the provider to take: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the ‘action we have told the provider to take’ section towards the end of the report.
Follow up: We will meet with the provider and request an improvement plan following this report being published to show how they will make changes to ensure the legal requirements are met and the rating of the service is increased to at least Good. We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However the care coordinator helped us with our inspection as the registered manager was unavailable.
We carried out an announced comprehensive inspection of this service on 17 August 2016. A breach of legal requirements was found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation 11.
We undertook this focused inspection to check that they had followed their plan and to confirm they now met legal requirements in relation to a breach of regulation 11. This report only covers our findings in relation to this requirement within the domain of ‘Is this service effective?’ and a recommendation we made within the domain of ‘Is this service safe?’ You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Leighton House on our website at www.cqc.org.uk”
At this inspection we found action had been taken to record and assess people’s mental capacity to consent to specific decision about their care. The registered manager and care coordinator had received additional training in the Mental Capacity Act (MCA). They had plans to deliver workshops to staff to enhance their awareness in supporting people within the principles of the MCA.
We also found that the provider had acted on our recommendation and had reviewed their recruitment process to ensure all staff were physically and mentally able to carry out their role.
There was a manager in place at the time of our inspection who was in the process of applying to be the registered manager as required by their conditions of registration. 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 and associated regulations about how the service is run.
People were supported by staff who were kind and caring and understood their responsibility to protect them from harm. Staff knew people well and adapted their approach and communication according to their needs. We observed people were comfortable amongst staff and they chatted together in a friendly manner. People enjoyed a healthy diet and took part in activities and chores around their home.
People were supported to attend health care appointments as required. The management and administration of their medicines was based on people’s individual support needs. People’s level of support was varied and tailored to their needs. Their individual needs and risks had been assessed and recorded. People’s support plans gave staff adequate information about their preferences and how they wished to be supported. However, the details of people’s mental capacity assessment and consent to receive care were not always evident when people could not make a decision about their care and support for themselves.
Suitable staffing levels were in place so people could be adequately supported in their home and carrying out activities. Staff had been trained and were supported to carry out their role. Plans were in place to update the training of staff. The employment and criminal history had been checked before staff started to support people. However the mental and physical well-being of staff to carry out their role had not been assessed. We have made a recommendation about the recruitment of staff.
The service had recently been purchased by another provider. The manager was working with the new provider to ensure that adequate governance processes were in place to ensure the service was safe and effective. The managers and the coordinators of the shared houses carried out frequent audits and checks of the quality of service being delivered. People and their relatives concerns were listen to and acted on immediately. A complaints policy was in place although there had been no recent formal complaints.
We found one breach 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.
The provider had carried out thorough risk assessments of how people would be supported. At the time of the inspection a number of people were away on holiday with staff support. We found that these holidays took into account peoples assessed needs.
We found that all staff had been trained in safeguarding and the staff we spoke were able to tell us what they would do if abuse was suspected, witnessed or alleged. One person supported told us if they were concerned about how they were being treated they would "tell the manager or my social worker".
The provider had effective systems in place to ensure that people were cared for, or supported by, suitably qualified, skilled and experienced staff. We found that the provider had ensured that there were enough qualified, skilled and experienced staff to meet people's needs. We were told by one person that "the staff are excellent" and by another that "they're all lovely, I like them all".
We found the provider had systems in place to assess and monitor the quality of service provided. We were told by a family member that they do "try to keep channels of communication open". The provider told us "continuous quality improvement is important to us".