Archived: Merrill House

At our last inspection in April 2017 we rated the service overall as ‘Requires Improvement’. At this inspection the service had improved to ‘Good.’

The home provides personal care and accommodation for older people, people with disabilities and sensory impairment.

A registered manager was in post. This is a condition of the registration of the service. 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's risk assessments provided staff with information on how to support people safely, though some assessments were not fully in place. Lessons to prevent incidents occurring had been learnt from past events. Staffing levels were sufficient to ensure people's safety.

Staff had been trained in safeguarding (protecting people from abuse) and, in the main understood their responsibilities in this area. Staff were subject to pre-employment checks to ensure they were appropriate to work with the people who used the service. People were protected from the risks of infection.

People using who used the service and the relatives we spoke with said they thought the home was safe. They told us medicines were given safely to them and on time. We found this to be the case.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives and they were of all their responsibilities under this law.

People had plenty to eat and drink and everyone told us they liked the food served.

People's health care needs had been protected acted on by referrals to health care professionals when necessary. A visiting district nurse said that staff ensured that the standard of health care provided to people was good.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way., though there was one occasion where staff had not shown respect for a person’s choice which the registered manager followed up. People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to people and covered their health and social care needs. Activities were organised to provide stimulation for people and they had opportunities to take part in activities in the community if they chose.

People and relatives told us they were confident that if they had any concerns these would be followed up.

People, relatives and staff were satisfied with how the home was run by the registered manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs and provide a quality service.

Merrill House is registered to provide residential care and support for up to 40 people older people. At the time of our inspection there were 14 people using the service. The service is located within a residential area of Derby. There are bedrooms on the ground and first floors. It is split into three wings each with its own lounge and dining area.

There was a registered manager in post. 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.

People who were supported with their medicines were not always protected against the risks associated with poor medicines management. For example our observation showed that staff did not always observe people to ensure they had taken their medicines.

We saw that a person had experienced weight loss between February and April 2017. However we saw no evidence that medical support was sought to ensure the person’s dietary needs were being met. This demonstrated that people were not always supported to ensure they received adequate nutrition.

We found that the provider's quality assurance systems had not picked up some of the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements.

People who used the service were positive about the support they received and praised the quality of the staff and management. People told us they felt safe at the service. We saw staff interacting with people in a relaxed and friendly manner. People were supported to socialise and take part in activities to promote their wellbeing.

Risk assessments and care plans had been developed with the involvement of people. Staff told us that they had relevant information on how to minimise identified risks to ensure people were supported in a safe way. There were sufficient staff available to support people.

Staff we spoke with understood their responsibility in protecting people from the risk of harm. Recruitment procedure’s ensured suitable staff were employed to work with people who used the service. Staff told us they had received training and an induction that had helped them to understand and support people.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. Staff gained people’s verbal consent before supporting them with care tasks and supported people to make their own decisions.

People told us staff provided support with kindness and compassion. People were treated with dignity and respect by staff and encouraged to express their views. The delivery of care was tailored to meet people’s individual needs and preferences. People were supported to use healthcare services.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People told us they felt if they raised any concerns these would be taken seriously and would be addressed by management.

People felt the service was well managed. There were processes in place for people and their relatives to express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We found a 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 the report.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw limited examples of how staff treated people with dignity and respect as staff were mostly involved in providing personal care in people’s bedrooms. One person told us. "Staff are lovely, very respectful but you can still have fun with them." People told us they felt safe. They told us that staff were very busy and did not always respond quickly when they called them.

People told us that they knew how they could raise and felt confident about doing so without repercussions.

People received their medications at the right time. The provider had effective arrangements for the safe management of medicines. Staff we spoke with understood how to identify and report signs of abuse. Procedures were in place for managers and staff to learn from events such as accidents and incidents as well as complaints

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control.

The provider employed housekeeping staff who cleaned the home. We saw that people's bedrooms and communal areas were clean and tidy. One person who used the service described the home as "clean and tidy".

People's care needs were not always taken into account when making decisions about the numbers and skills and experience of staff required. We saw records that showed there were high numbers of falls in one particular area of the home, Care records indicated that a significant number of people using the service required the support of two staff for personal care. We have issued a compliance action regarding employing enough staff to meet people’s needs.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Support plans included details of people's needs and information about how people were supported with those needs.

When we spoke with visitors, they told us they were confident that the service provided good care. One visitor told us, "I visit regularly and I have no concerns, my (relative) has a good relationship with staff.”

Is the service caring?

People told us they were supported by kind and caring staff. One person told us, "The staff are lovely." Another person said, “There’s good crowd here, this place is good, and I feel safe.”

People's preferences, interests and diverse needs had been respected. People who wanted to be were supported with their religious and spiritual needs. People had newspapers of their choice to read. However the service provided a limited range of communal and individual activities that people could participate in. One visitor commented. “There is no opportunity to do anything, so there is not much stimulation for people. They could make more of the garden and make it more pleasant for people to sit outside. Apart from Christmas they don’t do any major events, they did nothing for the D day commemoration the other day nor did they do anything around Easter. There aren’t enough staff to do that sort of thing.” We have issued a compliance action to the provider to improve this aspect of care.

Is the service responsive?

People told us that staff supported them with their needs. People told us they were well looked after. Most records we looked at showed that people had been supported with personal care and health needs.

Visitors we spoke with told us that they knew how to raise concerns and were confident they would be listened to. We saw that a relative's complaints had been investigated and resolved.

All visitors we spoke with told us that the service had kept them informed about their relative’s wellbeing.

People who used the service and relatives had participated in a satisfaction survey. The results of the survey showed that people were satisfied with their care. Relatives told us that their views were not always acted upon. The registered manager organised coffee mornings for people who used the service to be kept informed of changes in the service.

Is the service well-led?

The service had a system for monitoring the quality of service. This included checks of documentation and records.

The provider had carried out a survey of people who used the service. The survey gave people an opportunity to comment on their experience of the service.

You can see our judgements on the front page of this report.

People we spoke with were happy with the care they received. Comments included “It is nice here, much better than where I was before,” “I am finding it very nice so far” and “I feel safe here, my relative comes in every other day and is always made to feel welcome.”

We saw that people's needs were assessed, and care plans were in place. This meant they received support in a way that met their needs.

People were supported to eat and drink sufficient amounts to meet their needs and preferences. People we spoke with felt the food was good and there was plenty of it.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

The provider needs to ensure that there are sufficient staff available able to meet people’s needs safely.

Procedures were in place for managing complaints about the service. People using the service and relatives we spoke with told us they knew what to do if they had any concerns. They felt confident that they would be listened to and their concerns would be acted upon.

People told us they liked living at the home. One person said, "it is nice here, there is a relaxed atmosphere, and I feel comfortable." Another person told us, "we choose how we spend our day, and “it’s very flexible.”

People we spoke with were complimentary about the care and support provided by staff. Comments included “staff are understanding,” staff support us when we need them to” and “there are usually enough staff around.”

All the people we spoke with told us they felt safe at the service. One person commentated that “it’s safe as anywhere else.”

People told us the food was nice. Comments included “we always get a choice,” “we have plenty to eat “and “we have refreshments through the day.”

All of the people spoken to told us they knew how to raise any concerns, and systems were in place to address these.

One relative told us they were very pleased with the care received by x. They told us “I have nothing but praise for the staff” and “the staff are very kind, I cannot fault them.”