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

This service scored 62 (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 and relatives knew how to raise any concerns and felt confident to discuss issues with staff. Their comments included, “I have had no complaints. If I had one, I would go the person in charge and discuss it with them”, and “I have not had to [make a complaint]. I would know what to do if I had one.”

The provider had a process for investigating and identifying actions for improvement when concerns were raised. The deputy manager told us following an incident, accident, safeguarding or complaint they spoke with any staff involved. Actions identified following the investigation were discussed with staff during supervision, team and handover meetings. Comments from staff included, “When management is investigating, they come to the person who witnessed [the incident] to make sure they understand the circumstances” and “We discuss any incidents in team meetings. If it is thought that different equipment would make a difference, then we make sure we apply for that.”

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’s care and support needs were assessed before moving in to ensure the home could meet their needs. Staff visited the person to complete a preadmission assessment to identify the person’s support needs. The information was then reviewed by a team leader to develop the care plan. The person was offered the choice to transfer to the GP practice that visited their home, which would enable staff to access the person’s patient summary and medical records more easily. If the person preferred to remain with their existing GP, staff worked with that GP to ensure access to relevant medical information and to support regular GP visits.

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.

People and relatives told us care was provided in a safe way comments that included, “There is no harm here. I have never experienced anything like that. I do feel safe here”, and “We feel that 100% [family member] is safely cared for and that [they are] cared for in a gentle and kind way.” Staff completed training in relation to safeguarding adults. Staff were able to demonstrate that they understood what abuse was and how to report it. Staff said, “I can raise concerns at any time, either in writing or going direct to the registered manager. I am also very aware of how to whistle blow.”, and “I have done all of my safeguarding training which has given me confidence.” The provider had a process for the reporting and investigating any concerns about the care provided. Staff completed a list of safeguarding concerns, who they involved and what they related to so any trends could be monitored. Safeguarding records included information on the investigations and any actions which were identified.

The provider had undertaken assessments of risks in relation to people’s health and wellbeing. People’s care plans identified the medical conditions they were living with. However, staff were not always provided with guidance on how to identify any concerns in relation to people’s health and the support required with their specific conditions. This meant staff were not always given information to understand the impact of the medical condition on the care and how to provide appropriate support for the person. This was discussed with the registered manager who confirmed they would work with their clinical team to develop risk management plans for people’s medical conditions. The provider had undertaken additional risk assessments and developed risk management plans for staff. These included moving and handling, choking risk, skin care and pressure sore assessment. Staff undertook training in relation to health and safety, falls awareness and how to support people with their mobility.

The provider had procedures to ensure the care environment was safe, but they did not always follow best practice in providing an environment to support people with dementia.For example, the walls and ceiling of corridors were painted the same colour which made the area feel like they were very long. Bedroom doors had numbers and people’s names on the but were all the same so could make it difficult for a person to locate their bedroom. These issues could impact a person in relation to finding their way and locating where they were within the home and their independence. Lounge areas were laid out with chairs around the sides of the room which does not promote people to interact with each other. The dining rooms were not fully arranged in a way that encouraged people, who chose to eat there, to enjoy meals as a communal experience. Lounges had a television but did not always have items which people could access for activities they could undertake on their own. This was discussed with the registered manager following the assessment visit and they confirmed actions to reflect best practice in relation to dementia friendly environment would be identified and implemented.

People had their own bedrooms and access to lounge areas. Regular maintenance checks were carried out which included reviews of electrical equipment, water quality, mobility equipment, fire safety system and bed rails. A staff member told us, “Fire alarms are tested every 2 weeks, drills happen regularly, and I have been on several this year. We are trained on how to use the evacuation seat.”

The provider did not always deploy sufficient staff to meet people’s needs. For example, we observed staff on 1 floor who were responsible for administering medicines were also required to prepare breakfast and provide general support in the dining area. This meant staff were not always able to focus on the safe administration of medicines, which increased the risk of medicines errors. This also limited their ability to respond to people’s requests for support in a timely manner.

