About the service: Merrimore House provides accommodation, care and support for up to six people with a learning disability. It is a three-storey house in Hunstanton. There were four people living at the service on the day of inspection.

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’s experience of using this service:

¿ People were very positive about Merrimore House and liked living there. Comments included, “I definitely like living here,” and, “I’m really happy living here.”

¿ People were protected from avoidable harm and abuse. Action was taken to reduce the risks to people.

¿ The environment was monitored and was safe for people to live in.

¿ People received their medicines when they needed them.

¿ Staff were recruited safely and staffing levels were sufficient to meet people’s needs.

¿ Staff were knowledgeable and were kind, caring and patient.

¿ People were treated with dignity and respect.

¿ Staff knew people well and had developed meaningful relationships with them. Support was provided in a person-centred way based on people’s preferences.

¿ People were supported to manage their health and there were links with other services to ensure that individual health needs were met.

¿ The outcomes for people using the service reflected the principles and values of ‘Registering the Right Support’. People were supported to be as independent as possible and participated actively within their local community.

¿ People were supported to have maximum choice and control in their lives and staff supported them in the least restrictive way.

¿ People could take part in a range of activities, work and educational opportunities which promoted their wellbeing.

¿ Quality assurance processes were in place and actions were taken to address any issues identified.

¿ The service continued to be well managed and staff felt supported.

Rating at last inspection: Good ( report published 8 July 2016)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 7 and 8 June 2016 and was unannounced. Merrimore House is a residential care home providing personal care and support for up to six people, who live with a learning disability. On the day of our visit five people were living at the service, although one person was away.

The home has had the current registered manager in post since March 2013. 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 felt safe living at the home and staff supported them in a way that they liked. Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to equipment and systems in the home to ensure people’s safety.

There were enough staff available to meet people’s needs and additional staff were available if required.

Medicines were safely stored and administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Where they had not received training, they were given enough guidance and information to properly care for people. Staff received support from the registered manager, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, best interest decisions had been made.

People enjoyed their meals and were able to choose what they ate and drank. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and support was always available. Care plans contained detailed information to support individual people with their needs.

A complaints procedure was available and people were happy that they did not need to make a complaint. The manager was supportive and approachable, and people or other staff members could speak with her at any time.

The home monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

We considered all of the evidence we had gathered under the outcomes we inspected. We 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?

Records showed us that risk assessments were completed for all activities inside and outside of the home. All assessments included an evaluation for the level of risk that was presented plus any actions to be taken to reduce or eliminate such risks. Lawful requirements under the Mental Health Act were recognised and staff expressed a thorough knowledge of matters relating to the Deprivation of Liberty Safeguards (DoLS), providing examples of when this had been considered regarding the support of one particular individual.

Is the service effective?

Staff expressed a full understanding about the needs of each person they were supporting. We later saw that care plans reflected this same information. We saw that people were relaxed and confident when discussing matters with staff. One person told us that, “All the staff are really good and I can talk to them about anything.”

Is the service caring?

Our observations showed us that people living in the home were treated with respect at all times. Staff knew each individual and their routines, we saw that each person was encouraged to talk about their day and to make choices about future activities and goals.

Is the service responsive?

We saw that people's individual social and physical needs were being met. People were encouraged to decide what they wanted to do on the day of our inspection as well as choices for their future. Staff assisted people with their decisions by offering advice and providing further information, allowing time for the individual to fully understand their options.

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates when training was due to be updated. This showed that people were supported by a staff team who knew how to provide any support in a safe and appropriate way. Quality assurance systems were in place and a monthly audit was completed for all areas of the home, that provided observations of how the service and records could be improved.

During our inspection of Merrimore House we spoke with two people who used the service and two members of staff.

People we spoke with who used the service told us that they liked living at Merrimore House. One person went on to tell us that they were, “Happy here.” We examined documentation such as a tasks rota for the communal games room which demonstrated to us that people were involved in the day to day running of the home.

Care was planned in a way that supported people to live as independent a life as possible. We also saw that staff supported people with their daily activities of living. People were also encouraged and supported by staff to work and be involved in the local community.

The provider had policies in place which ensured that people would be protected from the risks of abuse. Staff we spoke with were knowledgeable about the signs of abuse and who they needed to inform and how to report any concerns they may have.

Staff were supported with their training. We found evidence which demonstrated to us that staff were supervised on a regular basis and had appraisals once a year.

There was an effective system in place for people to make a complaint if they wished to do so.

During our inspection of 20 December people we spoke with told us they enjoyed living at Merrimore House. One person we spoke with told us, "It's a nice place to live and I'm always busy. I go to work nearly every day". We examined evidence which demonstrated to us that people were involved in the day-to-day running of the home.

Care was planned in a way that provided support to people with their daily activities of living. People were encouraged and supported to be involved in the local community.

Staff we spoke with demonstrated an understanding of safeguarding vulnerable adults guidance and procedures. However, policies and advice provided to staff about whistle blowing procedures and the use of physical restraint was seen to not be in line with local authority safeguarding advice.

People were supported by an appropriate number of suitably trained and qualified staff.

We saw that there were effective systems in place to assess and monitor the quality of services provided at the home.

We saw that records maintained at the home provided guidance to staff which contradicted their own understanding of policies and procedures. Policies seen in relation to the safeguarding of vulnerable adults were not in line with local authority guidance and advice.