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Inspection carried out on 20 February 2019

During a routine inspection

About the service: Merlewood House is a residential care home and is registered to provide accommodation and personal care for up to 6 people with autism. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection, 4 people were using the service.

The service had 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, rights, independence and social inclusion. This was to support people using the service in living their life as other citizens.

People’s experience of using this service: A relative told us, “It gives me peace of mind knowing [my relative] is there. It’s marvellous.”

We observed people were relaxed and content in the company of staff and managers. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff had received training on positively responding to people’s behaviours and safeguarding and protection matters. Relatives told us they felt people were safe at the service.

Processes were in place to make sure all appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support; staffing arrangements were kept under review.

The provider had arrangements to promote the safety of the premises, this included maintenance, servicing and checking systems. There was a good standard of décor and furnishings to provide for people's individual needs, comfort and wellbeing.

People's needs were assessed, planned for and reviewed. Each person had a care plan which was designed to ensure their needs and choices were met. People were supported with their health and well-being, changes were monitored and responded to. Where necessary, people received appropriate medical attention. The service followed good processes to manage people's medicines safely, in a person-centred way.

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 at the service supported this practice. People had opportunity to develop their independence skills, gain confidence and try new experiences.

Relatives made positive comments about the caring attitude of staff. We observed staff interacted with people in a kind, pleasant and friendly manner. Staff knew people very well and they were respectful of their choices and preferred routines. People’s privacy and dignity was respected.

There were opportunities for people to engage in a wide range of community and in-house activities. People were supported to keep in touch with their families. Visiting arrangements were flexible, relatives said they were made welcome at the service.

People were offered a variety of meals and drinks; healthy eating was promoted and monitored. Individual needs and choices were known and catered for.

The service had creatively responded to and managed people’s complaints. Relatives had an awareness of the service's complaints procedure and processes and were confident in raising concerns.

The provider had arrangements to encourage people to express their views and be consulted about Merlewood House. They had opportunities to give feedback on their experience of the service and make suggestions for improvements. Managers and staff completed regular checks on quality, systems and processes.

We found there were management and leadership arrangements in place to support the effective day to day running of the service. Progress was ongoing to ensure the management arrangements met legal requirements.

Rating at last inspection: Good (21 July 2016)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will plan a follow up inspection as per our inspecti

Inspection carried out on 7 June 2016

During a routine inspection

Merlewood House is registered to provide accommodation care and support for up to six people. It specialises in providing care for people with autism. The home is a detached property in a residential area of Great Harwood. Accommodation is provided in six single rooms. There are shared bathing facilities and communal rooms. At the rear of the property is an enclosed private garden, which also includes a fully furnished wooden chalet. There are limited car parking spaces on the front driveway. At the time of the inspection there were six people accommodated at the service. The service is also registered to provide personal care in the community, however; this activity was not being carried out at the time of the inspection.

The service was managed by 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.

At the last inspection on 15 April 2014 we found the service was meeting all the standards assessed. At this inspection we found the service was meeting the current regulations.

People’s relatives and staff spoken with expressed confidence in the registered manager and the leadership arrangements at the service. Relatives spoken with indicated they were satisfied with the care and support their family member received. Their comments included, “We are very happy with the service” and “Absolutely brilliant.”

Relatives told us they had no concerns about the way people were supported. They considered their family members were safe. Risks to people’s well-being were being assessed and managed. We did find some individual risk assessments were lacking, however processes were in place to manage the risks and the registered manager took timely action to rectify this matter.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff said they had received training on safeguarding and protection matters. They had also received training on positively responding to people’s behaviours.

The service provided a calm and settled atmosphere, which aimed to help people with their anxiety and enhance their levels of concentration. Arrangements were in pace to provide a safe and well maintained environment.

Relatives made positive comments about the staff team, describing them as kind, caring and understanding. We observed positive and respectful interactions between people using the service and staff.

Arrangements were in place to maintain appropriate staffing levels to make sure people received the support they needed. Character checks had been carried out before new staff started working at the service.

There were systems in place to ensure all staff received regular training and supervision. This included specific training on autism and Asperger syndrome. We found some basic training was overdue but action had been taken to address this matter.

There was a focus upon promoting people’s confidence, independence and developing their skills. Staff expressed a practical awareness of promoting people’s dignity, rights and choices. People were supported to engage in meaningful activities at the service and in the community. Beneficial relationships with relatives and other people were supported.

People were supported as much as possible to make their own choices and decisions. We saw staff sensitively consulting with people and involving them in routine decisions and using their preferred way of communicating. We found the service was working within the principles of the MCA (Mental Capacity Act 2005).

