Merit Healthcare Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection, we rated this key question requires improvement. At this inspection, the rating has changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Systems have been improved since the last inspection by the management to provide oversight. Some more formal quality assurance systems were emerging. These were proving to be effective at identifying concerns and rectifying them.

People and relatives were positive about the culture and management of the service. Staff felt supported and received regular supervision. When concerns were identified with a staff member’s practice, appropriate actions were taken to support improvement.

Equality and diversity were understood by the management. Other health and social care professionals felt they were involved appropriately. Systems were in place to coordinate with the community, so people received the support they required.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The care manager and registered manager were both clear everyone was to be treated as equal, and to ensure people were happy and safe. The management gave examples of how they provided person-centred care in line with their shared vision, strategy and culture. They provided a wealth of examples about how they had ensured that people were the forefront of everything. For example, helping to support someone with housing due to no direct family. They were aware of the importance of supporting staff who had moved to the country from overseas. For example, they put things in place for staff not used to colder climates by offering free blankets and lessons on how to look after their cars.

Staff knew to place the person at the centre of everything they did. Comments included, “[We make sure] the client is ok. They are happy. Always make sure you are giving the service ok and happy to keep them safe. That is Merit” and, “The client is priority. Make sure the workers are giving effective work to the [people]…We are there to care for them and make sure [people] and workers are safe.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People and their relatives were positive about the management of the service. Comments included, “[The registered manager] is lovely. Very understanding and when they say they are going to do something they actually do it” and, “[The management] are very professional, agreeable and practically minded. A positive impression of [them] and I felt confident [they] were going to help me with my care.”

The registered manager was proud at how they worked with other managers and providers to ensure they maintained their knowledge. They shared their knowledge with staff who work for them and encouraged personal development. For example, the care manager would go to all the manager and provider meetings with the registered managers.

Improvements were now found with how the management worked with other health professionals. Health and social care professionals fed back how transparent they felt the management of the organisation were. This included during safeguarding meetings when it was clear people were always the most important. This openness was reflected during the inspection visits with both the care manager and registered manager.

Improvements were found with how staff felt supported and listened too. The provider now fostered a positive culture where people felt they could speak up and their voice would be heard.

People were able to raise positive comments or concerns to the office at any point. Records demonstrated that a range of concerns or compliments were logged. This also reflected what we heard whilst in the office during the site visits. There were systems in place to reflect upon them or resolve them if required. Comments included, “We have their telephone number here. Yes, they answer the phone. I talk to anyone there. I have had no problems” and, “[Management] have empathy and understanding. I can ring them and have a conversation with them. They are responsive and things are handled well.”

Staff felt able to speak out and knew the consequences if they did not. Comments included, “I look out for life and client safety. I am happy to speak my mind”, “You go to them, and they will help you out. Very approachable” and, “[Management] are always there for [speaking up] and will always listening and do something about the situation.” Staff told us where they would speak up externally if they were concerned no action was being taken

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Systems were in place to support staff to culturally adapt when they first moved to England. This included supporting them with weather differences, appliances they may not be used to and religious differences.

The registered manager talked us through ending a care package if it compromised the staff by challenging their ethnicity. They were not prepared for their staff to face an unpleasant time at work.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

Systems were emerging to formally audit care plans. The management had identified issues, identified patterns of concern and acted where required. The registered manager and care manager gave examples of how these had fed into staff supervisions over the last three months. Staff were positive about the feedback they were receiving to help them improve. One staff member said, “When something happens, incidents, they talk to you and they will call you in and tell you this is what you did wrong, you should have gone about it this way.”

The registered manager talked us through how the system they use alerts them to any concerns whilst staff were delivering care. They review the previous day and follow up with staff or people if they have to look into it more deeply. This helped them ensure each person’s care is in line their care plan. The care manager was responsible for carrying out regular supervisions for staff to ensure the quality of care. They talked through how all the reviews inputted into supervisions and ensuring the quality and safety of care. One relative said, “We have had people come out with the carer to have a chat and see what they are doing.”

The provider now understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They now shared information and learning with partners and collaborated for improvement. This was an improvement since the last inspection.

Examples were provided by the registered manager of times they had demonstrated partnerships with the community. This included supporting a person with declining health who had no family to get the care they required. Other examples were supporting people liaising with charities and the local authority to sort out difficult situations.

Health and social care professionals were positive about their interactions with the provider. Comments included, “On meeting some of the care workers on home visits they were very attentive to the customer and showed patience and professionalism” and, “Communication with the office staff was smooth and responsive.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

During the inspection, the registered manager had attended a ‘manager’s retreat’. They explained this was a chance to learn from other managers. Additionally, they are a member of a number of forums. The registered manager told us they, “Share news stories and articles, plus discuss them to share knowledge.” The registered manager attended all the local authority provider forums and encouraged their care manager to go with them.

Staff were encouraged to continuously develop. Health and social care diplomas had been sourced by the management. Some of the staff moved to England with a clinical qualification in their own country. The registered manager and care manager saw this as positive and supported the professional development. One staff member said, “I also go to the academic route to do my own personal training.”

Systems were in place to monitor accidents and incidents then learn from them. One staff member said, “When something happens in [an area] [the management] will send everyone working in that area a message to say this has happened and what needs to be done or has been done. All of you will discuss it.” This meant learning was shared with all staff who needed to know about it to prevent recurrence.