All inspections: Meyrick Rise - Care Quality Commission

This unannounced comprehensive inspection took place on 7 and 8 January 2016. At the last comprehensive inspection completed in January 2015 we found the provider had breached three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches regarded a repeated breach of people’s care records not being accurate, insufficient levels of staff and ineffective quality assuarance systems. At that inspection we served a warning notice on the provider for the repeated breach regarding people’s care records. We requested an action plan from the provider stating what they would do to meet the legal requirements in relation to each breach.

We undertook an unnannounced focussed inspection in June 2015 to check the provider had followed their action plan and to confirm that they now met legal requirements. At that inspection we found the provider had taken appropriate action and were compliant with the legal requirements.

At this unannounced comprehensive inspection we found the provider was compliant with the regulations.

Meyrick Rise is a care home comprising three floors providing accommodation, care and support for up to 74 older people. At the time of the inspection there were 29 people living at the home.

There was a manager employed at the home who was in the process of becoming registered with the Care Quality Commission. 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 their prescribed medicine when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. However, some minor shortfalls were found in the records relating to medicines.

During our inspection visit the home had a calm and friendly atmosphere with a selection of activities for people to join in with if they wished. There was a selection of quieter areas available for people to sit in which meant people had the opportunity to relax in a calm and homely area.

The premises had recently received a complete re-furbishment which provided a very good standard of decoration, equipment and soft furnishings throughout the home. The premises had clear signage displayed to help people navigate around the premises.

People and their relatives spoke very positively about the recent changes in both the décor and the management team. People told us they were very satisfied with the level of care and support they received and told us they fully enjoyed all aspects of living at Meyrick Rise. People told us they felt safe at the home. One person said, “I’m so happy living here, I have never been happier”.

Staff had a good understanding of how to keep people safe and free from harm. They spoke knowledgeably about how to prevent, identify and report abuse and the provider had systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

People’s needs were assessed including areas of risk, and reviewed regularly to ensure people were kept safe. People were cared for with respect and dignity and their privacy was protected.

People told us there were enough staff available to help them when they needed support and they were supported promptly by staff who were friendly and caring. Relatives told us they were always made to feel welcome when visiting the home and said their relatives were safe, well cared for and comfortable.

There was a robust recruitment and selection procedure in place to ensure people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Staff spoke positively regarding the induction and training they received and commented they had felt well supported throughout their induction period. Staff told us they now really enjoyed working at Meyrick Rise and found the support given by the new management team to be, “Excellent”.

Staff spoke knowledgeably about their roles and responsibilities and demonstrated interest in giving people the best possible care and support to meet their needs. Staff demonstrated a good understanding of how people liked to have their care needs met.

Supervisions and appraisals were regularly completed with staff. Records showed these gave staff the opportunity to comment on their performance and request further training and development opportunities if they wished. The provider had recently introduced some staff incentive schemes to reward and encourage staff to attain their full potential.

Equipment such as hoists, mobility aids, pressure relieving mattresses and cushions were readily available, clean and well maintained.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

People were supported and provided with a choice of healthy food and drink ensuring their nutritional needs were met. Menus took into account people’s dietary needs and people told us they really enjoyed the food and could ask for different choices if they did not like what was on the menu. We observed meal times were a pleasant and social experience for people and the dining area was attractively laid out with place settings, table decorations and staff available to ensure people received the assistance they needed.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. There was a clear system in place for people to raise concerns and complaints.

There was a schedule of daily activities for people to participate in if they wished. The provider ran a mini bus three times a week to places of interest that people had asked to visit, such as Poole Pottery, garden centres and local parks.

People told us they felt the service was now very well led, with a clear management structure in place with a visible, approachable management team that listened to them and the staff. People told us the management team were, “Fantastic”

There were systems in place to monitor and drive continuous improvement in the quality of the service provided.

