Meritum Integrated Care LLP (Ashford)

Meritum Integrated Care LLP (Ashford) is a domiciliary care agency. It provides personal care to adults who want to remain independent in their own home in the community. The service also provides care and support at Homebridge. Homebridge is a short-term rehabilitation unit where people have their own flat and stay for up to 6 weeks. At the time of the inspection 35 people were receiving the regulated activity personal care, two of these people were at Homebridge. Most of the people who use this service are older adults.

People’s care and housing at Homebridge are provided under separate contractual agreements. This inspection looked at people’s personal care and the support service. At the time of the inspection not everyone using the service or living at Homebridge received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the last inspection in December 2017 the service was rated overall as requires improvement. Following this we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, responsive and well-led to at least good. At this inspection we found that the service had improved, the service is now rated Good.

There was a registered manager at the service who was also the area manager for the providers’ two other locations. 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.

At the previous inspection we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider and registered manager had failed to adequately assess all risks relating to people's care and support, and they had failed to implement systems and processes to ensure the safe management of medicines.

At this inspection we found that the provider had taken the necessary steps to improve. Risks to people had been assessed and there was guidance in place for staff to minimise these risks. The administration of medicines had significantly improved and there were systems in place to ensure that people got their medicines as prescribed. However, we found that one person’s cream did not have the date on which it was opened.

At the previous inspection we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In that the provider and registered manager had failed to ensure that information within people's care plans reflected their assessed needs and

preferences. At this inspection we found that the service had improved. Care plans were detailed and provided staff with the information they needed about people’s assessed needs and how people liked to be supported with these needs.

At the last inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider and registered manager had failed to ensure the safe management of medicines. Records were not always complete or accurate. At this inspection we found that records were complete and accurate including medicine records. There were effective systems in place to improve the safety and quality of the service. Regular audits were being undertaken which had identified where action needed to be taken to improve the service and keep care plans up to date.

There were enough staff to support people to remain safe and there were no missed calls. People had regular carers and the care provided to people was consistent. People told us that staff were reliable and stayed for their allotted time. Staff were recruited safely and there were appropriate pre-employment checks in place.

People were protected from abuse. Staff understood how to report abuse. The registered manager understood their obligation to report concerns and knew how to do so. There had been no incidents or accidents involving people since the last inspection. Previous incidents had been reported, investigated and followed up appropriately and people’s care plans were updated. One of the providers’ other services had recently been inspected and learning from that inspection was shared across the providers’ services and was communicated to the staff.

There were systems in place to ensure that people were protected from infection, such as the use of gloves and aprons where needed.

People’s needs were assessed prior to the receiving a service or moving in to the Homebridge rehabilitation unit. This information was used to plan people’s care and support. Staff had the skills and training they needed to support people. New staff completed an induction which included shadowing more experienced members of staff. Staff were regularly supervised, undertook annual appraisals and there was a system for spot checking staff performance in place.

Where people needed support with eating and drinking this was provided. People had the support they needed to access healthcare. 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.

Staff knew people well and treated people with kindness and respect. People’s privacy and dignity were promoted. Records were kept confidential. Care plans provided the information staff needed to support people to maintain their independence. People’s views about their care were listened to and people were involved in planning their own care. Care plans were reviewed annually or where people’s needs had changed. There were processes in place if people wanted to complain if they chose to do so. There had been no complaints since the last inspection.

The service had a clear vision and values which were displayed at the office and understood by the staff we spoke to. There was an open and transparent culture and staff felt that they were well supported. There were regular staff meetings and staff were provided with a handbook which contained important information such as the provider’s policies.

People, their relatives and staff were given the opportunity to feedback on their experience of the service. The results from surveys were shared and action was taken when areas were highlighted for improvement. Relatives were positive about the service and how the service communicated with them.

The service was working in partnership with other health care services to promote partnership working. The provider and registered manager understood their legal responsibilities to notify CQC about important events and display the provider's latest CQC inspection report rating.

The service had a registered manager in post. A registered manager is a person who is 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.

We last inspected Meritum Integrated Care LLP (Ashford) in November 2016 when one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. We issued a requirement notice relating to safe care and treatment.

At our inspection in November 2016, the service was rated 'Requires Improvement'. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made, however, the provider had not met the previous breach of regulation and two further breaches were found. This is therefore the second consecutive time the service has been rated Requires Improvement.

At our previous inspection, medicines had not been managed safely. At this inspection there continued to be shortfalls in medicines management.

