Merlin Court Care Home

Merlin Court Care Home is a purpose-built residential home for up to 62 people, some of whom live with dementia. Rooms are on two floors accessed by stairs and a lift and are all ensuite. There are various communal areas including a cinema, café, hair salon, lounges and dining areas. At the time of our inspection there were 38 people living at the service.

People’s experience of using this service and what we found

The provider had reported events to the Care Quality Commission (CQC) when they were legally required to. The registered manager had a good understanding of what events needed to be reported. Records of incidents demonstrated notifications had been completed promptly when needed. Incidents had been managed well, with information shared with relevant health and social care professionals. Incidents had been reviewed and action taken to minimise the risk of them happening again.

Infection prevention and control systems had been updated to reflect the COVID-19 pandemic. There were robust systems in place to ensure the home was clean. People told us they were happy with the support that staff had provided. High contact areas such as door handles had additional cleaning throughout the day.

Staff had personal protective equipment (PPE) and had been trained on how to use it safely. Staff told us they felt safe working at the service. We observed staff working in safe ways throughout our visit.

Visitors were screened before entering the building to minimise the risk of COVID-19 being brought into the home. All visiting by relatives was planned and booked in advance. The provider had built a garden visiting room with screens to keep people and relatives safe. Plans were in place to arrange indoor visits, in line with the lifting of government restrictions.

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 22 July 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

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merlin Court Care Home 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Merlin Court Care Home is a purpose built residential home for up to 62 people, some of whom live with dementia. Rooms are on two floors accessed by stairs and a lift and are all ensuite. There are various communal areas including a cinema, café, hair salon, lounges and dining areas. At the time of our inspection there were 36 people living at the service.

People’s experience of using this service and what we found

The Care Quality Commission (CQC) had not been notified of all notifiable incidents and accidents as required by law. This was a repeated breach of regulation. Whilst incidents and accidents had been recorded and investigated, they had not been reported to CQC or the local authority in all cases.

There were robust systems in place to ensure the home was clean. People told us they were happy with the cleanliness of their rooms and communal areas. High contact areas such as door handles had additional cleaning throughout the day.

Staff had personal protective equipment (PPE) to use and had been trained on how to use it safely. Staff told us they felt safe working at the service.

Arrangements were in place to make sure visitors were screened before entering the premises. All visiting by relatives was planned and booked in advance. The provider had organised an indoor visiting room with screens to keep people and relatives safe. This was thoroughly cleaned after each visit.

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 22 July 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 enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 and 24 May 2019. A breach of legal requirements was found. The provider completed an action plan after that inspection to show what they would do and by when to improve their notifications submitted to CQC.

We undertook this targeted inspection to check the provider had carried out the improvement required in relation to the breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices, breaches of Regulations or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merlin Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the provider failing to notify CQC of serious injuries at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People were not always supported to have maximum choice and control over their lives, as it was not clear if staff supported them in the least restrictive way possible. The polices and systems in the service did not always support this practice.

People were not being supported by robust safeguarding systems. Not all incidents of alleged abuse had been reported to the local authority. The registered manager had also not submitted notifications to the Care Quality Commission (CQC)when required to do so.

Quality monitoring systems were in place but there were actions that appeared to be still open. We raised this with the registered manager and regional operations manager who told us they would go back over the audits and record the action taken to close the record.

People were supported to take their medicines as prescribed by staff who had been trained and were knowledgeable. Risks to people had been identified and risk management plans were in place to give staff guidance.

People were supported by staff who had been recruited safely. People told us, and we observed there were sufficient numbers of staff available to support them.

People received sufficient food which was of a good quality. People were not always supported to make choices of meal’s effectively. The registered manager said they would address this practice.

People had their needs assessed and a care plan put in place. People’s life story was explored, and information recorded to help staff understand people’s needs and communicate more effectively. People could have visitors without any restrictions. We observed families and friends visiting throughout our inspection. An area was available where they could help themselves to refreshments.

People told us the staff and management were kind, caring and approachable. People were involved in planning their own care and had the opportunity to share their views. People were involved in a ‘residents committee’ which made decisions about things like food and activities.

People were supported and encouraged to take part in group activities but also supported to follow their own interests. Staff developed and maintained good relationships with the local community and encouraged groups to visit the home.

People, relatives and staff told us they thought the service was well-led.

More information is in the detailed findings below.

Rating at last inspection: At our last inspection in October 2016 (report published in October 2016) we rated the service as Good.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Action we told provider to take can be found at the end of the full report.

Follow up: We will ask the provider to submit an action plan outlining what action they are planning to take and when it will be completed by. We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection schedule. If any information of concern is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s bedrooms were arranged over two floors with communal lounges and dining areas with satellite kitchens on each floor. There was a central kitchen and laundry located in the basement of the building. The home had undergone an extensive programme of refurbishment since our last inspection in July 2015. People, relatives and staff spoke positively regarding the physical changes to the home. Comments included “The décor is lovely, it’s so light in here now”, “The changes are lovely and residents have still kept all their personal belongings in their rooms so the rooms are individual” and “We were kept up to date with all the renovations. The changes were done without disturbing the residents. It’s lovely here now”.

We carried out this inspection over two days on the 05 and 06 October 2016. At a previous inspection which took place in July 2015 we found the provider did not meet the legal requirements for some of the areas we looked at. They wrote to us with an action plan of improvements that would be made. We found on this inspection the provider had taken all the steps to make the necessary improvements in these areas.

The previous registered manager had left the employment of the service in November 2015. A new manager had been recruited and was in the process of submitting their application to become the 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.

People and their relatives spoke positively about the care and support they or their family member received. During our inspection we observed people appeared happy and relaxed in the company of staff and did not hesitate to seek assistance and support. Staff responded promptly to requests for assistance, seeking permission before undertaking any care tasks.

Staff told us that people were encouraged to be independent as possible and explained how they ensured they maintained people’s privacy and dignity when undertaking personal care tasks. People received support from staff who had got to know them well.

People were receiving care which was responsive and tailored to their needs. Care plans were in place which clearly described how each person would like to receive their care and support. Records showed people and their relatives were involved in the planning of their care plans which were regularly reviewed and updated as required.

People were supported to have sufficient to eat and drink. Where people required assistance this was done at a pace appropriate to them.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner. People had access to healthcare services to maintain good health.

People were protected from the risk of harm and abuse. Staff had received safeguarding vulnerable adults training and were aware of their responsibility to report any concerns. Policies and procedures were in place to advise staff on what they should do if they had concerns. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

Safe recruitment practices were followed before new staff were employed to work with people. People received individualised care and support from staff who had the skills, knowledge and understanding needed to carry out their roles. Staff told us they had access to training appropriate to their role. New staff received a comprehensive induction prior to working independently with people.

People, their relatives and staff spoke positively about how the service was managed. Staff felt supported by the management team and were able to raise any issues or concerns they may have. Quality assurance systems were in place to monitor the quality of service being delivered. Plans were in place to ensure improvements to the service were identified and appropriate actions taken. People and their relatives were encouraged to provide feedback on the service and complaints were dealt with in line with the provider’s policy.