We carried out an unannounced comprehensive inspection of this service on 28 and 29 January 2015. At that inspection, we found a repeated breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, now Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not accurate records which included the appropriate information in relation to the care and treatment provided to people living at the service. We served a warning notice on the provider for this breach and requested an action plan from them stating what they would do to meet the legal requirements in relation to the breach.

The provider wrote to us and told us what action they would take in order to become compliant in respect of their record keeping. The provider told us the corrective action would be completed by 9 June 2015.

At the comprehensive inspection completed on the 28 and 29 January 2015 we found there were not sufficient numbers of staff employed with the right knowledge, experience, qualifications and skills to support people. Following the inspection the provider wrote to us and told us what action they would take in order to become compliant in respect of their staffing levels. The provider told us the corrective action would be completed by 30 April 2015.

We undertook an unannounced focussed inspection on 17 and 19 June 2015 to check that the provider had followed their plan and to confirm that they now met legal requirements. We found that the provider had taken appropriate action and had complied with the warning notice and that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Meyrick Rise’ on our website at www.cqc.org.uk.

Meyrick Rise provides accommodation, nursing care and support for up to 74 older people, many of whom have complex nursing needs. At the time of the inspection 24 people were living at the home. The home had an acting 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’s personal records were up to date, regularly reviewed and included accurate, consistent information.

Clear recording systems had been implemented to ensure people’s records were completed in a person centred way and recorded accurate information regarding their health and care needs.

The provider had recruited a number of staff across a range of levels to ensure the service ran with the required levels of staff. Recruitment was on-going and a new registered manager, deputy manager and two registered nurses had been recruited and were due to commence employment with the provider shortly.

The provider had recruited two designated activity co-ordinators to ensure people had the choice to engage in meaningful and interesting activities each day.

This was an unannounced comprehensive inspection carried out on 28 and 29 January 2015. Our previous inspection of the home on 30 April and 1 May 2014 found a breach of regulations relating to the care and welfare of people who use services, management of medicines and the maintenance of records.

We required that the provider send us an action plan by 30 August 2014 detailing the improvements they would make to keep people safe. We received the action plan and reviewed the actions the provider had undertaken as part of this comprehensive inspection. We found that although improvements had been made to meet the management of medicines, improvements were still needed relating to the care and welfare of people who use services and the maintenance of records.

People’s records were not always completed consistently. Some records gave conflicting advice which would prove confusing for staff and could result in people’s needs not being met correctly. We found the provider needed to make improvements in this area. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection, we found a repeated breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17(2)(d) of the Health and Social Care Act 2008 ( Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that quality assurance systems were not effective, as action had not been taken to assess and monitor the quality of record keeping. This is a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2005 ( Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

The Riseborough Care Home provides accommodation, nursing care and support for up to 74 older people, many of whom have complex nursing needs. At the time of the inspection 29 people were living at the home. The home had 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.’

Although the majority of people told us they felt safe living in the home, everyone said they felt there were not enough staff and they often had to wait for support and assistance.

There were not always enough appropriately trained staff available on each shift to ensure people were cared for safely. The registered manager told us they were in the process of recruiting staff and were one staff member short on each shift. They told us where possible they were using bank staff to ensure there were enough staff on shift but sometimes due to staff sickness they were running shifts with less than the desired number of staff. Staff told us they did not have enough time or support to do their job effectively. We observed staff delivered support and assistance in a gentle and friendly manner but did not have time to spend any quality time with people.

These shortfalls in staffing levels were a breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not consistently given access to social activities. The registered manager told us the activity co-ordinator had left the home and they were in the process of recruiting two further activity members of staff. People told us they had nothing to do and had not had any outings for months. We observed people were left in the lounge area for most of the day watching television or sleeping. Many people spent the majority of their day sat in their own bedrooms, relatives told us “There’s really never anything for them to do”.

The provider had a system in place to ensure staff received their required training courses. Staff were knowledgeable about their role and told us they received training but the training was largely on line training. They said they did not feel this was effective and felt they would benefit from more practical face to face training. Staff told us they were not well supported by the registered manager. They said they could approach the registered manager but felt they were often ignored and their views not taken seriously. Staff told us they felt very frustrated and stated that was the reason why so many staff were leaving the home. They stated the home had a demoralised atmosphere causing a culture of frustration and despondency.

