Merryfields

Merryfields is a residential care home providing personal care to 18 older people at the time of the inspection, some of these people were living with dementia. The service can support up to 20 people in one adapted building.

People’s experience of using this service and what we found

Risks were assessed relating to pressure ulcers developing or deteriorating, falls and nutrition. Systems were in place to mitigate the risks and guide staff on how risks were reduced.

The service was clean and hygienic. There were policies, procedures and risk assessments in place which provided guidance for staff in good infection control processes and how the risks associated with COVID-19 were reduced. Staff had received training in these areas, including how to don and doff personal protective equipment (PPE). Staff were following good infection prevention and control practices which helped to minimise risks to people. There was PPE available around the service for staff to use, and we observed staff were wearing PPE appropriately.

The service had developed an area in the service where people could have visitors. This was designed to mitigate any risks of cross contamination. In addition, to further reduce the risks of isolation, there was a programme of activities available to people to participate in.

Questionnaires had been provided to relatives and staff relating to how they felt the service was keeping them updated and keeping people safe.

The home was currently COVID-19 free. The registered manager and provider had considered zoning and cohorting, should this be required.

There was a routine of testing both people using the service and staff, in line with government guidance. The registered manager understood their responsibilities if any test results were positive for COVID-19. This ensured action could be taken promptly to reduce the risk of exposure of the virus.

The registered manager had a system to check that staff were not working in other care settings to reduce the risks of the spread of infection.

There were systems to reduce the risks of exposure to COVID-19 from individuals entering the service. This included the staff, who were required to wash hands, change and put on PPE. Visitors to the home had their temperature checked, wore PPE, washed hands and the completion of a questionnaire.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 April 2018).

Why we inspected

The targeted inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained injury. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risks associated with pressure ulcers. This inspection examined those risks. We found no evidence during this inspection that other people living in the service were at risk of harm from this concern. Please see the Safe key question of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merryfields on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection of 21 March 2016, the service was rated Good. At this inspection, we found the evidence continued to support the rating of Good. There was no information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. 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 service continued to provide a safe service to people. This included systems designed to protect people from abuse and avoidable harm. Staff were available when people needed assistance. The recruitment of staff was done safely. The service was clean and hygienic. People received their medicines safely.

The service continued to provide an effective service to people. People were cared for by staff who were trained and supported to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People received care and support to maintain a healthy diet and good health. People were supported to access health professionals where needed. The environment was suitable for the people living there.

The service continued to provide a caring service to people. People had good relationships with the staff. Staff interacted with people in a caring manner. People were consulted about the care and support that they received.

The service continued to provide a responsive service to people. People received care and support which was assessed, planned and delivered to meet their individual needs. People were supported to participate in meaningful activities that interested them. A complaints procedure was in place. There were systems in place to support people at the end of their life.

The service continued to provide a well-led service to people. The service had a quality assurance system to monitor and assess the service provided to people. These systems assisted the registered manager and provide to identify and address shortfalls promptly. As a result, the quality of the service continued to improve.

Further information is in the detailed findings below.

There was a registered manager in post. 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.

People received care that was personalised to them and met their needs and wishes. Staff listened to people and acted on what they said. The atmosphere in the service was vibrant and welcoming.

Feedback from people and relatives about the staff and management team was positive.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care. Procedures and processes guided staff on how to ensure the safety of the people who used the service.

People were provided with their medicines when they needed them and in a safe manner.

There were sufficient numbers of staff to meet people’s needs. Recruitment processes checked the suitability of staff to work in the service. People were treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

Staff were trained and supported to meet the needs of the people who used the service. The service was up to date with the Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and met. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People were provided with personalised care and support which was planned to meet their individual needs. People, or their representatives, were involved in making decisions about their care and support.

A complaints procedure was in place. People’s comments, concerns and complaints were listened to and addressed in a timely manner.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system where shortfalls could be identified and addressed promptly. As a result the quality of the service continued to improve.

We looked at some of the records held in the service including the care files for 10 of the 20 people who used the service. We observed the care and support people who used the service received from staff and carried out a tour of the building.

The summary below describes what people using the service, a relative and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found people's needs had been assessed and individual care plans drawn up to meet people's needs. These assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe.

The provider had arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

We found that people were protected from the risk of abuse because the provider had ensured that safeguarding policies and procedures were in place and available to staff. Staff had been trained in safeguarding and knew what to do in the event of abuse being suspected, witnessed or alleged.

People we spoke with told us there were enough staff to meet their needs. We found there were enough staff on duty to meet the needs of the people living at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

We saw people being cared for and supported in accordance with their plans. Staff had received training to meet the needs of the people living at the home. A relative we spoke with told us, 'Staff work closely with health professionals'.

We found the provider assessed people's capacity to make choices and decisions and ensured peoples' best interests were taken into account.

Is the service caring?

We found people were supported by kind and attentive staff. We saw staff talking with people with kindness and in a respectful manner. We observed staff supporting people to move about the home in accordance with their needs showing patience and consideration.

Staff we spoke with were knowledgeable about the individual needs of people. Staff told us they felt it was important for people to be cared for with kindness. One staff member said, 'I think this is a good home, we try to give residents the best care possible'.

People we spoke with told us, "The staff are nice" and, "Staff are very helpful, in the main'. A relative told us they were happy with the way their relative was cared for and supported.

Is the service responsive?

We found people's needs had been assessed before they moved into the home. We found that each person's needs were regularly reviewed with care plans updated if needed. Records showed that people were supported in line with these plans.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We found that quality assurance processes were in place. People's views had been obtained by the provider along with the views of relatives and staff. The provider made changes to improve the service people received as a result of people's views.

We found that staff received training and the provider was able to produce evidence that most of the staff held vocational qualifications relevant to their role.

Staff told us they were clear about their roles and responsibilities. Staff told us they found the manager of the home to be approachable and supportive.

The manager told us the home had achieved the Gold Standard Framework for end of life care. Staff members we spoke with told us they felt working towards this award had helped them improve the quality of care and support provided to people.

Care plans were up to date and regularly reviewed to ensure that people were given the treatment and care they needed. Risk assessments were made on relevant areas to protect the safety and welfare of people. Staff recruitment and retention policies and practices were in place and records were well maintained. Training was comprehensive; and met the needs of the service and the staff.

The provider used a comprehensive system of audits to ensure that standards were maintained. Regular surveys of people who used the service helped to identify areas for improvement, most survey respondents were full of praise for the service.