Meritum Integrated Care LLP (Folkestone)

Updated 29 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We gave the service 24 hours’ notice of the inspection visit because the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

Inspection site visit activity started on 11 December 2018 and ended on 17 December 2018. This was a comprehensive inspection. We visited the office location on 11 December 2018 and 12 December to see the manager and office staff; and to review care records and policies and procedures. On the 12 December 2018 we also visited Summer Court and spoke to people who received a service in the community. We also shadowed staff undertaking care calls to people to see how care was delivered. On the 17 December 2018 the expert by experience telephoned people to find out their experience of the care delivered. The inspection team consisted of two inspectors and one expert by experience who undertook telephone calls to people who used the service and their relatives. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the previous inspection report and notifications about important events that had taken place in the service which the provider is required to tell us by law. We used this information to help us plan our inspection.

We sought feedback from relevant health and social care professionals and staff from the local authority on their experience of the service. We contacted Healthwatch, who are an independent organisation who work to make local services better by listening to people’s views and sharing them with people who can influence change.

During the inspection, we visited five people in their own home and spoke to twelve people and two relatives on the telephone to gain their views and experiences. We looked at six people's care plans and the recruitment records of five staff employed at the service.

We spoke with one of the providers, the registered manager, and five care staff. We viewed a range of policies, medicines management, complaints and compliments, meetings minutes, health and safety assessments, accidents and incidents logs. We looked at what actions the provider had taken to improve the quality of the service. We also used information from a survey of people undertaken by the provider.

Updated 29 January 2019

This inspection took place on the 11, 12 and 17 of December and was announced.

Meritum Integrated Care LLP (Folkestone) is a domiciliary care agency. The service 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 Summer Court. Summer Court is an extra care service. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service. People living at Summer Court had their own flats in one building.

At the time of the inspection 172 people were receiving the regulated activity personal care, 33 of these people were at Summer Court. Most of the people who use this service are older adults.

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 one of the providers. 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. At this inspection there continued to be areas where risks had not been adequately mitigated. However, these were addressed at the time of the inspection. Risks to people had been assessed and there was guidance in place for staff to minimise these risks. At the previous inspection we also found that provider and registered manager had failed to implement systems and processes to ensure the safe management of medicines. At this inspection we found that the service had met the standards required and the administration of medicines had improved. There were systems in place to ensure that people got their medicines as prescribed.

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 now 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. In that the systems in place to assess, monitor and drive improvement in the quality and safety of the service were not effective. The provider and registered manager had failed to mitigate the risks relating to the health, safety and wellbeing of people. Records were not always completed. At this inspection we found that the service had taken the necessary steps to improve. The systems to monitor and improve the safety and quality of the service were effective. Regular checks on the service were being done which had identified where action needed to be taken to improve the service and keep care plans up to date. Records were up to date and accurate.

There were enough staff to keep people safe and meet people’s needs. New staff were safely recruited with the required checks such as references were completed prior to staff starting to work at the service. Staff had the skills, knowledge and training they needed to provide safe and effective care. New staff completed an appropriate induction which included shadowing more experienced care staff. Staff received regular supervision, checks on performance and undertook an annual appraisal. Staff told us that they felt supported in their role.

People were protected from abuse. Staff knew how to identify and report abuse. The registered manager understood their obligation to report concerns and knew how to do so. Staff had access to appropriate personal protective equipment such as gloves and aprons and people were protected from the risk of infection.

Where incidents had occurred, these had been recorded, investigated and action was taken where appropriate. There was a system to identify trends in incidents however no trends were identified.

Prior to receiving a service people’s needs were assessed so that the service could make sure that it could meet these needs. Where people needed support to eat, drink and access healthcare services this was provided. People told us that they were involved in planning their own care. 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.

People told us that they felt that the staff were very caring. Staff treated people with kindness and supported them to maintain their dignity, privacy and independence. People knew how to complain if they wanted to do so. Complaints were dealt with appropriately and in a timely manner.

The service had a clear vision and values which were understood by the staff we spoke to. There was an open and transparent culture and staff told us 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. People, relatives and staff were positive about the service.

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.