About the service: Mercers is a 'care home'. 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 care home provides care and support to people who have complex needs including mental health, learning disability and needs related to the Autistic Spectrum.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. ‘Registering the Right Support’ CQC policy.

People’s experience of using this service:

Staff had a good knowledge of how to keep people safe from avoidable harm and risk assessments were in place for staff to follow.

People were supported to take their medicines in a safe way.

Staff were recruited safely and appropriate checks were carried out before they started work at the service.

Training for staff had not always completed and not all staff had undertaken the Care Certificate where required to ensure they had the skills knowledge and experience to deliver effective care and support to people using the service.

Staff had a good understanding of key pieces of legislation and when they should be applied including the Mental Capacity Act 2005.

Where lessons were learned, feedback was provided to staff to ensure continuous improvement took place throughout the service.

Quality assurance processes did not always effectively identify issues in the service to ensure sufficient oversight of the service. Although audits were undertaken further work was needed to ensure themes and trends were identified and managed. The inspection found improvements had been made but the provider and registered manager need to ensure improvements are sustained and continue to drive improvements forward.

People received care and support based on their individual assessment, needs and preferences.

People were supported by staff who understood the need to ensure person centred care and to respect and listen to people. The registered manager ensured consistency in staffing to enable positive relationships between staff and people.

People were well cared for by staff who treated them with respect and dignity.

Systems were in place for people to raise complaints and concerns.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Staff spoke positively about working for the provider. They felt well supported and could talk to management at any time, feeling confident any concerns would be acted on promptly. More information is in the full report

Rating at last inspection: Inadequate (report published 30 June 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We found improvements had been made since our last inspection.

Follow up:

We previously inspected Mercers on 12 March 2018 where the service was rated ‘Inadequate’ and placed in special measures. This was because there were significant shortfalls in the way the service was led. People's safety and welfare was compromised where the provider did not have robust and effective quality monitoring and assurance processes in place to identify potential risks to people. Risk assessments had not been carried out thoroughly particularly in relation to individual's choking and to risks within the physical environment. Necessary maintenance work and health and safety precautions had not been taken within the home to protect people from risk of harm. The cleanliness of the service had been neglected and improvements were required regarding infection prevention. People were not supported to have maximum choice and control of their live. Risks ha

We undertook an unannounced focused inspection of Mercers on 12 March 2018.

Mercers is a ‘care home’. 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 care home provides care and support to people who have complex needs including mental health, learning disability and needs related to the Autistic Spectrum.

Mercers is registered to accommodate and care for up to seven people. At the time of inspection there were five people living at the service, four people lived in the main building and one person in a separate building across the road.

There was a registered manager in post. 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 a 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 comprehensive inspection of September 2016 we rated the service ‘Good’. This inspection focused on the areas of safe and well-led and we found that improvements were needed and we identified breaches of legal requirements. The Commission is considering it’s enforcement powers.

You can see what other action we told the provider to take at the back of the full version of the report.

People’s safety and welfare were compromised because the provider did not have in place robust and effective quality monitoring and assurance processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried out particularly in relation to individual’s choking and to risks within the physical environment.

Necessary maintenance work and health and safety precautions had not been taken within the home to protect people from risk of harm. The cleanliness of the service had been neglected and improvements were required regarding infection prevention.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible. Risks had not been assessed to ensure that the least restrictive option had been considered and decisions had not been properly taken or recorded to ensure people’s freedom was respected.

We received mixed feedback regarding staffing levels at the service and the impact that this had on service provision.

Although some auditing and monitoring systems were in place to ensure that the quality of care was consistently assessed, they had failed to identify the issues we found during our inspection.

There had been a lack of oversight of the service by the provider and the registered manager to ensure the service delivered was of a good quality, was safe and strived to continuously improve.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. The service 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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it

This inspection took place on 30th September 2016 and was unannounced. The last inspection of this service took place on 2nd April 2014 and at that time the service was meeting all required standards.

Mercers is a care home that provides care and accommodation for people with support needs related to their mental health and/or learning disabilities. At the time of inspection there were six people living at the service, five people lived in the main building and one person was housed in a separate building across the road.

