Archived: Merstone Hall

Updated 14 April 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.

The inspection was prompted by safeguarding concerns being raised with CQC.

The inspection was on 19, 20 and 22 February 2018 and 12 March 2018. It was unannounced on the first and fourth days. The inspection was conducted by one inspector, an assistant inspector and a specialist nursing advisor on the first day of the inspection. There were two inspectors on the second and fourth days of inspection. An inspector and an assistant inspector conducted the third day of the inspection.

During our inspection we met and spoke with all 35 people living at the home, three visiting relatives and one visiting friend. Some of the people living at Merstone Hall no longer used words to communicate, we spent time in communal areas and observed how staff supported and spoke with them. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with one of the directors [provider], the registered manager, four nurses, seven care staff, the cook and two students.

We looked at specific elements of five people’s care, health and support records and care monitoring records. In addition we looked at elements of 35 people’s daily monitoring records. We looked at people’s medication administration records and documents about how the service was managed. These included four staff recruitment files, five agency staff profiles and the staff training records, audits, meeting minutes, maintenance records and quality assurance records.

Before the inspection we looked at notifications we had received about the service. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them. We spoke with commissioners and safeguarding professionals to get information on their experience of the service.

Following the inspection, we asked for additional information from the provider. They sent us an action plan with their immediate and short terms actions, information about how they provide end of life care, staff training matrix, information about how they had covered nursing staff shortfalls and people’s preferences in relation to where they like to have their meals.

Updated 14 April 2018

The inspection took place on the 19, 20 and 22 February 2018 and 12 March 2018 and was unannounced.

At the time of our inspection the service was providing care to 35 older people some of whom were living with a dementia and mental health conditions.

Merstone Hall is a nursing ‘care home’ in Bournemouth for up to 45 people in Bournemouth. 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 manager has been registered with CQC since June 2016. 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 our last inspection in May 2016 the home was rated Good.

At this inspection we identified serious failings and shortfalls in the care, treatment, wellbeing and safety of people living at the home. These failing and shortfalls placed people at risk of harm. We raised multiple individual and whole service safeguarding alerts with the local authority, who are responsible for investigating any allegations of abuse. We also shared these concerns with the provider, registered manager and other statutory agencies.

The provider and registered manager did not take action in response to feedback provided by the local authority and clinical commissioning group (CCG), health and social care professionals to improve the care and treatment provided to people.

During the inspection a plan was put in place by statutory agencies to reduce the immediate risks to people. The provider and registered manager cooperated with the statutory authorities. This plan included checks on people’s welfare made by health and social care professionals. Following the fourth day of our inspection health and social care professionals were visiting the service daily to monitor people’s care, treatment, welfare and safety.

People did not receive the care and support they needed and this placed them at risk of harm or neglect. Their health and care needs were not always met because the care and support they needed was not delivered. People did not receive the fluids they needed to keep them hydrated, people were not repositioned to minimise the risk of pressure sores and people were not supported to use the toilet or have their continence wear changed. Risks to people were not managed or mitigated and this placed people at risk of harm and neglect.

People had poor mealtime experiences and some people were placed at risk by not receiving specialist modified diets.

Staff did not know enough about people as individuals to be able to provide personalised care. Some people were not treated with dignity and respect and staff did not respect people’s privacy. Not all of the staff were caring in their approach to people. Some staff did not smile at people or reassure them when they were upset or worried.

People did not receive a personalised service that was based on their needs and preferences and there was task focused approach to care. Some people who were cared for in their bedrooms did not have anything to occupy them.

There were not enough nursing staff to meet peoples’ nursing needs and to administer people’s medicines as prescribed. Medicines were not managed safely. People did not receive pain relief when they needed it. Most staff did not have the knowledge, experience or communication skills to be able to understand and communicate effectively with people who were living with dementia. Some staff were not recruited safely, they did not receive any formal support sessions and they did not all have the training they needed to be able to meet people’s needs.

The service was not fully meeting the requirements of the Mental Capacity Act 2005. Staff were not fully aware of the principles of the Mental Capacity Act 2005 and making best interest decisions. This meant people’s rights were not protected and their consent was not sought when making decisions.

The home was not well-led and there were no clear management arrangements in place at the home. The findings throughout the inspection showed there was a failure to assess, monitor and mitigate the risks relating to the health, safety and welfare of people and others who may be at risk. In addition, there was a failure to assess, monitor and improve the quality and safety of the services provided. The systems in place had not identified the shortfalls we found for people or driven improvement in the quality of care or service provided.

We identified 12 breaches of the regulations and the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The provider gave the statutory authorities two weeks' notice that they planned to close the home and find new placements for the people living at the home. The home closed on 28 March 2018.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.