People were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People’s individ

Inspection carried out on 15 April 2014

During a routine inspection

Merlewood House is a care home which provides accommodation for up to six people. It specialises in providing care for people with autism. The home is a detached property in a residential area of Great Harwood. Accommodation is provided in six single rooms. There are shared bathing facilities and communal rooms. At the rear of the property is an enclosed private garden, which also includes a fully furnished wooden chalet. Whilst the service is also registered to provide personal care in the community, this activity was not being carried out at the time of the inspection.

People living in the home had complex needs and had difficulties with verbal communication. The staff had developed a variety of innovative communication methods in accordance with people’s needs and preferences. For instance computer tablets were used to enable people to make choices about their daily pursuits and understand the sequence of tasks involved in specific activities. This approach reduced people’s levels of anxiety and stress.

People had person centred care plans and a health action plan. This documentation provided staff with detailed information about how best to meet people’s needs. The plans were underpinned with a series of risk assessments to ensure people were able to take managed and responsible risks as part of their daily lives. All care plan records seen were comprehensive, complete and up to date.

The home had appropriate policies and procedures in relation to the Mental Capacity Act, its associated code of conduct and Deprivation of Liberty Safeguards. (The Deprivation of Liberty Safeguards provide a legal framework to protect people who need to be deprived of their liberty for their own safety). Although the registered manager reported there had been no applications made to the local authority, staff and the management team had been trained to understand when an application should be made. Staff spoken with had participated in best interest meetings, which were held in circumstances where a person using the service lacked capacity to make their own decisions. The decisions and actions agreed in the meetings were detailed in the person’s support plan.

We spoke with four family members, all of whom expressed a high level of satisfaction with the service. One relative told us, “They (the staff) provide the best quality of life they can”.

Staff spoken with were positive about their employment and confirmed they were well supported by the management team. Staff had a good understanding of people’s needs and preferences. We observed kind and sensitive interactions with people living in the home throughout our visit. Staff had access to ongoing training which they told us was beneficial and useful for their role.

The manager had established systems to ensure the quality of the service was monitored on an ongoing basis. The management team operated an “open door” policy and staff were encouraged to discuss any aspect of the operation of the service. Staff spoken with had a high regard for the management team and felt the home was well managed.

Inspection carried out on 16 January 2014

During a routine inspection

We were unable to speak with people who used the service, because they could not always give their verbal opinions on the service they received. However, we considered people�s overall experience of the service and perceived they were mostly satisfied with the care and support provided at Merlewood House.

At the time of this inspection the service was not providing personal care in the community.

People were being involved as far as possible in planning and consenting to their support and were enabled to make decisions about matters which affected them. They were supported to access resources and activities within the community and keep in touch with others.

People were supported to make choices, try new experiences and develop independence skills.

People were getting support with healthcare needs and they had access to on-going attention from health care professionals.

People were provided with a good standard of accommodation, to promote their comfort and well-being.

The arrangements for staff recruitment helped to ensure people experienced, safe, appropriate support.

People had records which helped to promote good communication and ensured the monitoring of people�s well-being and accountability.

Inspection carried out on 17 January 2013

During a routine inspection

We considered people�s overall experience of the service and found they were satisfied with the care and support provided at Merlewood House.

People were being involved as far as possible in planning their support and were enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were supported to make choices, try new experiences and develop independence skills.

People were supported to access resources and activities within the community and keep in touch with friends and relatives.

People were getting support with healthcare needs and they had access to ongoing attention from health care professionals.

We found the staffing arrangements were sufficient in ensuring people received effective care and support.

There were systems in place to help support an effective complaints process.

Inspection carried out on 15 March 2012

During a routine inspection

We considered people�s overall experience of the service and perceived they were satisfied with the care and support provided at Merlewood. Relatives of people using the service told us, �This home is really good; they make sure he has a good quality of life�, �We are quite happy with things�, �It�s all very good� and �It�s fantastic, I don�t think he could be in a better place�.

People were being involved as far as possible in planning their support and were sensitively enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were enabled to make choices and develop independence skills. They were being supported to pursue learning opportunities and try new experiences.

They were supported to access resources and activities within the community and keep in touch with families and friends.

People were getting support with healthcare needs and they had ongoing attention from health care professionals. They were being supported sensitively with personal care needs.

People using the service were supported by well trained, capable staff.

Although we had no concerns about peoples� care and support; we found some improvements were needed to make sure guidelines were better worded to protect people using the service.

People were being consulted about their experience of service. We found that checks on practices and systems were being carried out and action was being to improve and develop the service.

Reports under our old system of regulation (including those from before CQC was created)