Merryfields

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents and incidents were recorded appropriately. Records showed managers reviewed incidents and took action to reduce the risk of recurrence, and communicated any lessons learnt to the staff team.

Actions plans were in place showing that the provider was taking appropriate actions and was aware of any concerns or improvements needed in the service.

People using the service said they would raise concerns confidently, knowing that action would be taken to prevent reoccurrence. A person said, “There have been concerns around people in our rooms and now I have my own key to my room.’

We reviewed staff training records where we saw that all staff had received induction training and had support while they got to know their role.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Before people moved into the service, a needs assessment was completed with the involvement of the person and their representatives. This helped to ensure the service could meet their needs and provide person-centred care.

Information gathered during assessments was used to develop care plans and risk assessments.

People were given opportunities to visit the service before moving in. This supported a gradual transition and informed choice.

A relative said, “[Person] started coming here for day visits to begin with.” Another said, ‘[Registered manager] came and saw [family member] in hospital, to make sure they were suitable for here.'

Staff worked proactively with a range of external health and social care professionals to help people achieve positive outcomes.

The electronic care planning system allowed staff to print a summary of people's care and support needs to share with other professionals when required, such as during a hospital admission.

‘This is me’ documents were available to people living with dementia. These provided important information about the person's history, preferences, communication needs and routines. This promoted continuity of care for people when away from the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received training in safeguarding and understood their role and responsibilities in identifying and reporting concerns of abuse. Information was on display in the service relating to the provider’s safeguarding procedures. As well as safeguarding policy and procedure, there was a whistleblowing procedure in place.

Staff said they felt comfortable and understood how and who to report to should they need to raise a concern.

The service was working in line with the Mental Capacity Act 2005 (MCA) and, where people lacked the capacity to consent, Deprivation of Liberty Safeguards (DoLS) were applied for and these were kept under review to ensure any restrictions on a person’s liberty were lawful. Staff had received training in MCA and DoLS.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The registered manager described supporting people through positive risk-taking approaches. One example involved reviewing previous assumptions regarding a person's alcohol use and behaviour and working with them to develop agreed monitoring arrangements that respected their wishes while managing known risks. Staff told us this enabled the person to remain engaged in activities and participate meaningfully in the life of the home.

Risks to people were assessed and measures put in place to reduce them. These included risks associated with falls, pressure injury, nutrition and hydration. Where people were at risk of falls, equipment was put in place to help reduce risk, including crash mats beside beds and pressure sensor mats, which alerted staff if a person was attempting to mobilise independently.

Staff received training in moving and handling, and we observed staff supporting people to change position safely.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We identified a risk relating to access to a staircase and some environmental concerns, including accessible razors and creams in people’s rooms, as well as some water damage. Appropriate equipment, such as lockable cabinets were in place but not being used. The registered manager responded promptly reviewing each concern and acted based on people's individual needs and preferences. This supported people's safety whilst promoting independence and choice.

Checks were undertaken in the environment to reduce risks to people, this included fire safety, electrical safety, portable electrical appliance checks, and window restrictor checks. Fire drills were undertaken to ensure staff understood their responsibilities in case of a fire. Emergency contacts were available in their emergency folder.

Mobility equipment was checked and items such as hoists and the lift were serviced as required.

Risks were monitored and addressed by the management team and the maintenance staff. We were informed that a bathroom was being renovated. There were sufficient bathrooms and shower rooms available during that time.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider used a dependency tool to help calculate the numbers of staff needed. Staffing levels were also regularly monitored and discussed through team meetingsand the provider told us they continued to review and adapt were needed.

Staff were recruited safely. Staff received training relevant to their roles and receive regular one to one supervision meetings which provided opportunities to receive feedback, discuss any concerns and identify any training needs.

A person using the service said,"Staff being here a long time is good, makes me reassured.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service was visibly clean. However, we found rust on a shower and a jug that looked visibly dirty in the first-floor bathroom. The provider addressed this immediately, providing the relevant fixes and replacements.

We spoke to domestic staff and reviewed cleaning schedules. Cleaning schedules demonstrated the service was routinely cleaned throughout. Guidance was in place for staff responsible for cleaning, including colour coded equipment to reduce the risks of cross contamination. Staff had signed records to show when cleaning had taken place.

Mattresses, pillows and bedding were routinely checked and laundered or replaced when needed. Mop heads and toilet brushes were cleaned and replaced regularly. Checks and actions such and descaling and running water from little used outlets, were undertaken by both housekeeping and the owner to reduce the risks of legionella bacteria in the water system.

Personal protective equipment (PPE) was available for staff, and this was used appropriately, including gloves and aprons.

The registered manager informed us that all domestic staff had completed the British Cleaning Level 5 Diploma.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preference. Staff did involve people in planning, including when changes happen.

We noted that creams were not always being signed for, to show staff were supporting people with their application. Open dates were not always clearly written on packaging and medicated creams were found in people’s rooms not stored securely. The provider took immediate action, while also finding safe ways for people who wished to administer their own creams if they chose to.

Guidance was shared with staff regarding the importance of ensuring creams were stored safety and signed for after application. We were assured actions were taken to mitigate risks going forward.

Medicine trollies were securely stored, and systems were in place for ordering and disposing of medicines safely. We highlighted that medicine administration record (MAR) chart coding was not always consistent. The registered manager told us they aware of this and were due to introduce a new system. Records showed people received their medicines when they needed them. Monitoring systems including audits supported the management team to identify any discrepancies and take action to keep people safe.

Staff responsible for supporting people with their medicines were trained and their competency assessed. Risk assessments relating to people’s medicines were in place, including protocols for medicines prescribed to be administered as required (PRN).

People told us they were satisfied with how they were supported with their medicines.