Merrymeet Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance at the service.

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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

Staff we spoke with were not aware of any clear vision or strategy, as this had not been shared by the provider. The provider had not completed recent staff surveys or questionnaires. The provider should seek the views of staff and analyse and respond to the information gathered to improve the service.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

The service lacked strong leadership, and the management arrangements in place did not ensure there was sufficient support and guidance to maintain appropriate oversight of the day to day running of the service. The oversight of medication, safeguarding, incidents and accidents was ineffective. Risk assessments and care plans required some improvement.

Where people displayed complex behaviours or required more support due to advancing age or declining health, managers did not explore strategies to better support them and to help reduce the risks. We were not assured staff were provided with the relevant skills and training.

However, the leadership team were proactive with concerns we raised and started to address these during the inspection.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff told us they felt able to raise concerns with the registered manager and the provider. Formal meetings were held with staff and we observed regular communication with managers during this inspection.

People told us they felt comfortable in raising any concerns verbally although they were unsure of any formal processes in place. One person told us they would speak to staff; they were confident they would be listened to

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff raised no concerns regarding discrimination and told us they did not feel there was a culture in which bullying occurred.

Staff felt fully supported by the registered managers and considered the service was flexible in the event staff should have any problems, such as childcare responsibilities. Night staffing arrangements were for 2 members of sleep-in staff, and staff told us they were rarely disturbed.

The provider had an element of mandatory training incorporating equality and diversity; 1 member of staff still needed to complete this and we were given assurances this would be done.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

At the time of this inspection there were 2 registered managers in post, with 1 being the main partner. We were told this was an oversight and the main partner planned to deregister.

Risk assessments specific to people’s changing needs had not always been identified or addressed. The failure to identify such concerns prior to this inspection placed people at risk of harm from the poor assessment and management of risk.

Quality assurance processes for medicines management failed to identify and rectify the shortfalls found during this inspection. As registered managers had not performed any medication audits, the controlled drugs errors we identified had gone unchecked.

We were not assured the arrangements for the training and development of staff were effective. The provider was unable to evidence staff had completed all elements of required training, and there was no oversight of this by either registered manager. Staff were not provided with the required knowledge and skills needed to safely deliver the care and support people living at Merrymeet Residential Care Home.

Due to the lack of reviews and care plan audits by both registered managers and the provider, the errors we found had not been identified. The registered provider failed to implement robust systems and processes to demonstrate good oversight of the service. It is essential to have robust governance systems in place to identify concerns and improve quality and safety.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

We received positive feedback from external professionals and stakeholders in relation to the attitude and approach of the provider, staff and leaders in relation to collaborative working. A health professional we contacted for feedback said, “Staff are professional and have a good rapport with myself and other visiting [professionals], which makes us and them feel comfortable with each other. Residents and staff seem to be happy and confident around each other; staff seem to genuinely care for residents but also maintain professional boundaries and structures.”

Although people’s care records did not consistently reflect outcomes of joint working with health and social care professionals; staff and leaders gave positive feedback about partnership and collaborative working with health and social care professionals.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider was asked to provide responses from staff and resident surveys or questionnaires but failed to provide these, suggesting they had not been completed. It is important that providers actively seek the views of a wide range of people, including staff, people and relatives who use the service and analyse the findings to drive improvements.

At this inspection we identified breaches in safe care and treatment and good governance; the provider was not compliant with regulations. More robust audit processes to assess, monitor and improve the quality and safety of the service were needed in areas such as risk management, administration of medication, care planning and governance to drive forward the improvements required.