People’s needs were assessed and care plans were person centred and outlined the support and care people needed to ensure their individual care needs were met. Medicines were managed safely and stored securely. People received their medicines as prescribed by their GP.

The provider had a system in place to ensure staff understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). The DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in nursing and care homes are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a nursing or care home only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them.

The provider had processes in place to safeguard people from different forms of abuse, however their safeguarding policy was dated 2006, and referred to an organisation that ceased to exist during 2010 and did not include current contact details for local authorities should people wish to raise concerns. Staff had completed training in safeguarding people and were knowledgeable about the provider’s whistleblowing policy. Staff told us they knew the correct process for raising concerns if they should observe any form of abuse.

There was a range of systems in place to protect people from risks to their safety. These included risk assessments for health issues such as, skin integrity, manual handling and falls as well as risk assessments for premises and maintenance issues, for example for equipment such as hoists, stair lifts and all electrical equipment.

The Riseborough Care Home is a nursing care home for up to 74 older people. At the time of the inspection there were 26 people living at the home. This was because the local authority had not been placing people at the home because of previous concerns. The local authority had revisited the home in February 2014 and they told us The Riseborough Care Home had met the shortfalls they had previously identified at their contract monitoring visits.

There was not a registered manager at the home although the manager had applied to be registered. There was a management structure in the home which gave clear lines of responsibility and accountability. There was always a trained nurse on duty which helped ensure people’s medical needs were met. People had access to healthcare professionals according to their individual needs. People we spoke with said staff were kind and polite. We observed that staff assisted people with their care in an unhurried manner. Overall, people and relatives spoke highly of the qualities of staff.

People’s needs were assessed and care plans were developed which outlined their needs and the support required to meet those needs. The risks to people had been assessed and planned for. However, we found that some care plans did not include all of the care that people needed. Some people did not receive the care they had been assessed as needing. People who needed two staff to support them told us they experienced delays in receiving care. We found the home needed to make improvements in this area. You can see what action we told the provider to take at the back of the full version of the report.

People received care that met their physical needs although we found there was limited support in place to meet people’s emotional and social needs. There was some information about individual’s likes and interests but there was limited social stimulation for people.

Records regarding whether people had received the care, treatment and support they needed were incomplete. This meant staff could not be sure that people had received the care they needed. We found the home needed to make improvements in this area. You can see what action we told the provider to take at the back of the full version of the report.

There were systems in place to manage medicines and staff had been trained to safely give people their medicines. However, some medicines and creams had run out of stock and this meant people did not receive their medicine as prescribed. We found the home needed to make improvements in this area. You can see what action we told the provider to take at the back of the full version of the report.

There were enough staff to meet to most people’s needs during the inspection and the provider had recently assessed the staffing levels. However, people told us they thought there needed to be more staff at night. The provider agreed to follow this up with people at the home.

Most people spent time in their bedrooms and did not routinely have access to social activities or occupation. There was a newly appointed activities worker who was introducing group and one to one activities. However, they had not been able to provide activities to all of the people living at the home who stayed in their bedrooms.

People’s end of life wishes were sensitively sought and plans were in place to meet these wishes. People’s wishes were regularly reviewed and updated if they changed their mind. However, one person receiving end of life care did not consistently receive the treatment they were prescribed to alleviate their symptoms.

We found the service was meeting the requirements of the Deprivation of Liberty Safeguards. There were systems in place to protect most people’s rights under the Mental Capacity Act 2005. However, one person’s rights were not fully protected because a decision to administer medicines covertly had been made when they had the capacity to make this decision themselves.

In May 2013 we carried out a scheduled inspection and made compliance actions related to staff recruitment: deployment of staff; assessing and monitoring the quality of service provision; notification of other incidents and records keeping. Following this inspection the provider wrote to us to tell us the action they would take.

