Archived: Merseybank

When we inspected Merseybank in October 2013 we found concerns about the provider's systems for ensuring people's protection from the risks of acquiring a health associated infection and the cleanliness, hygiene of the home. We also found concerns about the provider's maintenance of the home. We served two warning notices on 29 October 2013 requiring the provider to be compliant with the relevant regulations by 30 November 2013 and 31 December 2013.

At this inspection we found that considerable improvements had been made by the provider in their systems and the cleanliness and hygiene in the home, which better ensured people's protection from any risks of acquiring a health care associated infection. We also found the provider had commenced a planned programme for the total upgrade and maintenance of the home.

However, we found the provider's improvements, which included a programme for the upgrade and maintenance of the home were not fully completed and did not include the laundry.

We were told that a pharmacist from the supplying pharmacy had visited the service for two weeks to check that medicines were stored and managed safely. The management team told us this had been very helpful. We looked at the medicine administration records for 17 people and how the service ordered and obtained medicines. At this inspection we found that prescribed medicines were available to give to people.

Although we found that the warning notice had been met with regard to medicine availability we still found some issues with medicine management in the service. In particular we found that when people were prescribed medicines to be given when required that there was a lack of specific instructions to explain when the medicines should be given. This was discussed with the management team who agreed that 'there have been improvements. It is not perfect but it is better'

We found that although there were improvements in order to manage the risks associated with the unsafe use and management of medicines we found that the service remained non-compliant with medicine management

Although assessments were completed about their needs, care planning was not ensuring people received safe, appropriate care. We observed people were not always receiving care that met their specific needs.

We found consent was sometimes obtained for people's care. If people were unable to make their own decisions correct procedures were not being used.

We saw systems for infection prevention and control were inadequate and the home was not sufficiently clean or well maintained to protect people from harm.

A pharmacist inspector from the CQC found that despite problems being identified in August and October 2013 appropriate arrangements were not in place to manage the risks associated with medicine management.

We found that some training was provided for staff at the home. Records we saw showed that a high percentage of staff had not received adequate training to enable them to meet people's needs. We also saw supervision was not provided for staff on a regular basis and nursing staff were not receiving adequate support to maintain and develop their clinical skills.

We saw incident reporting systems in place were not being used consistently or information analysed. Although audits had been completed in the past, quality and possible risks were not being assessed and monitored at the home.

People told us their needs were met at the home. They said, 'I get all the help I need', and, 'I like it here, it's so quiet and calm, which suits me'. A relative told us, 'They look after her and they let me know if she's not well'. We found that new documentation and systems had been introduced to ensure that care was delivered as planned to meet people's needs.

We saw that improvements had been made to mealtimes to ensure a more pleasant experience for people using the service. People's views about the meals provided had been sought and were being taken into account in planning new menus.

We found that changes to the environment and new equipment provided had improved the standards of hygiene in the home.

We found that improvements had been made to the systems for assessing and monitoring the quality of the service provided. People's views had been sought and had been considered in making changes to the home.

At our inspection in November 2012, we found that the provider had taken appropriate action. We saw that people's capacity to consent to specific elements of their care and treatment was assessed. Where people did not have the capacity to consent, there was a record of how decisions were made in their best interests. We found that nearly all staff had received training and guidance about the Mental Capacity Act 2005.

We found that people's rights were not being upheld because the provider did not have suitable arrangements in place for obtaining their consent to care or treatment.

We found that people's needs were assessed and care was planned to meet their needs. However, we found that the delivery of care did not always meet the person's individual needs or ensure their welfare.

Most people told us they enjoyed the meals. We found that people were provided with suitable food and appropriate support from staff to meet their nutritional needs. However, we found that people did not always have the support required to ensure they had sufficient fluids.

We found that the system for assessing and monitoring the quality of the service provided did not include regularly asking for the views of people using the service, or their representatives. We found that risks to people using the service were identified. However, the risks were not always managed to ensure their safety and welfare.