The inspection took place on 14 November 2018 and was unannounced. The previous inspection took place on 5 April 2016 when it was rated as ‘Good.’

Mermaid Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation, for up to 10 people under the age of 65 years with a range of mental health needs including substance misuse. On the day of our inspection there were seven people living at the home. The home is converted from two residential properties and overlooks the seafront at Lancing. The home has 10 single bedrooms, each with its own en suite bathroom. There was a communal lounge and dining room as well as a room which people could smoke in.

The service had a registered manager, who was also the provider. 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.

The premises were generally well maintained, but there were exceptions to this. A first-floor bathroom had recently been refurbished but the ceramic floor tiles had cracked into pieces with sharp edges which raised from the floor when walked on. There was a risk people could cut their feet on the broken tiles. The provider had not taken steps to assess or mitigate the risks of legionnaires’ disease. Legionnaires’ disease is a potentially harmful type of pneumonia contracted by inhaling airborne water droplets. The provider did not know this needed to be assessed and had not carried out checks on the water system as advised by the Health and Safety Executive (HSE) Health and Safety in Care Homes. Arrangements for maintaining adequate fire safety had not been taken. The weekly test of the fire alarms had not taken place since 18 October 2018 and the provider had not completed personal emergency evacuation plans for each person. The home was inspected by the fire and rescue service on 1 November 2018 who issued a letter for eight areas in need of improvement.

Risks to people were assessed and plans in place to mitigate these. However, one person’s risk of going out unsupervised had not been assessed when an external professional had assessed the person as being in need of constant supervision. The provider agreed this needed to be clarified.

Improvements were needed regarding the system for ensuring the service complied with the Health and Social Care Act 2008. For example, the Commission asked the provider to complete a Provider Information Return (PIR) to give us information about the service. This was not responded to. Whilst people’s communication needs were assessed the provider did not know about the Accessible Information Standard (AIS) guidance, which requires service providers to ensure those people with disability, impairment and/or sensory loss have information provided in an accessible format and are supported with communication. The provider was aware of the General Data Protection Regulation (GDPR), which was effective from 25 May 2018, but had not yet considered this for the service’s record keeping.

Records of staff supervision were maintained until 2015 and 2016 but had then stopped; the provider said informal supervision took place. The provider stated staff were observed and assessed in their work, but this was not recorded; this included the assessment of staff as being competent in the safe management of medicines. Records were not readily available and the provider had to access several records from their mobile phone such as maintenance service records and correspondence with health and social care professionals about people’s care.

The pro

We inspected Mermaid Lodge on the 5 April 2016 and it was an announced inspection. The provider was given 48 hours’ notice as we wanted to be sure that people we needed to speak with would be available on the day of the inspection.

Mermaid Lodge is registered to provide care for up to 10 people. The home provides support to people with a range of mental health needs. On the day of the inspection nine people were living at the service.

The home had a registered manager. 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.

The experiences of people were positive. People told us they felt safe living at the service, staff were kind and compassionate and the care they received was good. One person told us “The reason I’m so happy here is that I feel so safe, there is no aggression to deal with so you can just live your life in peace”.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate the risks. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff on duty at all times to meet people’s individual care needs. When new staff were employed at the home the registered manager followed safe recruitment practices.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed.

Care and support provided was personalised and based on the identified needs of each individual. People were supported to develop their life skills and increase their independence. People’s care and support plans and risk assessments were detailed and reviewed regularly.

Support staff were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Staff attended refresher training to meet the provider’s requirements and had access to further qualifications in health and social care. One member of staff told us “We have regular training and updates and it’s great we get to be able to get a qualification in what we do. I am about to start my diploma”.

The home considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care and support tasks before they proceeded.

People were supported and encouraged to eat a healthy and nutritious diet. People had access to health care professionals. They had been supported to have an annual healthcare review. All appointments with, or visits by, health care professionals were recorded in individual support plans.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. They told us that communication throughout the service was good and included handovers at the beginning of each shift and through staff meetings. They confirmed that they felt valued and supported by the registered manager who they described as very approachable.

