We undertook an unannounced inspection on 9 November 2016.

Merecroft is registered to care for up to nine people with mental health needs or learning disabilities. At the time of our inspection there were six people living at the service.

There was a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

We carried out an unannounced comprehensive inspection of this service on 2 September 2015 when we found that they were in breach of the law because the provider did not have effective arrangements in place to monitor and improve the quality and safety and welfare of people using the service. The provider wrote to us to say what they would do to make the necessary improvements. At this inspection we saw that the actions required had been completed and the regulations were now met.

Relatives we spoke with said their family member had support from regular staff who knew them well. Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns. Staff were knowledgeable about how to manage people’s individual risks, these focussed on supporting people’s well-being. People were supported to receive their medicines by staff who were trained and knew about the risks associated with people’s medicines.

Staff had up to date knowledge and training to support people living at the home. Staff always ensured people agreed to the support they received. The management team regularly reviewed how people were supported to make decisions. People were encouraged to make their own choices about the food they ate. Relatives told us staff would access health professionals as soon as they were needed.

We saw staff were caring and patient with people living at the home. Relatives told us staff had built positive relationships with their family member, and treated them with dignity and respect. They said they were welcome to visit whenever they chose to.

Staff told us how they sought people’s views on how they were supported. The management team were developing further adaptations to support people to communicate their views. Relatives we spoke with knew how to raise complaints and the management team had arrangements in place to ensure people were listened to and appropriate action taken.

Staff were involved in regular meetings and one to one time with the management team to share their views and concerns about the quality of the service. Relatives and staff said the management team were accessible and supportive to them. The staff team were adaptable to changes in peoples’ needs and knew people well to recognise when additional support was needed.

The registered manager encouraged a culture of openness and inclusion for people living at the home and staff. The management team had systems in place to identify improvements and action them in a timely way.

Merecroft provides accommodation and personal care for a maximum of eight people who have a learning disability. The home was a new building with accommodation arranged over two floors. There were two flats downstairs and six bedrooms upstairs. There were six people living at the home at the time of our inspection.

This was an unannounced inspection and was carried out on the 4 December 2014.

A manager was registered with us but they had not been employed by the provider since October 2014 and so were no longer managing the home. 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. A new manager had started on 1 December 2014. There had been an interim manager to support people that lived at Merecroft during the recruitment of the new manager. The new manager had not completed the registered manager process.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and The Mental Capacity Act 2005 (MCA) and report on what we find. The manager had undertaken training in this area to ensure she understood her role and responsibilities. However the provider had not followed the guidance where some people’s liberty had been restricted. No applications had been submitted to the supervisory body so that the decision to restrict somebody’s liberty is only made by people who had suitable authority to do so.

Improvement was needed to the staffing arrangements to make sure there were enough staff with the right skills to meet people’s needs. The manager showed us that the night staff had not received training in first aid or management of actual or potential aggression [MAPA] or similar training. MAPA training enables staff to safely disengage from situations that present risks to themselves, the person receiving care, or others. The management team were working with the local authority to improve the training completed.

Relatives we spoke with told us that this was a caring home, and said that they felt staff really knew their family members; they were effective at supporting them. People and their relatives consistently told us they were happy with the service provided and that staff understood their needs. Professionals involved with people that used the service said that the Provider was trying hard to make improvements and were focussed on the needs of the people living at the home.

Staff we spoke with understood that they had responsibility to take action to protect people from harm. They demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet.

Risks to people’s health and wellbeing were well managed. They were supported to eat and drink well and had access to health professionals in a timely manner.

People knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

There were systems in place to monitor and improve the quality of the service provided; however, they had not always been effective. The manager had plans to make the required improvements that had been identified.

We found two breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Merecroft provides accommodation and personal care for a maximum of eight people who have a learning disability. The home with accommodation arranged over two floors. There were two flats downstairs and six bedrooms upstairs. There were five people living at the home at the time of our inspection.

This inspection took place on the 2 September 2015 and was unannounced.

At our last inspection on 4 December 2014 we asked the provider to take action to make improvements to protect people who lived at the home. The provider was not meeting two of the Regulations of the Health and Social Care Act 2008. The provider had not worked within the Deprivation of Liberty Safeguards (DoLS) and had not ensured there were enough staff with the appropriate skills and knowledge to effectively meet people’s needs. Following this inspection the provider sent us an action plan to tell us what improvements they were going to make. At this inspection we saw that the actions required had been completed and these regulations were now met.

The provider is required to have a registered manager in post. The provider had taken action and there had been three managers in post since our last inspection. The new manager was in the process of registering with us. 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. The new manager had started a few weeks prior to our inspection.

The provider managed the risks to people by making sure the home environment and equipment were regularly maintained and serviced. People had their needs and risks assessed. People who lived at the home and their relatives said they felt safe and staff treated them well. Relatives told us staff were kind and caring and thoughtful towards people. We saw positive interactions between staff and people who lived at the home; we saw people were treated with kindness. Staff knew how to protect people against the risk of abuse or harm and how to report concerns they may have. They demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these

Checks had been completed on new staff to make sure they were suitable to work at the home. The new manager had recently increased support to staff with meetings and a commitment to encourage staff to be involved in improving the quality of the service provision. Staff understood their roles and responsibilities and felt that the new manager was trying to make things better for staff and people who lived at the home.

People had their prescribed medicines available to them and these were administered by staff who had received the training to do this. Relatives and staff told us people were supported to access health and social care services to maintain and promote their health and well-being. We saw one person supported to visit a GP on the day of our inspection. We saw when people needed additional support to meet their health needs a referral was made to the right health care professional so that people remained healthy and well.

Relatives concerns had not been consistently carried forward through the different managers through the leadership of the provider. One relative told us that they had asked for regular updates on their relative; however this had not consistently been completed. People and relatives were getting to know the new manager. Relatives told us they felt they were approachable and they were hopeful that the new manager would provide some consistency to improve the effectiveness of the communication between relatives and the management team. Relatives knew how to make a complaint and felt able to speak with the staff or the manager about any issues they wanted to raise.

We found that the leadership of the provider had not ensured identified improvements were completed through the many changes in management. There was an inconsistent approach by the provider to overseeing the improvements needed to increase the quality of the service. Action plans were not fully completed to ensure the quality of the service was improved for people who lived at the service.

The new manager, deputy and area manager all expressed a commitment to introduce a range of checks to make sure the quality of the services people received were of a good standard. The new management team had started to carry out these checks and had identified some of the key areas to directly improve people’s experience of the care provided at the home. Such as improvements to the home environment and staff support. At the time of this inspection there was limited evidence to determine whether these improvements were effective and would have a sustained positive impact on the quality of care people who lived at the home received.

See what actions we asked the provider to take at the end of the report.