The inspection of Merit Healthcare Ltd took place on 5, 8,11 June 2018 and was announced. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, and younger disabled adults.

At the last inspection of Merit Healthcare Ltd in November 2017 we rated the service ‘Requires Improvement’ overall. We found three breaches of the regulations. This was because they had failed to assess or take reasonable actions to reduce the risks associated with the health and safety of people. People’s equipment and medicines had not been safely managed by staff and accurate and contemporaneous care records had not been maintained for each person.

After the inspection provider sent us an action plan of the actions they would take to meet these legal requirements. At this inspection we followed up on their actions and found that some improvements had been made but further improvements were needed to fully meet the regulation in relation to the management of people’s care records and embed their actions.

A registered manager was in place as required by their conditions of registration. 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 and associated Regulations about how the service is run.

People’s needs were assessed to ensure the service could meet their needs and the level of support provided varied according to their needs. Staff worked closely with health care professionals and people’s families. Relevant health and social care professionals were involved with people’s care when their needs had changed.

People’s risks had been identified and were being managed by staff who knew them well. However people’s care plans did not provide staff with sufficient guidance in managing people’s immediate risks. Arrangements were in place to make sure people received their medicines appropriately and safely, although people’s records relating to the management of their medicines were not always clear. The assessment of people’s capacity to consent to their care had not been assessed in line with the principles of the Mental Capacity Act 2005.

People and their relatives were positive about the caring nature and told us they were supported by staff who were kind and compassionate. They were confident that any concerns would be dealt with promptly. People were supported by familiar staff, although staff sometimes staff did not always arrive on time.

Staff felt trained and supported to carry out their role. The registered manager was involved in the delivery of personal care which allowed them to monitor the well-being of people and management of staff. Any concerns or accidents were reported and acted on to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm.

The registered manager needed to ensure all recruitment checks completed were recorded to evidence their safe recruitment decisions. We have recommended that the service seeks advice from a reasonable source regarding their recruitment systems and take action to update their practice accordingly. The registered manager had a good insight into the quality of care being delivered and monitored the service personally, however further improvement was needed in the quality assurance processes to identify shortfalls in people’s care and medicines records and drive improvement. The registered manager was reviewing the systems to monitor the quality of care being delivered and staff support and development when the registered manager was unavailable. Staff felt supported and could seek advice from the registered manager and staff team.

We found two breaches of the Health

Merit Healthcare Ltd provides care to people living in Gloucestershire. This service provides care at home. It provides personal care to 20 people living in their own houses and flats in the community. It provides a service to older adults, younger people, people who misuse drugs and alcohol and people with mental health problems. It can also support people with a physical disability, sensory impairment and people living with dementia. Not everyone using Merit Healthcare Ltd receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

This inspection took place on 2, 3 and 14 November 2017. The service had not previously been inspected. The service was first registered with CQC on 17 November 2016 and began providing personal care to people in March 2017. This is the first time the service has been rated Requires Improvement.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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 not being kept safe from the risks of potential harm. Risk assessments had not been completed describing the strategies in place to keep people safe from the risk of choking and how any tissue viability concerns were managed. Staff had not always followed people’s moving and handling and medicines care plans putting them at potential risk of harm. Medicines administration charts had not always been completed. People did not always get their medicines at times to suit them. People did not always receive their care to reflect their personal wishes or preferences. Staff had not reported missed visits or near misses. The registered manager was unable to respond to these and to make the appropriate changes or improvements to the service. Their quality assurance processes had not identified these issues. People’s capacity to consent to their care had not been considered in line with the Mental Capacity Act 2005.

Merit Healthcare provided care to people by staff they knew well. People liked the consistency of having a named person to deliver their care. Arrangements were in place to provide cover for absences. People said their visits were usually on time and staff stayed for the correct length of time to meet their needs. People’s dietary needs had been discussed with them and staff ensured they provided snacks and access to fluids when needed. People’s health and well-being was monitored. Staff reported any changes to the registered manager who liaised with the family and health care professionals. Staff understood how to recognise and report suspected abuse and how to ensure people stayed safe in their homes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were treated with respect and dignity and their independence was encouraged. Staff knew people well and had positive relationships with people. People’s needs had been assessed to make sure the service could meet their needs. People and their relatives had been involved in the planning of the care and support. People’s care plans were available to staff electronically and technology was being introduced which would monitor visit times. People’s diversity and human rights were respected and adjustments made to their care and support if needed. Information could be provided in alternative formats if needed. People knew how to make a complaint. Complaints had been investigated and action taken to improve people’s experience o