CQC report explained · a residential care home
What the CQC found at Mercers
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks such as choking, mobility and infection were assessed and managed. Medicines were administered safely, staff recruitment checks were completed, and there were enough staff.
- Effective?
- Good
- People had detailed assessments and care plans, and staff supported their health, nutrition, choices and independence. However, some training and Care Certificate work had not always been completed.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff understood people's preferences and used communication tools to involve them in decisions.
- Responsive?
- Good
- Care was personalised and plans were regularly reviewed. People took part in activities they chose and had information in formats suited to their communication needs.
- Well-led?
- Requires improvement
- Managers and staff were approachable and committed to person-centred care. However, quality audits did not always identify cleaning and maintenance problems, and managing another service was described as a struggle.
What inspectors found, February 2019
Rated Good overall and out of special measures; inspectors found safe, kind care but leadership and quality checks still needed improvement.
Inspectors made an unannounced visit on 28 November 2018. They spoke with two people and five staff, observed care, and checked care plans, medicines records, recruitment, training and quality monitoring.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found people were protected from avoidable harm, received personalised support, were treated with dignity, and were helped to make choices and stay independent.
Well-led was rated Requires Improvement. Staff training was not always complete, and quality checks had not found some cleaning and maintenance problems. The home had improved since its previous Inadequate rating and was no longer in special measures.
Risk management
The home had improved its approach to risk, including choking risks. Staff understood the guidance and knew how to support people safely without unnecessarily restricting them.
“Risks to people had been assessed and were safely managed.” from the report
Kind and respectful care
Inspectors saw staff treating people kindly and respecting their dignity. Staff knew people's histories, preferences and communication needs.
“People were treated with kindness and care by staff.” from the report
Personalised support
Care plans described people's routines, needs and preferences. People were supported with activities, communication, health care and everyday independence.
“People received personalised care and support specific to their needs and preferences.” from the report
Support with choices
People were encouraged to make decisions about their care, food and activities. Staff used pictorial information, communication boards and other tools where needed.
“There was a strong emphasis on involving people and enabling them to make choices wherever possible.” from the report
Incomplete training
needs fixingSome staff training had not been completed, and not all staff had completed the Care Certificate where required. Ask the home which gaps remain and when they will be closed.
“Training for staff had not always completed and not all staff had undertaken the Care Certificate where required” from the report
Quality checks missed problems
needs fixingAudits were in place but did not always identify issues with cleaning and maintenance. The report says more work was needed to spot patterns and make sure improvements lasted.
“Quality assurance processes did not always effectively identify issues in the service to ensure sufficient oversight of the service.” from the report
Minor environmental risks
needs fixingInspectors found exposed cement and damaged flooring that could affect infection control or create a trip risk. They also noted black marks on hallway flooring.
“The wooden strip around the edge of the flooring in the conservatory was coming away from the floor and wall, creating a potential trip hazard.” from the report
End-of-life planning
needs fixingNo one was receiving end-of-life care during the inspection, but plans recording people's wishes for the end of life were not in place. Inspectors recommended that these plans be developed.
“Documents to record the arrangements, choice and wishes people may have for the end of their life were not in place” from the report
- 01Which staff training and Care Certificate requirements were incomplete at the inspection, and have all of them now been completed?
- 02How do you check that audits identify cleaning, flooring and other maintenance problems promptly?
- 03Have the exposed cement, damaged conservatory flooring and marked hallway flooring been repaired?
- 04How are you making sure improvements are sustained while the registered manager is also responsible for another service?
- 05Have end-of-life care plans now been discussed and recorded for each person?
This was an unannounced inspection of the whole care home and all five key questions, including care, accommodation, medicines, staff and governance. This explanation was written from the published report of 26 February 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2018
Rated Inadequate and placed in special measures; inspectors found serious risks around choking, the environment, restrictive practices and weak management oversight.
This was an unannounced focused inspection on 12 March 2018. Inspectors looked only at whether the home was safe and well-led. They spoke with people, managers and staff, and checked care records, recruitment, training and other records.
Inspectors found that risks were not properly assessed or managed. This included choking, fire safety, the building, infection control and the use of restrictive practices. Staffing levels also needed review, as shortages sometimes affected people's activities and one-to-one support.
The home was not well-led. Its checks had failed to find or fix important problems, and the provider and registered manager had not kept policies and practice up to date. The home had been rated Good at the comprehensive inspection in September 2016, but this focused inspection found significant deterioration in the areas examined.
The overall rating was Inadequate. The home was placed in special measures, meaning CQC said it would be kept under review and normally inspected again within six months unless immediate enforcement action was taken.
Recruitment checks
The provider completed checks before staff began work, including references, criminal record checks, identification and employment history.
“The provider carried out safe recruitment. Checks were undertaken on staff suitability before they begun working in the service.” from the report
Time with people
Inspectors saw that staff were not rushed and had time to sit and talk with people.
“Staff were not rushed in their interactions and had time to spend sitting and chatting with people.” from the report
Safeguarding awareness
Staff could explain what they would do if they had concerns about abuse and had received safeguarding training.
“Staff had an awareness and understanding of abuse and their responsibilities to protect people.” from the report
Choking risks were not assessed
seriousInformation about people's choking risks was missing from care records or difficult for staff to find. Staff did not have consistent guidance, and eating and drinking assessments were not in place.
“Risks to individuals in relation to choking had not been assessed.” from the report
Unsafe environment and fire arrangements
seriousInspectors found hazards including uncovered radiators, unsecured furniture, damaged flooring, poor maintenance and outdated fire safety information. Personal emergency evacuation plans were not in people's records.
“The fire safety log book and fire risk assessment had not been updated since 2008 although the service had received a visit from the local fire service in Jan 2013.” from the report
Cleanliness and infection control
seriousParts of the building were dirty, damaged and poorly maintained. Infection control policies and risk assessments were out of date or missing.
“The cleanliness of the service had been neglected and improvements were required regarding infection prevention.” from the report
Restrictive practices
seriousSome restrictions had not been reviewed or properly agreed. Inspectors found that people were prevented from freely accessing parts of their home and that communication support was not being used as recommended.
“This meant that people were restricted unlawfully from freely accessing areas of their home.” from the report
Staffing shortages
needs fixingRotas showed four occasions in two weeks when staffing fell below the required level. The report says this could affect one-to-one support and people's opportunities to go out.
“Those who do not have a one to one worker miss out when there is not enough staff.” from the report
Poor quality oversight
seriousThe home's audits and monitoring had not identified or resolved important problems. The provider and registered manager did not provide enough oversight to keep care safe and improve its quality.
“There had been a lack of oversight of the service by the registered manager and provider to ensure the service delivered was safe and that they kept up to date with best practice.” from the report
- 01What current risk assessments and care plans are now in place for each person's choking, eating and drinking needs?
- 02What repairs and fire safety updates have been completed, including evacuation plans, emergency lighting, flooring and unsecured furniture?
- 03What positive conditions did CQC impose, and can you show us evidence that each condition has been met?
- 04How are restrictions on access to rooms reviewed, agreed and recorded using the least restrictive option?
- 05How do current staffing rotas ensure one-to-one support and prevent people missing activities when there is a staff shortage?
This was an unannounced focused inspection of Safe and Well-led only, prompted partly by concerns about choking risk; the other three key questions were not assessed or rated. This explanation was written from the published report of 30 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Mercers
3 rated inspections over 2 years: the service has held its Good rating throughout.
- February 2019Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2018Inadequatedown from GoodSafe: InadequateWell-led: Inadequate
- January 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2014Inspected but not rated
- October 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 3 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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