CQC report explained · a residential care home
What the CQC found at Merchant House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, suitable risk assessments and safe medicines systems. Staff understood safeguarding and followed people's risk management plans.
- Effective?
- Good
- No rating or detailed findings were given for Effective in this report.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff supported people to make choices and encouraged them to remain independent.
- Responsive?
- Good
- No rating or detailed findings were given for Responsive in this report.
- Well-led?
- Good
- Inspectors found approachable management, good staff morale, clear responsibilities and regular audits that were used to improve the service.
What inspectors found, December 2022
Rated Good; inspectors found safe, kind care and stronger management than at the previous inspection.
The inspection was unannounced and took place on 12 December 2022. One inspector and one Expert by Experience spoke with 13 people, three relatives and four staff. They reviewed care records, medicines records, staff files, audits and other documents, and observed care in the home.
The home was rated Good overall. Safe, Caring and Well-led were all rated Good. Inspectors found enough staff, safe medicines practices, suitable risk assessments and respectful relationships between staff and people.
Management had improved since the previous inspection. The Well-led rating changed from Requires Improvement to Good. Caring also improved from Requires Improvement to Good. A previous breach about dignity and respect was no longer in place.
Enough staff
People, relatives and staff said there were enough staff. Inspectors saw staff respond promptly and spend time talking with people.
“Throughout the inspection the staff responded promptly to people who needed support.” from the report
Safe medicines
Staff gave medicines as prescribed and records were accurate. Staff training and competence checks were also in place.
“We observed staff administering medicines to people in line with their prescriptions.” from the report
Kind and respectful care
Inspectors saw warm, respectful interactions. People were supported to express their views and make choices about their day.
“During our inspection we witnessed staff being kind and compassionate towards the people they supported and showed they had formed a strong relationship with people and knew them well.” from the report
Improved management
The management team was seen as approachable and supportive. Audits covered care plans, medicines and the day-to-day running of the home.
“Findings from audits were analysed and actions were taken to drive continuous improvement.” from the report
Inspectors raised no specific concerns in this report.
- 01The report did not rate Effective. How will you support my relative's health needs and check that care is achieving good outcomes?
- 02The report did not rate Responsive. How will you adapt care as my relative's needs, routines or preferences change?
- 03What changes were made after the previous concerns about choice, dignity and respect?
- 04How will you involve my relative and our family in reviewing their care plan?
- 05How do you use medicines audits and competence checks to make sure medicines remain safe?
This inspection rated Safe, Caring and Well-led; the report gives no ratings or detailed findings for Effective or Responsive. This explanation was written from the published report of 29 December 2022 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, August 2019
Rated Requires Improvement; the home had improved from a previous Inadequate rating and special measures, but inspectors still found safety, dignity and leadership concerns.
This was an unannounced inspection on 24 and 25 June 2019. Inspectors spoke with people living in the home, relatives, staff and health professionals. They observed care, checked the building and reviewed care, medicine, staff and management records.
There had been clear improvement since the previous inspection. Choking risks and care plans were better managed. Food, healthcare, activities, communication and consent were also handled well. However, a change to one person's risk management had not been handed over, some medicine records were not accurate, and a wet room floor presented a slip risk.
Inspectors found that staff were often kind, but people were not always treated with dignity and respect. The home had managers who understood what needed to improve, but the changes had not yet become consistent. The overall rating of Requires Improvement means the home was not consistently safe, caring or well-led, although Effective and Responsive were rated Good.
Improved risk planning
Choking risks had been reassessed and staff were following specialist advice. Inspectors saw appropriate support during meals and correctly thickened drinks.
“At this inspection we found the risk assessment was more robust, the person had been assessed by a speech and language therapist and staff were following their guidance.” from the report
Food and drink choices
People were offered choices at mealtimes and had drinks available. Inspectors saw staff asking people what they wanted.
“Four different meals were prepared for lunch on the day of our inspection.” from the report
Personalised care
Care plans included people's preferences, life histories and communication needs. Inspectors saw care being delivered in line with the plans.
“Care plans were detailed and reflected people's preferences regarding whether they had a shower or a bath, a male or a female carer and what food and drink they preferred.” from the report
More activities
The home had increased activities and entertainment. People, relatives and staff noticed that people were more engaged.
“Every person, staff member and relative we spoke with said they had noticed a change in the service since more activities were introduced.” from the report
Management oversight
The provider and managers had a clear structure and understood the areas needing improvement. They consulted people and staff about changes.
“There was a clear management structure and good communication between the provider, registered manager and deputy manager.” from the report
Dignity and respect
seriousStaff did not always take a person-centred approach. Inspectors saw an interaction where a person was not offered a choice and were told that this did not matter.
“Staff culture and attitude towards delivery of care was sometimes task focussed and did not consistently treat people with dignity and respect.” from the report
Risk information was not handed over
seriousOne staff member had not been told about a change to thickened drinks. Inspectors said this could have put the person at risk.
“However, we noted that when we spoke with one staff member who had not been in work since thickened fluids were introduced this information had not been handed over to them.” from the report
Medicine records
needs fixingA medicine was out of stock on one person's record, although it had been stopped. Daily checks had not identified this, and the use of another pain medicine needed review.
“Medicine administration records (MAR) showed pain relief for one person was out of stock.” from the report
Wet room slip risk
needs fixingWater pooled on the ground floor wet room floor after use. The manager knew about the problem, but it had not yet been fixed.
“The ground floor wet room had water pooled on the floor after use.” from the report
Time with staff
minorAlthough there were enough staff to meet people's needs, people said they wanted more time with staff. Inspectors mainly saw staff completing care tasks or checks rather than spending time with people.
“We did not see care staff spending time with people other than to complete care tasks and check on people.” from the report
- 01How do you now make sure changes to people's risks, such as thickened drinks, are handed over to every staff member?
- 02What checks are now in place to keep medicine records accurate and to review medicines being taken regularly?
- 03What action has been taken to fix the wet room drainage and prevent water pooling on the floor?
- 04How do you check that staff treat people with dignity, offer choices and do not become focused only on tasks?
- 05What activities and support are now available for people who want to go out or spend more time in the community?
This was an unannounced, planned inspection based on the previous rating and covered all five CQC questions, including care and the premises. This explanation was written from the published report of 15 August 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.
Every inspection of Merchant House
2 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- December 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2019Requires improvementSafe: Requires improvementCaring: Requires improvementWell-led: Requires improvement
- April 2019
Registered with the Care Quality Commission on 24 April 2019.
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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9 live-in carers within about an hour of Plymouth
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