Date of inspection: 10 April to 7 May 2025. We inspected the service due to concerns around recruitment and leadership of the service. People were supported by kind and caring staff who understood how to keep them safe. Staff knew how to recognise potential abuse. The management promoted openness and transparency placing the people at the centre of everything. People, relatives and staff felt comfortable speaking up and provided examples of where they had. Systems were in place to monitor the quality and safety of care. Some of these were relatively new and being embedded into regular practice. They were identifying concerns and putting things in place to rectify them. Alert systems were in place to create oversight for people’s daily care. Management regularly checked the alert systems and took action when required. Systems were in place to safely recruit staff and ensure they had received enough training. Staff from overseas were supported to settle and learn about the new cultures and ways of working in this country. Staff were observed by the management when delivering support and received regular supervisions to ensure people received safe, high-quality care. Staff told us the training available met their needs. However, one staff member felt training could be improved. Although, no concerns were raised by people, or their relatives and no impact was found. Equity and diversity were considered throughout the organisation. The registered manager promoted staff development and reflective practice.
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Merit Healthcare Ltd improved from Requires Improvement to Good overall following a focused inspection of Safe and Well-led domains, having remediated all previous regulatory breaches. However, the Well-led domain remains Requires Improvement due to persistent staff dissatisfaction with management communication and inconsistent engagement with health and social care professionals.
Concerns (3)
moderateLeadership: “The majority of staff did not feel supported or valued by the management team. Of the 11 staff that provided feedback to us, 9 raised concerns about support from the management.”
moderateCommunication with families: “2 professionals raised concerns that communication from the management team had been poor at times, which had led to an inconsistent service and a delay in an assessment.”
moderateGovernance: “The management team did not always communicate effectively with staff and health and social care professionals or create a culture that empowered staff.”
Strengths
· Medicines administration records fully completed and electronic system introduced enabling prompt follow-up of any gaps in recording.
· Risk assessments balanced protecting people with supporting independence and were reviewed and updated as needs changed.
· Effective safeguarding systems in place with staff demonstrating good understanding of abuse prevention.
· Provider completed thorough pre-employment checks including criminal record checks and references before staff started work.
· Effective infection prevention and control systems including PPE training and updated guidance compliance.
Quality-Statement breakdown (8)
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careGood
well-led: Engaging and involving people, staff and partners; Promoting a positive, open and empowering cultureRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
Focused inspection of Merit Healthcare Ltd identified multiple regulatory breaches across medicines management, risk assessment, infection control, recruitment, governance and CQC notifications, with the overall rating dropping from Good to Requires Improvement and Well-Led rated Inadequate. CQC issued warning notices under Regulations 12 and 17, with the provider subsequently engaging and giving assurances of remedial action.
Concerns (13)
criticalMedication management: “We were not assured that people had received their medicines as prescribed and in line with the provider's policy and national guidance.”
criticalRecord keeping: “Medication administration records (MAR) had not always been maintained, to the extent it was not possible to be assured people had received their medicines as prescribed.”
criticalCare planning: “Risk assessments were not always in place for people. Some people had no risk assessments or management plans in relation to moving and handling, skin care or continence care.”
criticalInfection control: “We could not be assured that all staff took part in weekly COVID-19 testing... the registered manager did not have a process to check staff compliance with testing.”
criticalStaff training: “Three of the staff records we looked at contained no evidence of staff training. Another staff member had completed training, but this had all expired over 12 months ago.”
criticalGovernance: “There had been a failure to establish and maintain effective quality assurance systems within the service.”
criticalLeadership: “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalStaff competency: “The service had not always carried out the relevant checks in relation to people's employment history, qualifications, or conduct in previous roles... had not always carried out DBS checks on all staff.”
criticalIncident learning: “There had been seven notifiable incidents since the beginning of June 2020. The registered manager had failed to notify CQC of these incidents.”
moderateSupervision / appraisal: “We discussed staff supervision with the registered manager who told us formal staff supervision was not taking place.”
moderateMissed or late visits: “People and their relatives told us staff punctuality was inconsistent and staff would not always arrive on time. People and relatives told us they felt rushed by staff.”
moderateConsent / capacity: “We also saw that people's consent to care had not always been recorded in people's care files.”
moderatePerson-centred care: “concerns found at the inspection included but were not limited to, training, care records, risk management, consent and the mental capacity act and lack of person-centred information.”
Strengths
· People and relatives told us they felt safe with the staff who supported them.
· Staff were knowledgeable about safeguarding procedures and felt confident to raise concerns about poor care.
· Staff had access to and used personal protective equipment (PPE) during care calls.
· Environmental risk assessments of people's homes had been completed.
· The service had built working relationships with the local authority, GP practices and pharmacies.
Quality-Statement breakdown (9)
safe: Using medicines safelyNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Preventing and controlling infectionNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Promoting a positive cultureNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
Merit Healthcare Ltd improved from previous breaches and is now rated Good overall, with positive feedback on caring, safe and effective personal care delivery. Well-led remains Requires Improvement due to quality assurance systems and audits not being fully documented or implemented to monitor service quality over time.
Concerns (4)
moderateGovernance: “Effective systems were not fully in place to monitor the quality of the service being delivered and staff development.”
moderateRecord keeping: “A medicines audit had been developed... However, these audits had not been recorded. The registered manager told us they were auditing care plans, but these had also not been recorded.”
moderateCare planning: “the associated care plan had not always been updated to reflect people's current level of need... For another person, their care plan still reflected their old care schedule which had changed due to a change in their needs.”
minorMedication management: “they had recognised that not everyone's medicines care plans contained clear guidance around the support people required with their medicines.”
Strengths
· Staff were kind, caring and compassionate; people felt safe with staff visits
· Sufficient, consistent staff arrived on time and stayed for the designated duration
· Robust recruitment procedures including DBS checks were followed
· Staff received appropriate training, induction and the Care Certificate
· Safeguarding training in place and staff confident to whistle blow
Quality-Statement breakdown (20)
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experience