We undertook this unannounced inspection on 27 & 28 September 2018. Meridan House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission [CQC] regulates both the premises and the care provided, and both were looked at during this inspection. Meridan House is registered to accommodate a maximum of 12 people. On the day of this inspection there were nine people living in the home with mental health needs.

At our last comprehensive inspection on 14 January 2016 the service met the regulations we inspected and was rated Good. At this inspection we found the service to be deficient in some areas and have rated it as Requires Improvement. Following the inspection we received concerns in relation to the care of people who used the service and the management of care workers. We therefore made further enquiries with the registered manager and provider.

People who used the service informed us that they had been treated with respect and dignity. The service had arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse.

Risks assessments had been carried out and risk management plans were in place to ensure the safety of people. The service followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs were met. There were suitable arrangements for the administration of medicines and medicines administration record charts (MAR) had been properly completed.

With one exception, the premises were kept clean and tidy. One bedroom had not been fully cleaned and there was litter on the floor. The state of the bedroom posed a fire and health and safety risk as the person who used the service had smoked in their bedroom. There was a record of essential maintenance and inspections by specialist contractors. Fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEPs) were prepared for people to ensure their safety in an emergency.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

Care workers had received a comprehensive induction and training programme. There were arrangements for staff support, supervision and appraisals.

Care workers prepared appropriate and up to date care plans which involved people and their representatives. People were encouraged to be as independent as possible and to engage in various activities within the home and in the local community. Some people had made progress and their mental health had improved.

The service listened to people who used the service and responded appropriately. There were opportunities for people to express their views and experiences regarding the care and management of the home. One complaint made had been recorded and promptly responded to.

Comprehensive checks and audits of the service had been carried out by the registered manager and the team manager to ensure that the service provided care of a good quality. We however, noted that there continued to be issues related to cleanliness of a person’s bedroom. We also noted that an allegation of abuse was not notified to the Care

We carried out an unannounced inspection of Meridan House on 4 January 2016.

Meridan House provides accommodation and care services to people with mental health needs. The service provides an intense service to prepare people for independence to move on to their step down services nearby to help develop their life skills further. This would eventually lead to people moving on to their own independent accommodation in the future. All rooms are single occupancy and have en-suite facilities. At the time of our visit there were seven people using the service.

People were treated with dignity and respect by staff who were supportive and caring. We observed that staff interacted with people in a respectful manner and people responded positively. We saw that there was a system in place for managing medicines, however, Staff understood the requirements of Deprivation of Liberty Safeguards (DoLS) and acted where this was to safeguard people. People were protected from the risk of abuse because staff knew what action to take if they suspected that anyone was suffering abuse. The service had submitted a DoLS application for one person who was subject to restriction. We saw evidence of this on their care files. People subject to decisions made by the Court of Protection had copies of documents in their care files.

People’s nutritional needs were met by the service. People were able to prepare their own meals, were given choice and involved in the weekly shop for the service. We observed people accessing the kitchen on the day of our inspection. Staff also provided support to people where this was required. People’s risks were assessed and reviewed and risk management plans were in place.

People received care and support that was responsive to their needs. Support plans provided detailed information about people so staff knew exactly how they wished to be cared for and supported in a personalised way. People were encouraged to pursue their own interests and hobbies.

People were actively involved in developing the service and interviewed and met with new staff before being employed by the service. Residents’ meetings were held to encourage people to give their views about the service and make suggestions for improvement and involved in making decisions about the environment, such as choosing the colour of paint to decorate communal and personal bedroom areas.

The service was well led by a staff team who was knowledgeable and motivated. The home had a set of vision and values which was incorporated into the way the service was run and helped to deliver high quality support in line with people’s individual requirements.

Staff had received recent training in areas such as, the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), safeguarding, medicine management, assessment of risk and support planning.

We have made a recommendation about the management for managing  as required medicines (PRN). 

During our inspection, we met six of the eight people using the service. They were all complimentary about the service and the care provided. One person said, “The manager and staff know what they are doing. If anything needs doing, the staff do it. They are all very helpful.” This was echoed by another person who said, “I am very pleased with my progress. The staff are very helpful.”

One person said, “The staff are ok. They are respectful. They give me choices. They help me to cook and also cook for me sometimes.”

People felt that they got on well with their key workers. One person said, “My keyworker keeps me informed. We have meetings. We talk about things, about how I feel. Staff are very helpful.” This was echoed by another person who said, “We have meetings. We discuss shopping and activities.” Another person said, “My key worker is great. The staff are all very good and supportive.”

We found that refurbishment work was in progress to improve the premises, including people’s en suite bedroom facilities and the decor in the communal rooms.

We noted that care plans were well maintained and confidential records, including electronic records, had been kept securely.

The service had followed the provider’s complaints policy and procedures and complaints had been responded to within 28 days.

The service provided support and encouragement to people who use the service to enable them to develop their independent living skills. The aim of the service was that people would be able to move on to more independent living within two years. We spoke with four of the seven people who use the service. They were all positive about the support provided to them by staff. Everyone said they liked the service. One person said, “staff take care of me” and another said, “I like all the people here.”

People took part in a range of activities and further education classes which helped develop their independent living skills. People said that both their physical health and mental health needs were addressed by staff. Everyone told us they felt safe using the service. Staff demonstrated the knowledge and skills needed to protect people from possible abuse.

The service worked with a multidisciplinary team of professionals to ensure that people’s needs were met. Appropriate checks were carried out on staff before they started working in the service. The provider regularly monitored the service to make sure that an appropriate standard of care and support was provided to people who use the service.

During our visit we spoke with some people who used the service. They told us that they felt safe in the home and were happy with the support they received. They said that staff were ‘polite and nice’ and treated them with respect. People particularly liked the building and environment and said it was always clean and pleasant to live in. One person’s comments were typical when they said, ‘I really like it here’.