Archived: Mercers Place

During the inspection we spoke with one person using the service and two members of staff. Following the visit we spoke to the registered manager and the local authority safeguarding team. We considered all the evidence we had gathered under the outcome's we inspected. We have used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

There were systems in place to ensure people's safety. The staff had received training on protecting vulnerable adults from abuse and there were clear policies and procedures setting out how staff should respond if they suspected or witnessed abuse occurring in the home.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Normal assessment and care planning arrangements considered people's capacity, needs and abilities. Where people were unable to make day to day or significant decisions, we saw that Mental Capacity Act (MCA) 2005 assessments had been undertaken; however some of these required review.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLs). We were told that nobody living at the service was subject to a DoL decision. Staff spoken with told us that they had received training and understood the Mental Capacity Act 2005, its Codes of Practice and DoL Safeguards. However, they were unsure of the changes relating to DoLS following a supreme court judgement in March 2014 and during discussion felt that this may apply to one person using the service. The registered manager informed us after the inspection that this was being addressed.

Is the service effective?

People's care records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. From our observations and time spent at Mercers Place we saw that the people living there were receiving the care and support they needed in an individual way and wherever possible staff tried to facilitate choice.

Is the service caring?

We found the home provided a very happy, inclusive and homely environment that enabled people to live a normal lifestyle. We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. We found that staff were understanding of people's individual needs and cared for their wellbeing. Whilst people had detailed and personalised care plans in place that guided staff as to the type and level of support they needed, improvement was needed to ensure care plans incorporated people's emotional and psychological needs and how best these could be met by staff.

The staff spoken with demonstrated empathy and compassion in relation to their recent experience of end of life care. Records showed that there were clear care planning arrangements in place in order to guide staff on how to deliver the best care at that time.

People told us they had a good relationship with the staff. Staff spoken with demonstrated a good understanding of people's needs and were aware of their personal preferences, choices and behaviours.

Is the service responsive?

We found that care and support provided met people's wishes and needs. We also saw that where concerns about their wellbeing had been identified the staff had taken appropriate action to regularly review care plans. This included seeking support and guidance from relevant health care professionals.

Records showed that staff took the lead from health professionals and worked in partnership during a recent event in delivering end of life care.

People using the service were provided with the opportunity to access the community and participate in activities which suited their individual needs. This included attending social clubs and therapeutic activities. Staff were responsive to people's needs.

Is the service well led?

The service was well led. The home had a registered manager and there was a clear hierarchy of staff. The registered manager was not on duty during our inspection, however the team leader was very knowledgeable and able to assist us effectively and efficiently in their absence.

Prior to our inspection we received information enquiring about the appropriateness of some decision making in relation to the delivery of end of life care. The local authority under their safeguarding role looked into the issues raised. They found that end of life care was delivered appropriately and in conjunction with specialist palliative care services. The provider told us that communication and training was the lesson to be learned in this instance with regards to areas of care where staff may have a knowledge gap, assurance was given that this was being addressed.

We saw that staff were knowledgeable about people's needs and promoted their independence. We found that they had a good understanding and awareness of people's care needs and preferences. We saw that care plans and risk assessments were regularly reviewed and updated. One person told us: "The staff always talks to me about my care and support; they are going to help me to move back home."

People told us that there were sufficient numbers of staff on duty to meet the needs of the people who lived in the service. One person who used the service told us, "The staff always have time to talk to me and take me to appointments."

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We observed that the staff were attentive to people's needs. Staff interacted with people in a friendly, respectful and professional manner. We saw that staff sought people's agreement before providing any support or assistance. The people we saw were relaxed and engaged with their surroundings.