Meryton Place Care Home

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. This is the first assessment for this registered service. This key question has been rated 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.

People were encouraged and supported to raise concerns with the staff and management through resident meetings, feedback surveys and via an open-door policy. People and relatives told us they would speak to the manager if they had any concerns. Where concerns had been raised, people said they were satisfied with the response. Staff were able to raise any concerns and were confident it would be acted on by leaders. There was evidence of lessons learned from safety incidents or complaints, resulting in changes that improved care for people. For example, where a person had been administered an underdose of pain relief medication in error, the provider completed an internal investigation, addressed the error with staff members and provided refresher training for all staff involved in medicine administration.

The provider also commissioned independent mock inspections to assess service quality. Recommendations from these inspections were put in place, such as the introduction of a “lesson learned” tracker to identify trends and make improvements. Where concerns had been identified, the provider carried out investigations, and completed a lesson learned analysis, in order to adapt their practises to mitigate future risks.

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.

People told us they had received good support when moving into the service. One person told us, “Staff are very good, which made the transition [into the service] so much easier.” Staff told us they were assigned to support specific people, and the service had introduced designated roles such as a ‘Homemaker’ and ‘Homemaker Lead’. These roles were introduced with the aim to create a homely environment by focussing on the small, meaningful details of daily life that matter to the people who use the service. Staff also told us they received all the information about people before they arrived at the service, and they had the opportunity to review all the information and ask relevant questions. One partner told us, “Yes, they support transitions in partnership with patients and their relatives, and they do make appropriate referrals when required, for example, to the mental health team, dietician etc.” We saw evidence of a recent hospital admission where the service had provided the hospital with the person’s medical notes and a copy of the person’s wishes for resuscitation.

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. Overall, people told us they felt safe and if they had any concerns, they would raise them with the registered manager. One person told us, “Oh golly, yes, I am very safe here.” People appeared relaxed and at ease around staff.

Staff understood their responsibilities in safeguarding people from harm and abuse. They told us they had completed safeguarding training and knew where to access the safeguarding policy. Staff were clear on what to report and how to report it. One staff member told us, “I’d document everything the person has said at the time, as you don’t want to forget important information, and then consult the nurse in charge, clinical lead or the manager.”

Staff had also received training in safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). Care plans included relevant information to keep people safe. Daily record showed actions to safeguard people being taken, and a safeguarding policy was in place to guide staff practice.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

During the inspection we spoke with one person who was not using their walking frame and was instead using furniture to mobilise around their room. They told us they didn’t use their walking frame because, “I’m bent over, and I can only see the top of the frame or the floor. I have fallen and got up and got on with it. Sometimes I tell staff, but it’s difficult, they can’t be with me there are [other] people who need more help.” The person told us staff were “very good at getting me to use my frame and I know I should be using it.” When we raised this with the registered manager, they told us they had not been made aware of this issue previously. They acknowledged this posed an additional risk and said they would explore how best to manage this. Later during the inspection, the registered manager confirmed they had spoken with the person, and it was agreed a referral would be made to the service’s physiotherapist to see what support could be offered.

We also identified inconsistencies in the same person’s documentation regarding their history of falls. For example, the person’s dependency assessment and additional plan stated they had no history of falls, whilst their falls risk assessment recorded two falls in the last year. Although we identified no harm had come to the person when they had sustained their falls, the conflicting information in documentation meant there was a risk staff did not have accurate and up-to-date information to support the person safely. The registered manager confirmed they would review all documentation in relation to falls.

Additionally, we identified two people who had been assessed at being at high risk of falls who required hourly checks, as outlined in their care plan. However, a review of daily notes showed these checks were not consistently documented. We were unsure if this was a documentation error or if staff had not been checking on people in line with their care plan. We saw no harm had come to people during these periods where they had not been checked on. The registered manager told us, “There had been several previous unwitnessed falls in the service, but these had reduced since the beginning of the year. People were being checked on hourly unless they had capacity and chose not to be checked on. We have recently appointed a clinical staff member who would have oversight of falls and be the ‘falls champion’ for the service.”

However, people had care plans and risk assessments in place which had been set up with them, relatives and partners. People and relatives did not raise any concerns about the way risks were managed. The service regularly analysed falls data and had previously identified a specific time of day when falls were most likely to occur, leading to increased monitoring during that period.

Processes were also in place to support people on modified diets, and we identified people were being monitored with their fluid intake to prevent the risk of dehydration. Pressure wounds were being managed effectively in collaboration with internal clinical teams and district nurses.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People and their relatives told us they had access to the equipment they needed. People had access to call alarm bells and analysis of response times was being completed by the provider. The service had integrated lighting beneath people’s beds that activated when they placed their feet on the floor, so people could orientate themselves. Motion-activated lighting was also installed in bathrooms to enhance safety. Call alarm points were available throughout the building for use in emergencies.

