We carried out a review of the data available to us about Merchant House 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 Merchant House, you can give feedback on this service.
At our last inspection we rated this key question Requires Improvement. At this inspection the rating has changed to Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.
Promoting a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people
¿ People, their relatives and staff expressed confidence in the management team. Comments included, “Yes, it’s well managed. I know (name) the registered manager and (name) the deputy.", “It’s well organised” and “It’s friendly has a happy atmosphere like a big family”.
¿ Staff told us, and we observed morale was high. Staff told us the management team were approachable and supportive. One staff member told us,“(Registered Manager) is absolutely brilliant, I can go to him with anything, he is approachable. He’s the best boss I’ve ever had”.
¿ The registered manager and staff team promoted a person-centred culture to ensure people received personalised care and support. People told us they were happy living at Merchant House, and we saw they were relaxed and happy with staff.
How the provider understands and acts on the duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong
¿ The CQC sets out specific requirements that providers must follow when things go wrong with care and treatment. This includes informing people and their relatives about the incident, providing reasonable support, providing truthful information and an apology when things go wrong. The provider understood their responsibilities.
Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements, Continuous learning and improving care
¿ The registered manager and staff understood their roles and responsibilities and strived to ensure care was delivered in the way people needed and wanted it.
¿ There were effective communication systems in place along with clear lines of responsibility and accountability across the staff team.
¿ The service had governance arrangements in place. Both the registered manager and provider recognised the importance of systems being effective to strengthen the quality of the service that people received.
¿ Regular audits were carried out by the registered manager and the provider. These included audits of care plans, medication and the day to day running of the service. Findings from audits were analysed and actions were taken to drive continuous improvement.
Engaging and involving people using the service, the public and staff, fully considering their equality characteristics
¿ From our observations and speaking with staff, the provider demonstrated a commitment to providing consideration to people’s protected characteristics.
¿ There was a positive open culture at the service that valued people as individuals and looked for ways to continually improve people's experience.
¿ Staff told us that they were involved in the development of the service, through discussions at individual supervisions and staff meetings.
Working in partnership with others
¿ The service worked in partnership and collaboration with a number of key organisations to support care provision, joined-up care and ensure service development.
¿ Records showed the provider worked closely and in partnership with multidisciplinary teams to support safe care provision. Advice was sought, and referrals were made in a timely manner which ensured there was continuity of care.
Merchant House is a residential care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 19 people in an adapted building set over two floors. There is a stair lift and stairs for access to the first floor and the service has a dining room, large lounge, gardens and an external smoking area.
People’s experience of using this service and what we found
People told us they felt safe living in the service. Staff were patient when administering medicines and had been trained and observed as competent before administering by themselves. There were enough staff to meet people’s needs. However, people said they would like to spend more time with staff. Where people faced specific risks, these were assessed, and staff followed the advice in the risk assessment to mitigate these risks. However, during the inspection a change in risk management was not handed over to a staff member.
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 said they enjoyed the food and were offered a choice for each meal. Some people ate in their rooms or the lounge and some ate in the dining room. People were supported by staff that asked them for consent before delivering care, had attended training and had been supported through group supervisions and regular team meetings.
People told us staff, “Couldn’t be kinder” and described how the atmosphere in the service had become homelier since the décor had been improved. Staff culture and attitude towards delivery of care was sometimes task focussed and did not consistently treat people with dignity and respect.
Relatives, people and staff told us there had been an improvement in the level of activity in the service and people were feeling more engaged and supported in this area. Care plans were person centred and contained detail of people’s life history. People said they felt happy to complain though had not done so. People’s communication needs were met through signs, pictures, different styles of conversation and translated documents depending on peoples’ individual needs and preferences.
The service had a robust management structure in place and managers had oversight of the day to day running of the home. There was an awareness of what still needed to be improved and a realistic timeframe for improvement, as an inherited staff culture from the previous provider was embedded and parts of the building were quite shabby. Staff felt supported and people and staff were consulted on changes taking place in the service.
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: This service was registered with us on 10/10/2018 and this is the first inspection.
The last rating for this service was Inadequate (published 20 June 2019) and had been in Special measures. Since this rating was awarded the registered provider of the service has changed. We have used the previous rating and enforcement action taken to inform our planning and decisions about the rating at this inspection.
At this inspection we found improvements had been made and the provider had been aware of an area of improvement that was needed regarding dignity and respect from when they took over the service, we found a breach in this area at this inspection.
Why we inspected: This was a planned inspection based on the previous rating.
Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.