We carried out a review of the data available to us about Merit Homecare on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Merit Homecare, you can give feedback on this service.
Merit Homecare is a domiciliary care agency providing personal care and support to people living in their own homes. 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. At the time of inspection 282 people were receiving personal care.
People’s experience of using this service and what we found
People and their relatives were positive about the supported provided by staff and commented that staff were kind, respectful and caring. People felt safe and told us that staff made a positive difference to their lives.
There were enough staff to support people safely in line with their assessed needs. People commented that staff always attended visits and there was a continuity of staff. Staff felt that they needed additional support at weekends and the management team were pro-actively addressing this.
People were supported to engage in the local community and to maintain social relationships. Staff encouraged people to be as independent as possible. 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.
People’s needs were fully assessed and reviewed regularly to make sure they were receiving the most appropriate support. Care plans were person centred, individualised and reflected their personal choices.
Risks to people were fully identified and steps put in place for staff to follow to mitigate the risks. Medicines continued to be managed safely and staff followed best practice guidance. Staff had regular checks of their competencies.
Staff received regular training to keep their knowledge and skills at the required level. New staff completed an induction which included the ‘Care Certificate’. The management team provided support to the staff by having regular supervisions, appraisals, meetings and communication updates.
The registered manager was fully aware of their responsibilities and worked closely with partnership agencies to provide a continuous level of care to people.
The quality and assurance systems in place allowed the provider to monitor and continually improve the quality of care provided to people. People, relatives and staff were engaged by the service to find ways for it to develop and improve.
Partnership agencies provided positive feedback about the registered manager and the care provided by staff. People’s care records included guidance and advice from other healthcare professionals.
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 01 December 2017).
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.
The service was last inspected in January 2017 where it achieved an overall rating of good with individual ratings of good in the five domains.
This responsive, focused inspection was carried out to check any potential risk associated with unsafe medicines management. This was due to CQC had received a notification about a serious medicines error.
As this inspection took place over six months since the comprehensive inspection a rating is not published or changed.
A registered manager was in place. 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.
Systems were in place for people to receive their medicines in a safe way. Appropriate training was provided and staff were supervised and supported. We have made a recommendation that some staff receive further medicines training.
Communication was generally effective to ensure people received safe care that met their needs and to ensure the smooth running of the agency.
A quality assurance system was in place that was quite robust to check the quality of the service provided. However, it had not identified the issue that we found during the inspection. This was rectified immediately by the registered manager. There were systems to enable people to raise complaints and to give feedback about their experiences of care received.
Merit Homecare provides personal care for people in their own homes. There were 111 people using the service.
The service had a registered manager in post. 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 told us they felt safe with care staff and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.
Risks associated with people’s care needs and working practices were assessed and steps taken to reduce the likelihood of harm occurring. Staff had access to personal protective equipment, such as gloves and aprons. They were aware of and trained in good hygiene practices.
People told us staff were courteous, professional and polite. They acted in a safe manner when supporting people. Staffing levels were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.
Systems for the safe management of medicines had been reviewed and strengthened to ensure medicines were appropriately accounted for.
Where appropriate, people’s mental capacity was considered through relevant areas of care, such as with medicines and distressed behaviour. Staff routinely obtained people’s consent before providing care.
Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager and other senior staff.
People were supported with their meals, including with meal preparation and checking best before dates, where this was an assessed need. People’s health needs were considered in the planning and delivery of care. Help from external professionals, such as the GP, was sought if necessary. This ensured people’s general medical needs were met.
Staff explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.
People using the service and staff spoke well of the registered manager and they felt the service had good leadership. We found there were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. Staff performance was subject to periodic spot checks. New systems to monitor and audit the service had been introduced to help ensure expected standards were achieved. Quality monitoring included feedback from people receiving care.
This was an unannounced inspection which we carried out on 31 July 2015 and 13 & 24 August 2015. We last inspected Merit Homecare in June 2014. At that inspection we found the service was meeting the legal requirements.
Merit Homecare is a domiciliary care agency providing care and support to people in their own home. It is registered to deliver personal care.
A manager was in place and they were in the process of submitting an application to become registered with the Care Quality Commission. 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.
