Merlin Manor Care Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At the last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had detailed assessments in place at admission and throughout their care, including information about their health conditions, communication needs and risks. Care records we reviewed included information such as nutrition, mobility and clinical risks, and were regularly reviewed. However some care plans lacked meaningful or personalised guidance. For example, the same generic information was provided in care records for all people who had a particular condition but no information about actions to take, which were relevant to the person. In addition, electronic record systems did not always support accurate recording of care delivery time, which impacted the reliability of dependency assessments and staffing decisions. Staff required additional training to use systems effectively, and the gaps in their knowledge affected their ability to evaluate the care provided and respond to requests for information consistently.

Care and treatment was delivered in line with current best practice and supported by evidence-based tools. Staff used recognised guidance and tools to support people’s care and treatment, and there was evidence of appropriate referrals to other professionals when required. People told us staff knew them well and supported them in ways that reflected their preferences. Care plans reflected evidence-based approaches, including nutrition and hydration assessments and risk monitoring for complex conditions. Staff worked closely with healthcare professionals to ensure timely interventions, such as GP visits and medication reviews. People and relatives were positive about healthcare support. A healthcare professional told us staff escalated concerns appropriately and had good knowledge of peoples’ conditions.

Staff worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff worked in partnership with a wide range of external professionals to support people’s health and wellbeing. Feedback from professionals was largely positive, with one stating they had “a great working relationship with the staff and the care home manager,” and staff were “always respectful and value my assistance.”

Staff supported people to manage their health and wellbeing to maximise their independence, choice and control. People’s nutritional needs and preferences were assessed and well understood by staff. Staff had a good knowledge of people’s preferences and dislikes regarding food. While activities were available and some people enjoyed them, we observed limited stimulation in some areas of the home. For example, people were sitting with no meaningful activity and several people were asleep in communal areas with minimal engagement. Staffing levels had impacted on the ability to promote healthier lifestyles. Staff reported that limited time meant they prioritised essential care tasks, reducing opportunities for personalised support and engagement. A staff member said, “People are well cared for but we feel as if we are rushed when attending to personal care as we need to get them all done in a limited amount of time. People are getting more complex but the staffing numbers don't take that into consideration.”

Staff routinely monitored people’s care and treatment to continuously improve it. The registered manager’s quality assurance processes included regular audits of medication, infection control, and the care environment, with action plans being implemented promptly. However, these systems were not always effective in driving improvements. Issues identified during the inspection, including staffing levels, lack of information in care records and consistency, had already been recognised but had not been fully resolved. Staff and relatives highlighted ongoing concerns about staffing pressures, which impacted care delivery and outcomes. Staff described how workload and shortages affected their ability to provide timely and person-centred care. Relatives also reported variability in care and outcomes, including inconsistency in personal care and communication.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff demonstrated an understanding of the Mental Capacity Act and sought consent in day-to-day interactions. We observed staff offering people choices and checking consent during care, for example asking, “Is that ok?” and offering alternatives during mealtimes. Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. Capacity assessments and ‘best interest decisions’ were in place, but these needed extending to cover a wider range of decisions. For example, being only going out with staff, management of monies, and restricted access to items such as knives. Also, these needed to fully explain how staff had tried to support the person make decisions. At times staff struggled to find capacity assessments and ‘best interest decisions’ on the electronic care records system.