Each person had a care plan in place which consisted of a task list outlining what staff needed to do at each call, and an assessment of the risks related to providing care and support to each person. Although risks relating to people’s care and support, such as moving and handling, mobility and any healthcare conditions had been identified, detailed guidance was not always available to staff on how to mitigate these risks.

Some care plans contained detailed step by step guidance regarding how to support people. However, others required more detail to adequately inform staff how people liked their care to be provided. Staff worked independently in people’s homes, without supervision, so clear guidance was essential to ensure people received the support they needed.

The registered manager and senior staff worked in partnership with other professionals to ensure people received consistent care. Some people received support from the district nursing team with their health care needs and staff provided assistance with their personal care. Staff told us that communication was good and they were able to share information when needed. The provider and senior staff were involved in a variety of local forums and worked in partnership with colleagues across the sector to develop new ways of working.

Staff had received the necessary training to carry out their roles effectively. They told us they were well supported by the management team and received regular spot checks when they were providing support to people, to ensure they were doing so appropriately. Checks by the registered manager and senior staff had not identified the continued issues relating to medicines and risk management. People had been asked for their views on the service and these had been reviewed by the management team.

Staff told us the management team were approachable and knowledgeable about providing domiciliary care.

People told us that staff were kind and caring and treated them with respect and dignity. Rotas showed that staff were allocated time to travel between people; and people we spoke with said that staff were generally on time and stayed for the entire agreed duration of their call. Staff had been trained in infection prevention and control and people told us that staff always wore protective equipment to prevent the spread of infection.

Some people were supported to prepare meals or to eat safely. Everyone we visited had drinks of their choosing left out for them, so they could remain hydrated throughout the day. When people became unwell staff supported them to contact relevant healthcare professionals.

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. Staff had an understanding of people’s equality and diversity needs and told us they would challenge discrimination in any form. There was an open and inclusive culture and people were supported to be as independent as possible. The registered manager told us they wanted to learn from incidents when they happened and encouraged staff to be open and transparent if things went wrong.

There was information available for people regarding how to complain, and any complaints had been documented and investigated in line with the provider’s policy. Staff had been recruited safely. Staff knew how to recognise and respond to abuse and any potential safeguarding issues had been reported to the local authority. The provider had notified us of important events that had happened in the service and had displayed their rating on their website and at the service, as required by law.

You can see what action we told the provider to take at the back of the full version of the report.

The service is run by an established registered manager. 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.

People told us they received their medicines when they should and felt their medicines were handled safely. However there were shortfalls in some medicine records and a lack of guidance about an area of medicine management to help ensure risks associated with medicines were reduced.

Risks associated with people’s care and support had been identified, but there was not always sufficient guidance in place for staff, to aid risk management and help ensure people were safe.

There were audits and systems in place to monitor that the service ran efficiently. These had been effective in identifying most of the shortfalls highlighted during the inspection, but not all. The provider was implementing new systems to address some of the shortfalls. Most people felt the service was well led and that communication with the office was polite and courteous. People had opportunities to provide feedback about the service provided to help drive improvements.

People felt safe using the service and when staff were in their homes. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

People were involved in the initial assessment and the planning of their care and support and some had chosen to involve their relatives as well. Care plans reflected the care and support people received. People told us their independence was encouraged wherever possible.

People had their needs met by sufficient numbers of staff. All of people’s visits were allocated permanently to staff schedules and these were only changed when staff were on leave. Most people told us staff generally arrived on time. People on the whole received a service from a team of regular staff. New staff underwent an induction programme, which included relevant training and shadowing experienced staff, until they were competent to work on their own. Staff received training appropriate to their role and nearly all of the staff had gained qualifications in health and social care or were working towards this.

People told us their consent was gained at each visit. People were supported to make their own decisions and choices. No one was subject to an order of the Court of Protection, or had Lasting Power of Attorney arrangements or a Do Not Attempt Resuscitation (DNAR) in place. People were able to make their own decisions, although some people chose to be supported by family members. The Mental Capacity Act provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were supported to maintain good health and they told us staff were observant in spotting any concerns with their health and taking appropriate action.

People felt staff were very caring. People said they were relaxed in staffs company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and knew people and their support needs well.

People told us they received person centred care that was individual to them. They felt staff understood their specific needs relating to their age and physical disabilities. Staff had built up relationships with people and were familiar with their personal histories and preferences.

There was an open and positive atmosphere in the office and staff were committed to improving the services people received. The provider’s aim for the service was included in literature people received and we found these principles were followed through into practice. New systems were being implemented to aid the effective running of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.