Each floor of the building had a separate kitchen area for people and their relatives to use. Risk assessments had been completed for each kitchen, tailored to each person who resided on the floor. The service was in a good state of repair, with dementia-friendly signage in use and wide corridors for people to have ease of access.

Staff were confident on what to do in responding to an emergency and were familiar with people’s personal emergency evacuation plans (PEEPS). They were also able to describe how to use hoists and equipment in line with training they had received.

Regular safety checks were being completed and there was a business continuity plan in place. A fire inspection conducted by the local fire and rescue service in September 2024 identified minor recommendations, all of which had been actioned by the provider.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. People told us there were enough staff to meet their needs and were complimentary about the staff and the care they received. Staff told us they mainly supported four people per shift. Whilst most staff said they were not rushed and had sufficient time to carry out their duties, some noted that in the morning on the ground floor, it could feel a bit rushed when helping people get ready for the day. However, they felt there was adequate time throughout the rest of the day and night to meet people’s needs.

All required employments checks had been completed by the provider in line with their policy and legislation. A staffing dependency tool was in place to determine the appropriate staffing levels based on people's needs. On the day of our onsite visit, staffing levels appeared sufficient to meet people’s needs. Staff told us they received regular supervisions, attended team meetings, and participated in daily handovers and we saw evidence to support this.

However, some relatives expressed concerns that staff were not always proactive in encouraging people to participate in activities outside their rooms. The registered manager told us, “People’s wishes were respected, and if they don’t want to attend activities, this was their choice. Staff do provide encouragement to people, but we have to respect their preferences and would never push people into a situation where they’re uncomfortable. If after encouragement people still don’t want to participate in group activities, we will discuss with them about having a one-to-one activity in their room.” We saw evidence of one-to-one time being scheduled for individuals who chose not to participate in group activities during our onsite visit.

One person told us, “They vary the carers throughout the home, not everyone knows everyone. I’d prefer it if they stayed on one floor so that they all get to know [person] as they can’t communicate well.” The registered manager told us they moved staff around to ensure staff had a broad range of knowledge about people’s needs and this helped when there were staff shortages and cover needed to be arranged. They told us this offered better continuity of care for people.

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. Comments from people about the cleanliness of the service were positive. For example, people told us the home, “was very clean,” and “I live in a property that is clean and well looked after.”

People were assessed prior to admission the service to identify any infection risks. The resources available in the service supported good infection prevention and control (IPC) practices. For example, paper towels were located in each communal toilet and bathroom areas, and anti-bacterial soap was present throughout the service and in high-risk areas such as kitchens and laundry rooms. Hand sanitiser was located at the entrance of the home, and an electronic temperature check was available for visitors. When signing in via the electronic system, visitors’ temperature was automatically taken and monitored by the receptionist who was based in the lobby. The laundry area was visibly clean, including high areas. There was no build-up of laundry, and housekeeping staff told us people’s clothing was washed, dried and ironed, and returned to people’s wardrobes on the same day. People confirmed laundry was complete in a timely manner. A deep-cleaning schedule was in place, and we observed a room allocated for deep cleaning on the day of our onsite visit had been completed. We heard the person entering their room afterwards saying to the housekeeping staff, “Oh there is a lovely smell, thank you.”

Staff had received training in IPC and there was personal and protective equipment (PPE) available for staff to access. Regular IPC audits were taking place, and an action plan was in place to address any concerns.

However, we identified one instance where there was a strong smell of urine in a person’s room. This was reported to the registered manager, who responded to the concerns immediately. We were informed staff would assist the person, and the clinical team would carry out a dip test to check for signs of infection due to the person having a regular history of urinary tract infections (UTI’s).

The service did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

People’s wishes and preferences were respected in relation to administration of medicines. People received their medicines as prescribed. The environment for medicine storage, including Controlled Drugs (CDs) and fridge items, was adequate, with designated treatment rooms on each floor. Regular checks were carried out on CDs stock levels and documented. There was, however, one occasion where a CDs entry was missing a specified date, and this was fed back to the clinical lead who took immediate action to find out if the medicine had been administered

There was an overarching medicines policy which was comprehensive and up to date. This covered best practice principles of medicines administration in a care home setting. Training and competencies for staff were done on induction and annually.

There were processes in place to support the safe administration of medicines.

However, some PRN (as needed) protocols reviewed contained conflicting information regarding whether the documented maximum dose referred to a single administration or a 24-hour period. This was not clear for staff to follow. Clinical staff told us they would review all the PRN documents on file to ensure the information was clear for all staff.