Merrymeet Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them, or appropriate representatives.

Needs assessments were undertaken prior to admission to the service, but these did not always fully inform care plans and risk assessments. People’s care records did not reflect direct involvement from themselves, relatives, friends or any representatives in their development, to ensure individual needs, wishes and preferences were reflected.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People’s care plans and risk assessments did not include industry recognised assessments to assist the management team to identify potential risks and put measures in place to reduce them. For example, we saw no use of the Malnutrition Universal Screening Tool (MUST) used to identify adults who might be malnourished, at risk of undernutrition, or obese.

We identified one person was at risk of losing weight due to changing health conditions and a recent health diagnosis. The speech and language therapy team (SaLT) and the dietician were involved following referrals by the provider and fortified drinks had been prescribed.

Weight records we saw were not consistent. Despite the continued weight loss we identified, the person was not being regularly weighed, nor were food and fluid charts in place at the time of this inspection.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Overall, the provider evidenced good partnership working with external professionals such as GP’s, pharmacists and specialist nurses to support people’s health needs.

The management team demonstrated how they worked well with other professionals involved in people’s care. For example, supporting people to attending hospital appointments, treatment, best interest meetings and reviews. Staff told us they worked well together; they had good relationships with external partners and agencies.

External professionals were complimentary about their working relationship with the service and felt staff escalated concerns appropriately. One professional told us, “The staff I have dealt with have always been friendly, approachable, and responsive when liaising with primary care services; [staff] continue to provide appropriate support to residents while seeking medical input when required.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were receiving treatment for serious health conditions, sometimes attending appointments independently. The registered manager made inspectors aware people had the right to make unwise decisions; appointments were sometimes missed or people chose not to stay for the full treatment.

There were no risk assessments within care plans, or strategies for staff on how to encourage and promote people to attend medical appointments. There was no information within people’s care plans to indicate the potential consequences of any missed health appointments or refusal of treatment.

Resident meeting minutes reflected how the service tried to encourage people to reduce or quit their smoking habits to improve their lifestyle; 2 people had tried vaping, however 1 had reverted back as their preference was to smoke.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Daily food and fluid charts were inconsistently recorded for people identified to be at risk of losing weight. Staff had no access to visual body maps on which to record when people sustained injuries, either from accidents, skin damage, pressure ulcers, bruising, wounds or other areas of concern. These were introduced during this inspection as part of the improved incident reporting process.

Standardised medical tools such as the Waterlow scale (a risk assessment tool used by healthcare and social care staff to identify people who are at risk of developing pressure ulcers, pressure sores or bed sores) and MUST to monitor for pressure sores and malnutrition were not used. There were missed opportunities in offering pain relief to people when they most needed it.

Both registered managers told us about the progress made by some people since arriving at the care home, although this progress needed to be better reflected within care plans.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider was working in line with The Mental Capacity Act 2005 (MCA), which provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People’s mental capacity had been assessed, and where people had capacity, they chose to make unwise decisions. The service participated in best interest decision meetings, for example in relation to people receiving specific hospital treatment. Whilst we could see they had contributed to best interest decisions, outcomes from meetings had not always been recorded within people's care plans.