Merit Healthcare Ltd

Merit Healthcare Ltd is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 56 people receiving personal care from the service.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Following the last inspection, the provider had taken action to address the breaches of regulation and improve the service. However, further action was needed to ensure improvements were sustained and to improve engagement with staff and professionals.

The management team did not always communicate effectively with staff and health and social care professionals or create a culture that empowered staff. The majority of staff we received feedback from did not feel supported or valued by the management team. Some professionals felt the service worked well with them to meet people’s needs. Other professionals felt communication with the management team was not always effective, which had resulted in delays and inconsistencies.

People felt safe receiving care from staff. The provider had taken action to keep people safe and respond to concerns raised. There were effective systems to protect people from the risk of abuse.

People were supported to take medicines safely and staff sought advice from health and social care services when necessary. Staff kept good records of the medicines support they provided to people.

Staff had a good understanding of the support people needed and how to manage any risks they faced. Staff supported people to do as much for themselves as possible and maintain their independence.

The provider thoroughly checked staff before they started providing care for people. People said staff had the skills and knowledge to meet their needs.

The provider had established systems to monitor the quality of service provided and make improvements where needed.

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 24 August 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a focused inspection of this service on 13 July 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care, good governance, notification of incidents and employment checks.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merit Healthcare Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Merit Healthcare is a domiciliary care service providing care to people in their own homes. The service is provided to people who have a range of needs including a learning disability, mental health needs, physical disability and age-related frailty. At the time of the inspection, there were 30 people receiving support from Merit Healthcare.

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

The management of medicines within the service was not always safe. We could not be assured people had always received their medicines. Staff practices in relation to medicines were not always in line with national guidance or the provider’s policy.

Risk assessments in relation to people’s care were not always accurate or completed. Where people were supported with moving and handling, continence care or skin care their risk assessments were either inaccurate or had not been completed.

We could not be assured staff were routinely testing for Covid-19. Although staff had access to Covid-19 tests, the registered manager had no process to ensure staff had routinely tested as per current guidance.

The recruitment of staff was not always safe. Safe recruitment practices had not always been followed and recruitment checks had not always been completed.

The recording of care delivery in the service had not always been completed. We also found inconsistencies relating to call monitoring. This meant, management could not always identify whether people had received their care calls as agreed and also what support people had received from staff. The people and relatives we spoke with provided mixed feedback relating to the punctuality of care staff.

We could not be assured staff had received training which was relevant to their role. The registered manager had not maintained up to date training records and was unable to provide evidence and reassurances that all staff had received training relevant to their role.

There had been a failure to establish and maintain effective quality assurance systems within the service. Shortfalls within the service were not identified and as a result appropriate action had not been taken to address areas that require further improvement.

The registered manager had not always notified CQC of incidents they had a legal obligation to report to us.

Staff knew what action they needed to take if they had any concerns relating to the safety of the people using the service.

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

Rating at last inspection

The last rating for this service was Good (published 11 September 2019).

Why we inspected

We undertook this inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the risk management in relation to people’s care and the punctuality of care staff.

We undertook this focused inspection to examine those risks. This report only covers our findings in relation to the Safe and Well-led key questions.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this report.

We found multiple breaches of regulation. You can see some of the action we have asked the provider to take at the end of this full report. 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.

Following our inspection, the provider has engaged with us and have given assurances that people will receive safe care and treatment. The provider took immediate action to ensure staff were completing COVID-19 testing in line with current guidance and also the action they were taking to ensure the safe management of risk and medicines within the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merit Healthcare 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 breaches in relation to the management of medicines, safe staff recruitment, safe infection control practices, ensuring accurate and cotemporaneous records, maintaining good governance within the service and notifying CQC of incidents.

Please see the action we have told the provider to take at the end of this report.

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.

Merit Healthcare Ltd is a domiciliary care service that provides personal care and support to people living in their own homes. The service supported 30 people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Effective systems were not fully in place to monitor the quality of the service being delivered and staff development. We have made a recommendation relating to the recording of governance systems.

People and their relatives were positive about the caring nature and approach of staff. People told us they were supported by staff who were kind and compassionate. They told us they felt safe when staff visited and were confident that any concerns would be dealt with promptly. Appropriate numbers of staff who arrived on time supported people and stayed for the designated amount of time to deliver the care and support people required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff told us they had received appropriate training which supported them to carry out their role. Staff told us they could seek advice from the registered manager and senior carers. The registered manager and staff were passionate about the care they delivered and were driven to improve the service. They communicated and engaged with others such as family members to improve the lives for people.

The registered manager acted on concerns to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on.

The registered manager monitored the delivery of care through staff observations and feedback from people. They were reviewing and implementing the systems they used to monitor the quality and effectiveness of the service such as staff recruitment and performance.

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

Rating at last inspection

The last rating for this service was requires improvement (published 25 July 2018) and there were multiple breaches of regulation. 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

This was a planned inspection based on the previous rating.

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.

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 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 this report. We will also be asking the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘Is the service safe?’, ‘Is the service effective’ and ‘Is the service well-led’ to at least good.

This inspection took place on 2, 3 and 14 November 2017. The service had not previously been inspected. The service was first registered with CQC on 17 November 2016 and began providing personal care to people in March 2017. This is the first time the service has been rated Requires Improvement.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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 were not being kept safe from the risks of potential harm. Risk assessments had not been completed describing the strategies in place to keep people safe from the risk of choking and how any tissue viability concerns were managed. Staff had not always followed people’s moving and handling and medicines care plans putting them at potential risk of harm. Medicines administration charts had not always been completed. People did not always get their medicines at times to suit them. People did not always receive their care to reflect their personal wishes or preferences. Staff had not reported missed visits or near misses. The registered manager was unable to respond to these and to make the appropriate changes or improvements to the service. Their quality assurance processes had not identified these issues. People’s capacity to consent to their care had not been considered in line with the Mental Capacity Act 2005.

Merit Healthcare provided care to people by staff they knew well. People liked the consistency of having a named person to deliver their care. Arrangements were in place to provide cover for absences. People said their visits were usually on time and staff stayed for the correct length of time to meet their needs. People’s dietary needs had been discussed with them and staff ensured they provided snacks and access to fluids when needed. People’s health and well-being was monitored. Staff reported any changes to the registered manager who liaised with the family and health care professionals. Staff understood how to recognise and report suspected abuse and how to ensure people stayed safe in their homes.

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 in the service supported this practice. People were treated with respect and dignity and their independence was encouraged. Staff knew people well and had positive relationships with people. People’s needs had been assessed to make sure the service could meet their needs. People and their relatives had been involved in the planning of the care and support. People’s care plans were available to staff electronically and technology was being introduced which would monitor visit times. People’s diversity and human rights were respected and adjustments made to their care and support if needed. Information could be provided in alternative formats if needed. People knew how to make a complaint. Complaints had been investigated and action taken to improve people’s experience of their care.

The registered manager had a vision for the service to provide personalised care to people by staff they knew well. They recognised the need for improvements to achieve this. Quality assurance systems sought feedback from people and their families to find out their experience of their care. She recognised the need to value staff and to maintain a stable staff team. The registered manager kept up to date with best practice and current guidance through links with other agencies.

We have made one recommendation to ensure new staff complete a robust induction programme. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.