Background to this inspection
Updated
24 July 2019
The inspection:
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team:
Two Inspectors carried out this inspection.
Service and service type:
The Merchant’s House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection:
This inspection was unannounced.
What we did before the inspection:
We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We looked at an action plan sent to us by the provider following our last inspection. We took this into account when we inspected the service and made the judgements in this report. We sought feedback from the local authority. We used all of this information to plan our inspection.
During the inspection:
We met with the three people who used the service and spent time observing the daily support they received to find out about their experience of using the service. We spoke with six members of staff including the registered manager, members of the management team and support staff.
We looked around the environment and reviewed a range of records. This included care and medication records belonging to the people living there and recruitment files for three members of staff. We also looked at records relating to the safety of the service, staff training and quality assurance.
Updated
24 July 2019
About the service
The Merchants House is a care home providing support for up to six people over the age of 18. The house is a large Victorian building that fits in with other houses in the local area. People living there each have their own bedroom and share communal living space. There is off road parking available for several cars and an enclosed back garden people can access.
Improvements had been made since the last inspection in relation to supporting people in a person-centred way, supporting people to stay safe, minimise the risk of abuse, and maintaining a safe environment. Improvements had been made to the systems in place to monitor the quality and safety of the service and to sharing information with relevant organisations. Improvements had also been made to the training staff received and the providers oversight of that training.
Further improvements are needed to how people are supported with dignity and respect. We have therefore given a requirement related to this.
We have made three recommendations in relation to recruitment checks, training records and continuing to improve how they support people in line with the principles of Registering the Right Support.
The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.
People’s experience of using this service and what we found
The service didn’t consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
Improvements had been made in the way people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the polices and systems in the service supported this practice. This was an on-going process within the home with room for further improvement.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons: Although a number of improvements had been made to the environment of the home this was a work in progress with parts of the provider’s action plan still underway. Other aspects of the building such as the use of a staff toilet in a prominent position, a large menu board nobody used and labels on people’s furniture detracted from creating a homely environment as opposed to one which appeared institutional.
We saw an improvement in the culture amongst staff at the home. Staff were more aware of their body language and of the need to provide support as unobtrusively as possible. There was room for further improvement, particularly around ensuring written and spoken language was respectful and promoted people’s dignity.
People were protected from abuse and the risk of harm. Changes had been made to the staff team and to people living together at the home. This had created an opportunity for making improvements to the support individuals received and to the environment. Robust checks of the environment were undertaken to make sure it was safe. Risks to people were clearly identified and staff followed agreed procedures to support people to stay safe in as unobtrusive a way as possible. There had been no use of restraint with the home within the six weeks prior to the inspection.
Plans had been implemented and were underway to increase the opportunities people had for becoming more independent, make more choices and have more control over their home and their daily lives.
People received the support they needed with their physical and mental health and with their medication.
A settled staff team were available to support people. Staff had received training to enable them to understand people’s individual support needs. Recruitment checks were in place and generally followed. Staff felt supported by senior staff and the provider.
A registered manager was working at the home who was knowledge and enthusiastic about the service provided. They were open and honest with other agencies about how the home was operating and had clear plans for continuing to make improvements to the service.
Clear systems were in place to improve the quality of the service and check improvements were maintained.
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 Inadequate (14 January 2019) 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 not enough improvement had been made in one area and the provider was still in breach of regulation 10. We found improvements had been made and the provider was no longer in breach of regulations, 9,12,13,17 and 18 and regulation 18 (Registration Regulations 2009)
This service has been in Special Measures since 19 January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.
The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the Caring section of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Merchant’s House on our website at www.cqc.org.uk.
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.
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.