In August 2013 we received information of concern and carried out a responsive inspection. Following this inspection we served a warning notice which had a timescale to achieve compliance by 18 October 2013.

We carried out this unannounced inspection to check whether compliance had been achieved in all these areas.

We looked at people's care plans and when possible spoke with them. We also spoke with visitors and members of staff.

We found that all compliance actions had been achieved and the warning notice complied with. People's care needs were being met and there were details in their care plans on how support should be given according to their assessed needs. Improvements had been made in record keeping and there was an action plan in place to ensure this continued.

There were adequate numbers of staff available to support people. Staff had been recruited in a safe manner, with all necessary checks being carried out prior to their employment.

The provider had suitable quality monitoring systems in place which ensured people's views were listened to an acted upon and their health safety and welfare maintained.

We carried out this unannounced inspection in response to safeguarding concerns raised with the local authority. We looked at three care plans in depth and spoke with the people who the plans were about. We also sampled one other plan.

Also present during our visit were representatives from the safeguarding team and the community health team. The safeguarding team reviewed seven care plans and the health team reviewed two. Both teams shared their findings with us.

We found that people were not protected against the risk of unsafe or inappropriate care. We found that people did not experience care, treatment and support that met their needs.

This was because they did not receive the care and medical treatment that they needed. They did not receive sufficient fluids to keep them hydrated and when people lost weight appropriate action had not always been taken. People were not consistently offered a shower as detailed in their plan of care and pain relief was not given as needed to control individual's pain or other symptoms.

Advice had not been sought from other health professionals when a person's condition did not improve or when issues were identified which differed from their plan of care.

People's needs were assessed and a care plan developed from this assessment. People we spoke with considered that their care needs were met. People were able to participate in a range of activities. There was a choice of food and special diets could be catered for.

Risks associated with their care and welfare had been identified and minimised when possible.

Infection control procedures within the home protected people from the risk of harm. One person told us that the home was always clean and tidy.

Recruitment procedures carried out by the home were not always consistent and improvement was needed to ensure all checks were carried out prior to a new employee starting work.

Staff benefitted from ongoing training and the opportunity to gain qualifications in health and social care.

Staffing levels had not been based on people's needs and there were variations in the number of staff deployed in the home to meet people's needs.

The provider had quality assurance systems in place, but did not fully take account of comments received about the service provision.

The provider had failed to ensure records were accurate and up to date and had not notified the Commission of significant events that had occurred in the home.

We inspected The Riseborough Care Home in June 2012 and September 2012. We made compliance actions related to respecting people's privacy and dignity, care planning, staffing levels, mealtimes and record keeping.

On 29 November 2012 we visited to check whether compliance had been achieved. During our visit we spoke with four people, one relative and three members of staff and the manager. We looked at the care records of three of the four people we spoke with. We observed interactions using our Short Observations Framework Interventions (SOFI) during the lunchtime meal.

People's privacy and dignity was respected and they had been involved in care planning, with their relatives or representatives. Staff were seen addressing people politely. Individuals were offered a choice of meal and activities to participate in.

Staffing levels had been increased in the home and people's needs were met at a pace suitable to them.

Mealtimes had improved since the introduction of a waiter service, this meant staff could focus on meeting people's needs.

Care plans had been audited regularly and updates had been made.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time There was a peripatetic manager in post and a new permanent manager is due to start work in January 2013.

People said they were looked after and staff were 'kind'. We saw that care plans had been drawn up from an assessment of need and the person had been involved in this process.

People were able to choose how they spent their time and their decisions were respected.

People's health needs had been met and there was involvement from other health professionals, such as the GP and district nurse if needed.

Daily records evidenced care given and care plans had been reviewed regularly and updated if required.

The duty rota indicated that there were adequate numbers of staff available to meet people's needs. However, people who lived in the home and their relatives considered that there was insufficient time allocated to meet people's needs. People said they felt 'rushed'. Staff said that care was task focused rather than person focused.