People, relatives and staff told us the service was well led. One person told us ”Her [the manager] door is always open if you have a problem. She runs a good ship here”. The registered manager told us they carried out a range of internal audits to review the quality of the care pr

We spoke with three people who used the service and reviewed the records of four people. We observed care being given to people by staff and the provider. We also looked at three members of staff's records.

We considered all 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?

People told us they felt safe receiving care from staff employed by Mermaid Lodge. One person said, ”I can trust the staff to help me when I need it. They make me feel safe when I have concerns about my mental health.”

Staff had completed training in the safeguarding of vulnerable adults. Information about reporting safeguarding concerns was displayed in prominent areas of the home. Risks to people’s health and safety in the home had been assessed and management plans were in place to reduce these risks. Appropriate checks were carried out on staff before they began working with people.

We found the provider had effective systems in place concerning the administration of medicines. Medicines were stored safely and in the correct environment. Records concerning medication administration were completed appropriately. Staff had received suitable training to administer medicines.

The home had appropriate policies and procedures in relation to the Mental capacity act and Deprivation of Liberty Safeguards, although no applications have been made. The service had an open front door policy and people could walk in and out of the home whenever they wished to.

Is the service effective?

People we spoke with told us they were involved in planning their care. One person said, “I think I am involved in my care plan. I talk to staff regularly about my health concerns and how I am managing to look after myself and they write it down.” Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills to care for people living in the home. Where appropriate, the service sought advice from appropriate professionals to assist with the care provided for people. People’s needs were assessed and the care plans reflected those identified needs.

Is the service caring?

People were supported by staff who were aware of their needs and how they wished to be supported. One person told us “the staff always have time to talk to me. They help me to do more things for myself but aren’t pushy about it.” We saw people were asked by staff how they wished to be supported and waited for a response before delivering care. The provider told us of a person who had left the service for another placement with minimal staff support. Staff from the service visited the person regularly in their new setting to offer support and help to the person.

Is the service responsive?

An assessment of needs was carried out before people began to receive support from the service. The care records contained details of how each person wished to be supported, including their personal likes and dislikes. These were reviewed every month by the provider or when required to meet the changing needs of people who used the service. People told us they could change some aspects of their care and could discuss this with staff or the manager. One person told us, “One night I was in a lot of pain and called out to the staff. They came immediately and called the ambulance out. The next day I had my appendix removed and the doctor told me they had just caught it at the right time.”

Is the service well-led?

Quality assurance systems were in place. The provider carried out regular audits which looked at the care and support people received along with checks of people’s care plans. Annual questionnaires had not been done for two years. The provider told us they were developing a new one and would send it out when it was ready. Staff told us the management team were supportive and always available for advice and help. The provider was always available to support staff and people who used the service.

We saw effective care based on detailed written plans delivered by committed, experienced and conscientious providers and staff. The environment was clean and the people we talked to said that they enjoyed the calm, relaxed atmosphere that enabled them to develop their interests and independence.

Meals were flexible and food was well balanced and varied. People were encouraged to give feedback which was reflected in adjustments to the menu.

The complaints procedure was accessible but difficulties were dealt with through regular dialogue and a constructive response.

The home was clean and tidy and appropriate precautions were taken to prevent the spread of infection and promote health and wellbeing.

Staff and people who used the service appreciated the therapeutic effect of the seafront location.

During our visit we spoke with five people who used the service and one member of staff as well as one of the providers. The people we spoke with told us that they were well looked after.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs. Care plans held information on all aspects of a person's care needs.

People using the service were protected from abuse as they were supported by staff who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to one of the providers or the staff member.

We looked around the location and saw bedrooms, communal areas, bathrooms and toilets were clean and well maintained.

We spoke to one of the care co-ordinators following the visit who was really positive about the service and how they support the people there.

People told us that they liked living at the home.

They said that they could express views about the care they received and were involved in their care planning.

Those we spoke with said they were happy with the care that they received and the way it was provided.

People told us that if they were unhappy about anything they would report it to the manager and felt confident that it would be dealt with.

They said that their privacy and dignity was respected.