We observed occasions where people did not receive appropriate support because staff were busy supporting others. For example, one person had been assisted by night staff with personal care, dressed, and given breakfast, but was then returned to bed fully dressed. This was not the person’s choice. The person asked us on two occasions within one hour if we could arrange breakfast for them. Staff told us the person had already been given breakfast; however, there were no staff available at the time to check whether the person required further support.

We also observed another person repeatedly requesting assistance to use the bathroom, but staff were not available as they were supporting other people. The nurse told us there were no staff members available at that time to provide the support requested.

Staff raised concerns that the staffing levels were not always appropriate to enable them to meet people’s needs. A staff member explained that the dependency needs assessments (a tool which determined staffing levels) did not always reflect the level of support a person needed. A staff member told us the dependency assessments “did not take into account the total physical dependency.” This had an impact on the allocated staffing levels. Other staff members commented, “The impact of this is that those who need 2 carers, will have to wait to be assisted to bed”, and “Seniors will help with the care, but they have their own responsibility like medicines. Assisting people to bed up there is very difficult. Most of them require double hoisting and many need assistance with eating. It is difficult to get all our tasks done [by the time] we go off shift.”

This issue was discussed with the registered manager, who confirmed they had developed an alternative approach to the provision of care. However, we found that this approach did not always enable people to make choices about their care. Following the assessment, the provider submitted an action plan to address the identified shortfalls.

The provider had a recruitment process which enabled them to recruit appropriate new staff. Recruitment checks included references, right to work and criminal records. New staff completed an induction, training and shadowing of an experienced staff member. A staff member said, “The training is good and has given me confidence to do my job. I would be happy to have advanced dementia training; this would really help me to do my job better.”

Staff received support through supervision, handover and team meetings. A staff member told us, “I have regular supervision, I discussed hydration and urinary tract infections last week, it was very helpful. We also discuss resident’s cultural needs and preferences.”

The provider assessed and managed the risk of infection with processes for the cleaning of the environment, but issues were identified in relation to other aspects of the service.

During lunch on one floor, we observed staff using a food temperature probe to check the temperature of the meals. The probe was wiped between checking meat and vegetarian meals rather than being fully cleaned or using separate probes. This meant the staff could not be assured the probe was free from contamination. This was discussed with the registered manager who told us additional food temperature probes had been ordered and would be clearly labelled for different food types.

We also found issues with the storage of continence products. Staff were storing open packets of continence products on the floor and on furniture in people’s bedrooms. We found a bathroom on 1 floor had been used to store multiple boxes of continence products in addition to open bags of the products. The bathroom was not secure which meant people could access this area where there were risks of contamination of the products. The registered manager told us that there was an issue with storage due to the size of the continence product deliveries and confirmed they were looking at creating additional secure storage areas. Despite these concerns, the home was clean and tidy with no malodour. The provider employed staff to undertake housekeeping tasks round the home. The staff had access to appropriate equipment and training for the role. Staff providing care had access for personal protective equipment (PPE) which they used appropriately. People told us, “They clean my bedroom when I am not in here”, and “They regularly clean all the rooms which is important.” A relative commented, “[Family member’s] room is always kept clean. We have no concerns about the cleanliness of the place.” The kitchen was well managed, and the staff checked the temperatures of the fridges and of cooked food regularly. Kitchen staff completed appropriate training.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored securely with room and fridge temperatures monitored daily and recorded. Staff who administered medicines had completed training and had their competency assessed. Medicines administration records (MAR) were completed. Staff were provided with guidance for medicines prescribed to be administered when required. Audits of the administration of medicines were completed regularly.

Relatives were happy with the administration of their family member’s medicines with a relative telling us, “At dinner, [family member] gets their medication, and they take it with no problem. There is a little cup with the tablets in, which the staff make sure [family member] takes.”