We inspected the Riseborough unannounced and made two visits on 19 and 22 June 2012.

We were able to speak with five people that lived in the home and three staff members that worked there.

People considered that generally they were able to make decisions and their choices were respected. However, one person raised concerns about their hot drink not being brought to them. Another person was unaware of what was contained within their care plan and said that their decisions about how to manage their health needs had not been respected.

People were supported at lunchtime to eat and drink, but the meal service was task focused.

People were protected from harm by safeguarding protocols at the home. Staff were aware of how to report abuse and actions required when an alert had been made were followed.

Medicines were handled and administered safely and staff were aware of the correct procedures for disposal of unwanted medicines.

There were suitable numbers of staff who had been recruited safely, available to assist people. However, at times people were left unsupervised and did not receive attention quickly when they needed it.

Records related to the running of the service were kept securely and locked away when not in use. However, the content of care plans did not fully evidence how people's needs would be met and in what way.

On 2 August 2011 following an inspection of The Riseborough, we issued a Warning Notice as a result of identifying serious failings of the home to look after the care and welfare needs of one person who was being cared for in bed. The purpose of this inspection carried out on 30 August and 6 September 2011 was to follow up on the compliance with the Warning Notice and compliance and improvement actions made at previous inspections.

We case tracked the needs of four people being cared for in bed and visited them in their bedroom. We were able to speak with two of these people and with one of their relatives about the care they received.

We were told staff were meeting their needs and that they were satisfied with the service they received. One person told us that they were concerned about the frequent changes in staff.

We also spoke with five members of the staff team, as well as the manager. Staff told us that staffing levels in the nursing side of the home were sufficient to meet the needs of people, but that staffing levels did not enable staff to meet people's need within the residential care part of the home.

We carried out this inspection on 9 December between 9am and 12:15pm. The purpose of the visit was to check whether the home had achieved compliance with a Warning Notice issued to the home in August 2011 and compliance actions made at a further inspection of the home in October 2011.

During the inspection we spoke with five people living at the home, three members of staff as well as the manager of the home.

We were told by people living at the home that their care and treatment was managed appropriately at the home. No one told us of any concerns about the way their care was managed with people telling us that there were enough staff on duty each day, call bells being answered in a reasonable period of time and the staff team being kind and caring.

The staff we spoke with told us that systems in the home had been improved and there were clearer expectations as to their role in meeting people's needs.

We carried out this review of The Riseborough because we received serious concerns

through safeguarding of vulnerable adults procedures about the care of one particular

person. When we visited the home, we focused on the management of this person's care

and we also spoke with them.

They told us that generally they were happy with the service that they received and found

the staff kind and courteous. We were told that the food was okay and that the home had

respected their wishes for how their food was served. We were told that generally, call

bells were answered in a reasonable time.

During the visit we spoke with as many people living at the home as possible and also with some visiting relatives. We were told that generally, people were treated with respect and dignity and involved in planning their care. In circumstances where they were not able to do so, relatives would be involved. We were told that medical needs were acted upon with GP visits arranged when appropriate. We were told that medication was managed through trained members of staff. There were differing views concerning adequacy of staffing levels with some people feeling there could be more staff on duty. In general people felt their needs were being met. We were told that the home provided a good standard of food and that good standards were maintained in the home.

Archived: Meyrick Rise

All Inspections

7 and 8 January 2016

During a routine inspection

17 and 19 June 2015

During an inspection looking at part of the service

28 and 29 January 2015

During a routine inspection

30 April and 1 May 2014

During a routine inspection

4 November 2013

During an inspection looking at part of the service

14 August 2013

During an inspection in response to concerns

20, 23 May 2013

During an inspection in response to concerns

29 November 2012

During an inspection looking at part of the service

5 September 2012

During an inspection looking at part of the service

22 June 2012

During a routine inspection

30 August 2011

During an inspection looking at part of the service

6 February 2012

During an inspection looking at part of the service

2 June 2011

During an inspection in response to concerns

1 February 2011

During a routine inspection