There were sufficient staff employed to provide safe care to people and they were appropriately vetted to make sure they were suitable to be employed to work with people.
The provider had in place plans to deal with emergency situations through the use of an on call system that was manned out of hours by senior staff.
People received their medicines in a safe way.
Staff had received training and had an understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. Plans were in place for staff to receive other training to meet people’s specialist needs.
People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.
Staff helped ensure people who used the service had food and drink to meet their needs. Some people were assisted to cook their own food and other people received meals that had been cooked by staff.
People told us staff were compassionate and kind but care was not always provided by the same staff to give consistent care.
Communication was not always effective with people from the main office.
A complaints procedure was available and people we spoke with said they knew how to complain, most people said they had not needed to. Where complaints had been received we found they had not always been satisfactorily resolved.
Records were not always available with detailed guidance for staff to provide individual care to people.
The service had a quality assurance programme to check the quality of care provided. However the systems used to assess the quality of the service had not identified the issues that we found during the inspection to ensure people received individual care that met their needs.
You can see what action we told the provider to take at the back of the full version of the report.
. Is the service safe?
. Is the service effective?
. Is the service caring?
. Is the service responsive?
. Is the service well-led?
This is the summary of what we found.
Is the service safe?
An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills in order to meet the person's support requirements.
Risk assessments were in place to help protect people and keep them safe.
Is the service effective?
People we spoke with were positive about the service provided. People commented how helpful and friendly the workers were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions.
We saw staff had received some training to help them understand some of the different care and support needs of people they worked with, however not all staff had received specialist training with regard to working with people who live with dementia.
Is the service caring?
People and relatives we spoke with talked well of the level of care provided by staff. We were told staff were helpful and offered people information and support about their care.
Is the service responsive?
Information was collected by the service with regard to the person's ability and level of independence before they started to use the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.
Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.
People's individual needs were taken into account and they, or their representative if they were not able, were involved in all decision making with regard to their care. They were kept informed and given information to help them understand the care and choices available to them.
Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.
Is the service well-led?
There was a focus from management on the provision of individual care and support to people who use the service. Staff we spoke with were knowledgeable about the support needs of people.
Staff spoken with commented they felt supported by the manager however this and advice and support was not available from all the management team.
We saw people who used the service had the opportunity to comment on the quality of the service and they said they felt able to speak to the manager and staff about any issues.
At our previous inspection in January 2013 we found minor concerns with the arrangements in place in order to ensure that staff received appropriate training, and supervision. We had also found minor concerns with the standard of record keeping within the service.
During this inspection we found that improvements had been made to staff training, supervision and in the quality of record keeping.
Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.
We found the quality of records had improved and most documents were named and dated with accurate entries made. Records were clear and easier to follow to ensure that people received appropriate and safe care.
We spoke with seven people who used the service, and with the relatives of six people who used the service. People were very positive about the care which was provided. One person said, "My usual carer is gold dust. She knows exactly what I want and how to do it. She works alongside me so well and I can't praise her enough." A relative told us, "Our main carer knows my mam's needs really well. She treats my treats my mam so well. They have a really good rapport."
Appropriate checks were undertaken before staff began work to ensure staff were of good character and suitably qualified to work within the service.
People who used the service were asked for their views about the care and service which was provided and the provider took account of comments to improve the service.
We saw there was an effective system to regularly assess and monitor the quality of service people received.
During our visit we spoke with two people who used the service and two relatives. People told us that staff were polite and treated their home with respect. One person said, "The service is first class, I'm extremely happy with my regular carers. They genuinely care about me and always go out of their way to make sure I'm ok."
We reviewed five care records. Assessments had been carried out when people had started to use the service and care had been planned to meet their needs. We spoke with two members of staff. Staff were knowledgeable about the care needs of the people who used the service and what they should do to support them.
People were positive about the care they received. One person said, "I find the office girls really helpful. They are always happy to work around me if things change.
We found that appropriate arrangements were in place to manage medicines. However staff had not been supported, through adequate training and supervision, to care for people safely and to an appropriate standard. Care records were not always accurate and fit for purpose.