Archived: Merstone Hall

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.

Merstone Hall provides both residential and nursing care for up 45 people, some of whom may be living with dementia. There were 24 people living in the home at the time of our inspection.

The home was being led by an acting manager who confirmed that they had applied to be registered with the Commission. 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 last inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, the management of risk, the condition of the premises and equipment and a failure by the provider to monitor the quality of the service that was being provided. The service was rated as requires improvement in relation to the questions: Is the service safe? Is it effective? Is it caring? Is it responsive? and is it well led? At that inspection the service received a rating of requires improvement overall.

Since the last inspection the provider had recruited an experienced manager who had previously been registered at a similar service and had employed a consultant to assist the new manager to implement the changes that were required to improve the service.

All of the people living at the home and visitors that we spoke with told us that they felt safe and cared for. We received only positive comments about Merstone Hall throughout our inspection. Staff in the home were also positive about the changes that had been made. They told us they felt well supported by the management team that was in place.

Following the previous inspection, the provider drew up an action plan in order to address the issues of concern that were identified. This inspection found that the service had addressed all of the issues and no new breaches of regulations were found.

People received care and support that was person-centred and respectful. People were kept safe and protected from risks wherever possible. Medicines were managed safely. There were appropriate numbers of staff on duty to meet people’s needs.

People’s needs were assessed and plans were in place to ensure that their needs were met. People’s choices and decisions were respected and staff enabled people to retain their independence.

Staff received regular training and supervision and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience to help people with their care and support needs.

Observations and feedback from staff, relatives and professionals showed us that the home had an open and positive culture.

There were systems in place to monitor the safety and quality of the service. This included the use of audits and surveying the people who used the service and their representatives.

People had an assessment of need carried out prior to and on admission to the home. These assessments covered areas such as eating and drinking and personal hygiene needs. There was information within care plans on what people were able to do themselves and where they required support.

The manager ensured that appropriate information was obtained from other health professionals, such as nurses and social services, when an individual was admitted to the home.

We saw that people were able to choose how they spent their time and could participate in range of activities such as art work, singing and baking.

When other health professionals or providers were involved in an individuals care, information relevant to their treatment was provided by the home.

The provider and manager ensured that notifications required by law were sent to us in a timely manner. These notifications covered areas such as accidents and incidents

We visited the home on 11 December 2012 to check on whether compliance had been achieved. We looked at the care records of four of the people living in the home. We spoke with the manager and two members of staff.

We found that care records had been completed fully and evidenced the care and support people needed to meet their needs. When a person's condition had changed this was recorded, along with the interventions needed. Where a risk to the person had been identified in the assessment and care planning process, a separate risk assessment had been completed.

We saw that records had been reviewed on a regular basis and changes in support needed detailed. Daily records evidenced the support given to meet people's needs.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time There was a new manager in post who is in the process of being registered with us.