Meritum Integrated Care LLP (Ashford)

Updated 30 November 2018

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 October 2018 and ended on 16 October 2018. This was a comprehensive inspection. We visited the office location on 11 October 2018 to see the manager and office staff; and to review care records and policies and procedures. On the 15 October 2018 we visited Homebridge and spoke to people who received a service. We also shadowed staff undertaking care calls to people to see how care was delivered. On the 16 October we returned to the office to speak to the provider who had been away.

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.

Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

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 three people in their own home and spoke to three people and five relatives on the telephone to gain their views and experiences. We looked at six people's care plans and the recruitment records of four staff employed at the service.

We spoke with one of the providers, the registered manager, and five members of 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 recent survey of people undertaken by the provider.

Updated 30 November 2018

This inspection took place on the 11, 15 and 16 of October 2018 and was announced.

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.