At the time of inspection there was no registered manager in post with no active plans to recruit which meant that the service was not meeting a condition of its registration. The registered provider was acting as manager and was responsible for the day to day running of the service assisted by a deputy manager. 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.

People were safe because the management team and staff understood their responsibilities in terms of managing risk and identifying abuse or poor practice.

Potential risks to people had been identified with steps recorded of how the risk could be reduced. This meant that people received safe care that met their needs, protected them from harm whilst promoting their freedom and rights to exercise choice and control.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

There were sufficient staff employed who had been recruited safely and who had the skills and knowledge to provide care and support that met people’s needs and preferences.

The physical and mental health needs of people were managed effectively with input from relevant health care professionals as necessary.

People had access to food & drink that they enjoyed which matched their preferences and met any health needs.

Staff respected people’s privacy and choices and treated people with kindness and respect.

People were encouraged to be independent and take part in interests they enjoyed.

The service supported people to maintain relationships with friends and family and links with their community so that they were not socially isolated.

There was an open culture and the provider encouraged and supported staff to provide care that was centred on the individual.

There were systems in place to monitor and review accidents and incidents to safeguard people’s wellbeing. The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements.

Mercers provided care and support for seven people with learning disabilities who may also have mental health needs. Six people lived in the main building and one person lived in a separate house nearby.

During our inspection we met three people who were willing and able to speak with us with some support. We saw that people were relaxed and confident in their interactions with staff. We also spoke with a relative of someone who lived at the service and a health professional who visited the service one or more times a week. The relative told us they were happy with their relative’s progress and they had become more independent. The health professional told us that their specialist knowledge was sought to ensure risks were managed in the best interest of the individual.

We found people who used the service were receiving safe and effective care which met their needs and promoted their well-being. Their health was monitored and they were supported to access health professionals according to their individual needs.

People’s human and legal rights were upheld by staff and the risk of abuse and avoidable harm was minimised.

People were cared for by staff who were considerate and respectful and who understood their needs and preferences. Staff consulted with people and encouraged them to express their views.

Staff received the training and support necessary to develop the knowledge and skills to care for people. Staff responded to changes in people’s needs to ensure they received care that was effective. We found there were sufficient staff to support people with both their care and their social needs. When people were at home staff had time to have conversations with them in a relaxed manner. If someone wanted to go out for a walk or shopping staff accompanied them.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had procedures in place in the event a DoLS application needed to be made. At the time of our inspection no applications had needed to be submitted by the service.

There was no registered manager at the time of our inspection but the management team, which consisted of the provider and the care manager, provided effective management of the service.

We talked to three people living in the home, they told us they liked living there. People told us that the staff were nice and that they supported them to go out to the local park and shops in town. One person who used the service told us: “I like living here." We saw a person who used the service preparing to go out to do the house shopping with a member of staff.

We observed that staff were attentive to people`s needs and treated them with respect and dignity calling them by their name. We saw that staff sought people`s agreement before providing any support and assistance.

We saw that the building was comfortable, clean and well maintained. We saw that equipment had been checked and serviced within expected timescales.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

During our inspection we spoke with people who said they were happy living at Mercers. We saw that people spoke confidently with members of staff and made them aware of their needs and wishes. Staff showed a good understanding of people’s needs and preferences and we noted that staff treated people with respect.

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the needs of the people using the service.

We saw that there was a relaxed atmosphere in the home and that people chose how they spent their time.

Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at the service to be positive.

People with whom we spoke told us that generally they were able to make choices about some aspects of their care. For example, we spoke with two people about how they are supported to choose what to eat each day. They told us that staff offer them a choice of meals each day and that they can also choose where they have these, for example in the comfort of their own room or in the dining room. They are also able to make a decision as to whether or not they participate in social activities.

Another person who uses this service told us they are able to make decisions about going out and what time they go to bed.

People spoken with indicated that they were satisfied with the level of care and support they received at Mercers.

Those people with whom we spoke indicated they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

The people with whom we spoke made the following comments “It's good here.” and “I like living here and the staff are nice.”

People told us that they feel well looked after by the staff at Mercers. One person with whom we spoke said "I like the staff here they are very kind."