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Merit Healthcare Ltd Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 25 July 2018

The inspection of Merit Healthcare Ltd took place on 5, 8,11 June 2018 and was announced. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, and younger disabled adults.

At the last inspection of Merit Healthcare Ltd in November 2017 we rated the service ‘Requires Improvement’ overall. We found three breaches of the regulations. This was because they had failed to assess or take reasonable actions to reduce the risks associated with the health and safety of people. People’s equipment and medicines had not been safely managed by staff and accurate and contemporaneous care records had not been maintained for each person.

After the inspection provider sent us an action plan of the actions they would take to meet these legal requirements. At this inspection we followed up on their actions and found that some improvements had been made but further improvements were needed to fully meet the regulation in relation to the management of people’s care records and embed their actions.

A registered manager was in place 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’s needs were assessed to ensure the service could meet their needs and the level of support provided varied according to their needs. Staff worked closely with health care professionals and people’s families. Relevant health and social care professionals were involved with people’s care when their needs had changed.

People’s risks had been identified and were being managed by staff who knew them well. However people’s care plans did not provide staff with sufficient guidance in managing people’s immediate risks. Arrangements were in place to make sure people received their medicines appropriately and safely, although people’s records relating to the management of their medicines were not always clear. The assessment of people’s capacity to consent to their care had not been assessed in line with the principles of the Mental Capacity Act 2005.

People and their relatives were positive about the caring nature and told us they were supported by staff who were kind and compassionate. They were confident that any concerns would be dealt with promptly. People were supported by familiar staff, although staff sometimes staff did not always arrive on time.

Staff felt trained and supported to carry out their role. The registered manager was involved in the delivery of personal care which allowed them to monitor the well-being of people and management of staff. Any concerns or accidents were reported and acted on to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm.

The registered manager needed to ensure all recruitment checks completed were recorded to evidence their safe recruitment decisions. We have recommended that the service seeks advice from a reasonable source regarding their recruitment systems and take action to update their practice accordingly. The registered manager had a good insight into the quality of care being delivered and monitored the service personally, however further improvement was needed in the quality assurance processes to identify shortfalls in people’s care and medicines records and drive improvement. The registered manager was reviewing the systems to monitor the quality of care being delivered and staff support and development when the registered manager was unavailable. Staff felt supported and could seek advice from the registered manager and staff team.

We found two breaches of the Health

Inspection areas

Safe

Requires improvement

Updated 25 July 2018

The service was not always safe.

People received their medicines as prescribed, although there was limited recorded guidance in the management of people’s medicines for staff to follow. The management of people’s risks were known by staff but were not always comprehensively recorded to provide staff with guidance.

Further improvement was needed in the recording of the recruitment checks that had been completed. There were sufficient numbers of staff to support people.

People were safeguarded from abuse and harm. Any concerns or accidents were reported and acted on.

People were protected by the prevention and control of infection.

Effective

Requires improvement

Updated 25 July 2018

The service was not always effective

Where required, assessments of people’s mental capacity to consent to the care had not been carried out in line with the principles of the Mental Capacity Act.

People were supported with their personal care by staff who were trained to meet their needs. Plans were in place to provide staff with additional training.

Staff worked effectively with other organisations to ensure people’s needs were met. People were referred appropriately to health care services if their care needs changed. They were supported to plan and eat a healthy diet.

Caring

Good

Updated 25 July 2018

This service was caring.

People and their relatives were positive about the care they received. Staff had a good relationship with the people they cared for.

Staff were respectful of people’s own decisions and encouraged them to retain and develop in their confidence and levels of independence.

Responsive

Good

Updated 25 July 2018

The service was responsive.

People were supported by staff who were knowledgeable about their support needs and were responsive to any changes in their well-being.

People and their relatives were mainly confident that any concerns would be dealt with promptly.

Well-led

Requires improvement

Updated 25 July 2018

The service was not consistently well-led.

The registered manager had a good understanding of all aspects of the service, however the systems to monitor parts of the service were not always effective.

The registered manager and staff worked as a team and engaged with others to improve the lives for people.

People, their relatives and staff felt supported and were confident in the management of the home.