Archived: Merlin Court

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service Safe?

People were cared for safely. Staff understood the needs of the people they supported. People's needs were assessed. Care and treatment was planned and delivered in line with their individual care plan.

People told us they felt safe at Merlin Court. We found that there was a clear safeguarding policy and procedure in place. Staff we spoke with had an understanding of the different types of abuse and what action they would take if they suspected abuse had occurred. Staff told us they would use the whistleblowing process if they felt appropriate action had not been taken by the provider. One member of staff told us, 'I raised my concerns and the manager acted immediately. I would feel confident to do it again as I was well supported.'

During our visit we saw there was an appropriate number of staff on duty with the necessary skills and experience to meet people's needs. We saw care staff interacting in caring and respectful way. We saw that when people asked for support this was given in a timely manner. People's call bells were answered promptly.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made the manager was able to describe the circumstances when an application should be made. Relevant staff had been trained to understand when an application should be made and how to do so. This meant that people's human rights were properly recognised, respected and promoted.

Is the service effective?

People received support that was effective. Care and support was provided that aimed to keep people physically and emotionally well. This was achieved because people had an individual care plan which set out their care needs. People's needs were assessed and people told us they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans identified the needs of people living with dementia and were recorded in a dignified and respectful way.

People told us they were happy with the care they received and felt their needs were understood and met. People's relatives were also complimentary about the service. One person's relative told us, 'I have seen some amazing improvements in my mum's self-esteem since she came here'. We observed a number of warm and meaningful interactions that had a positive impact on people's mood.

People were supported by staff who understood people's needs. Care workers had clear knowledge of the people they were supporting. For example a care worker we spoke with was able to tell us about the special dietary requirements of one person and how these were met.

Is the service caring?

The service was caring. People we spoke with felt cared for. One person told us, 'I can't fault them, very patient, just wonderful people'. Another person told us, 'I am very lucky, I know the carers well, they know what I need, it makes the hard times bearable'. Relatives we spoke with were positive about the care their relatives received. One person's relative told us, 'they (care staff) are fantastic, I can't praise them enough, the care and understanding shown to people is exemplary and I am here a lot'.

We saw care staff supporting people in a caring and respectful manner. The atmosphere in the home was pleasant and we observed caring interactions between care workers and people. Staff were caring, relaxed and friendly. Staff we spoke with clearly enjoyed their role and showed respect when speaking about people. One care worker told us, 'It is a very nice place to work.' Another said, 'I love my job.'

Is the service Responsive?

The service was responsive. People's needs were assessed when entering the home. Regular reviews were carried out to assess changing needs. When people's needs changed the service responded and took the appropriate action. For example, advice and guidance was sought from other professionals when required. We saw that people's lifestyle choices and religious beliefs were respected.

An activity plan was displayed in the home. During our visit people were supported to attend a musical event. We saw that where people did not want to attend group activities one to one interactions took place. For example one person being cared for in their room had a book read to them.

People we spoke with confirmed they would know how to raise concerns, but this was rare as they were pleased with the service provided. We saw that where complaints had been made these had been investigated and responded to appropriately.

Staff told us they felt listened to. One staff member told us they had made a suggestion about a change to care plan paperwork. They told us the manager, 'Took my suggestion seriously. It's good to feel listened to.'

Is the service well led?

People were supported by a service that was well-led. Staff we spoke with told us they had clear leadership from the registered manager. Staff felt supported by the manager, they told us their door was always open and they were always willing to listen to concerns. Robust systems were in place to monitor the quality and safety of the service. Systems in place ensured that care files were kept up to date and people's care plans/needs were reviewed. These systems also ensured that staff received regular training and support.

The manager was clearly passionate about the health and wellbeing of people living in the home and had a clear understanding of their needs. During our visit the manager was actively engaged with people living in the home and the staff.

Where issues were identified appropriate action was taken. People told us they completed satisfaction surveys and attended relatives meetings. Actions from these meetings were led to improvements to the service

At this inspection, we saw the provider had made improvements.

People were happy about the care they received. They said the staff were 'helpful,' 'respectful,' 'pleasant' and 'gentle.' We received varying comments about staffing levels from people who used the service. Some people said they did not have to wait for their call bell to be answered. Others told us the home was short staffed and staff had little time to talk to them.

People looked well supported with clean clothing and manicured nails. Those people who were being nursed in bed looked comfortable. They were given staff support to change their position to minimise their risk of developing pressure ulceration.

There was a staff presence throughout the home and no evidence people were kept waiting for assistance. An additional member of staff had recently been deployed to the first floor. The manager confirmed staffing levels would be further reviewed, as the numbers of people in the home increased.

Staff had undertaken a range of training courses in relation to their role. The manager had reviewed the systems for the supervision of staff. Since our last inspection, all staff had received a one-to-one formal supervision session with their head of department. A matrix documented when supervision and appraisals were to take place. This was kept under review to ensure the staff supervision system worked effectively.

Relatives told us overall staff were caring although there was varying opinion about the standard of care provided. We observed care which was patient and supportive. Some moving and handling practice was unsafe and posed a risk to people and staff. Care was not always delivered in line with care plans. People's care records were not regularly updated.

The standard of cleanliness in the home was satisfactory. People's equipment such as wheelchairs were stained and not up to the right standard of cleanliness. Some staff did not wear the appropriate personal protective equipment when providing care.

We found there were not enough staff to meet people's needs safely and effectively. Staff did not have appropriate supervision in line with the provider's recommendations. New staff were not adequately prepared to support people.

We observed staff were patient and kind when they explained to people how they were going to support them. People we spoke with told us they were asked for their consent before care was provided.

People and their relatives said they were satisfied with the support they received with their physical care needs.

We found record keeping had improved. People's monitoring records were up to date and reviewed regularly to ensure people were receiving the care they needed.

We observed people received appropriate support to eat their meals in a timely manner. People told us the food was good. People at risk of not eating and drinking enough were monitored regularly.

Most staff told us they felt supported. New staff had a comprehensive induction and the support of a mentor. We found overall staff received relevant training to enable them to support the people they cared for safely and effectively.

We looked at staff rotas. Staffing numbers met the provider's recommendations. We saw there were just enough staff to meet people's physical care needs. Staff and relatives told us there were not enough staff to spend quality time with people.

People told us staff respected the amount of privacy people requested. For example one person told us 'I like my privacy and they respect this.' We observed staff were respectful and encouraged people to remain independent for as long as possible.

We observed staff were kind and caring and knowledgeable about the people they cared for.

Overall people enjoyed the meals. There were choices and people were able to have an alternative meal if they wished. Not all people who required assistance to eat had the appropriate support.

Staff received training and support to assist people with the care they required.

People's records were not regularly and accurately completed and care given was not always in line with people's plans of care.

The provider had a system in place to monitor the quality of the service.