Merit Homecare is registered to provide personal care to people in their homes. At the time of inspection approximately 328 people were being supported by 124 staff members.

The service was last inspected in January 2017 where it achieved an overall rating of good with individual ratings of good in the five domains.

This responsive, focused inspection was carried out to check any potential risk associated with unsafe medicines management. This was due to CQC had received a notification about a serious medicines error.

As this inspection took place over six months since the comprehensive inspection a rating is not published or changed.

A registered manager was in place. 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.

Systems were in place for people to receive their medicines in a safe way. Appropriate training was provided and staff were supervised and supported. We have made a recommendation that some staff receive further medicines training.

Communication was generally effective to ensure people received safe care that met their needs and to ensure the smooth running of the agency.

A quality assurance system was in place that was quite robust to check the quality of the service provided. However, it had not identified the issue that we found during the inspection. This was rectified immediately by the registered manager. There were systems to enable people to raise complaints and to give feedback about their experiences of care received.

We carried out an inspection of Merit Homecare on 8, 9, 16 and 31 December 2016 and 13 January 2017. The first day of the inspection was announced. We last inspected in July 2015 and found the service was meeting the relevant regulations in force at that time, with the exception of one relating to person centred care.

Merit Homecare provides personal care for people in their own homes. There were 111 people using the service.

The service had a registered manager in post. 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 told us they felt safe with care staff and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

Risks associated with people’s care needs and working practices were assessed and steps taken to reduce the likelihood of harm occurring. Staff had access to personal protective equipment, such as gloves and aprons. They were aware of and trained in good hygiene practices.

People told us staff were courteous, professional and polite. They acted in a safe manner when supporting people. Staffing levels were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.

Systems for the safe management of medicines had been reviewed and strengthened to ensure medicines were appropriately accounted for.

Where appropriate, people’s mental capacity was considered through relevant areas of care, such as with medicines and distressed behaviour. Staff routinely obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by the registered manager and other senior staff.

People were supported with their meals, including with meal preparation and checking best before dates, where this was an assessed need. People’s health needs were considered in the planning and delivery of care. Help from external professionals, such as the GP, was sought if necessary. This ensured people’s general medical needs were met.

Staff explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.

People using the service and staff spoke well of the registered manager and they felt the service had good leadership. We found there were effective systems to enable people to raise complaints, and to assess and monitor the quality of the service. Staff performance was subject to periodic spot checks. New systems to monitor and audit the service had been introduced to help ensure expected standards were achieved. Quality monitoring included feedback from people receiving care.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of our inspection.

At our previous inspection in January 2013 we found minor concerns with the arrangements in place in order to ensure that staff received appropriate training, and supervision. We had also found minor concerns with the standard of record keeping within the service.

During this inspection we found that improvements had been made to staff training, supervision and in the quality of record keeping.

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

We found the quality of records had improved and most documents were named and dated with accurate entries made. Records were clear and easier to follow to ensure that people received appropriate and safe care.

We spoke with seven people who used the service, and with the relatives of six people who used the service. People were very positive about the care which was provided. One person said, "My usual carer is gold dust. She knows exactly what I want and how to do it. She works alongside me so well and I can't praise her enough." A relative told us, "Our main carer knows my mam's needs really well. She treats my treats my mam so well. They have a really good rapport."

Appropriate checks were undertaken before staff began work to ensure staff were of good character and suitably qualified to work within the service.

People who used the service were asked for their views about the care and service which was provided and the provider took account of comments to improve the service.

We saw there was an effective system to regularly assess and monitor the quality of service people received.

People who use the service told us they were generally satisfied with the care and support they receive. However, a local council told us a person using the service, and their family, had expressed some concerns about the care and support they received. The registered manager was in the process of addressing these concerns at the time of our visit.

This was an unannounced inspection which we carried out on 31 July 2015 and 13 & 24 August 2015. We last inspected Merit Homecare in June 2014. At that inspection we found the service was meeting the legal requirements.

Merit Homecare is a domiciliary care agency providing care and support to people in their own home. It is registered to deliver personal care.

A manager was in place and they were in the process of submitting an application to become registered with the Care Quality Commission. 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.

There were sufficient staff employed to provide safe care to people and they were appropriately vetted to make sure they were suitable to be employed to work with people.

The provider had in place plans to deal with emergency situations through the use of an on call system that was manned out of hours by senior staff.

People received their medicines in a safe way.

Staff had received training and had an understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. Plans were in place for staff to receive other training to meet people’s specialist needs.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

Staff helped ensure people who used the service had food and drink to meet their needs. Some people were assisted to cook their own food and other people received meals that had been cooked by staff.

People told us staff were compassionate and kind but care was not always provided by the same staff to give consistent care.

Communication was not always effective with people from the main office.

A complaints procedure was available and people we spoke with said they knew how to complain, most people said they had not needed to. Where complaints had been received we found they had not always been satisfactorily resolved.

Records were not always available with detailed guidance for staff to provide individual care to people.

The service had a quality assurance programme to check the quality of care provided. However the systems used to assess the quality of the service had not identified the issues that we found during the inspection to ensure people received individual care that met their needs.

You can see what action we told the provider to take at the back of the full version of the report.