Merevale House Residential Home

Merevale House Residential Home is a residential care home providing accommodation and personal care to up to 31 people. The service provides support to adults of all ages with their mental health needs, including people who are living with dementia. At the time of our inspection there were 29 people using the service.

Merevale House comprises three buildings named the house, the cottage and the lodge. All three buildings are accessible and share communal gardens.

People’s experience of using this service and what we found

Systems to identify areas of improvement could have been more effective, to ensure improvements were identified and made promptly. Improvement plans were in place to meet fire regulations and to improve compliance and audits at the home.

People were supported by staff who understood what action to take if they had any concerns for their safety. Staff were provided with the guidance required so they could support people to manage their risks. There were enough staff to care for people and spend time chatting with them, so people did not feel isolated. The registered manager undertook checks before new staff worked at the home, so they could be assured new staff were suitable to work there. People were supported to have the medicines they needed by staff who had been trained to do this. Systems were in place to reduce the likelihood of the spread of infections. The registered manager had worked with people and their visitors to ensure people continued to receive visits safely. Accidents and incidents were regularly reviewed so any lessons would be learnt.

People’s needs were assessed and informed through work with their relatives and other health and social care professionals. Staff monitored people’s health needs and advocated for them so they would enjoy the best health outcomes possible. Where staff had any concerns about people’s fluid or nutritional intake plans were developed to support them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager and provider undertook checks on the quality and safety of the care provided. Staff told us the culture at the home was open and focused on the needs of the people living at the home. This helped to ensure people had good outcomes. The management were fully engaged with our inspection and committed to providing high standards of care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good overall published (December 2020).

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Merevale House Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service provides accommodation, support and personal care for up to 31 people. There are three buildings at the location which provide specialist care for people living with dementia. Merevale House provides care for up to 15 older people living with dementia. Merevale Lodge provides care for up to 12 people living with early–onset dementia, and 5th Lock Cottage provides care and rehabilitation for up to four people living with alcohol related dementia or other mental healthcare needs. On the day of our inspection there were 29 people living at Merevale House Residential Home.

People’s experience of using the service and what we found

Relatives gave positive feedback about the quality of care and were reassured their loved ones were kept safe during times of imposed visiting restrictions. One relative said, “We have been very happy, we have visited during the summer, and when it was safe, outside,” and another relative said, “They have personalised safe visiting plans. It’s really reassuring”.

Staff knew people well and were able to respond quickly to support them. People were encouraged to maintain their hobbies, interests and skills and the provider encouraged staff to help people contribute to general household maintenance tasks if they were able to. One relative commented, “There is real stimulus for [person] there as well, [person] has games, entertainers and staff interacting with them.” Staff had time to be with people and the provider helped staff learn how to care for people using a positive approach to risk. People felt confident to raise concerns knowing they would be listened to and the provider’s system for monitoring accidents and incidents meant trends or patterns could be identified quickly and acted on to review risks to people.

The provider had improved their training and staff gave positive feedback about the support they had to look after people whose needs could challenge the service. We found improvements in how risks to people’s health and safety were assessed and managed and the implementation of an electronic medication system improved the safe management of medicines. Quality assurance systems gave greater oversight of care practice so risks and quality of care could be continuously monitored and improved.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection and update: The last rating for this service was requires improvement (published 13th February 2020) and there were multiple breaches of the regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12th September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding, good governance and notifications of other incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Merevale House Residential Home on our website at www.cqc.org.uk.

The service provides accommodation, support and personal care for up to 31people. There are three buildings at the location which provide specialist care for people living with dementia. Merevale House provides care for up to 15 older people living with dementia. Merevale Lodge provides care for up to 12 people living with early–onset dementia, and 5th Lock Cottage provides care and rehabilitation for up to four people living with alcohol related dementia or other mental healthcare needs. On the day of our inspection there were 28 people living there.

People’s experience of using this service

During a period of changes in the senior management team, the provider had not maintained a good level of organisational oversight of the service. This meant some previously demonstrated standards had not been sustained. The provider had not fulfilled their regulatory responsibility to inform us of important incidents that happened at the service. However, people and relatives were positive about the quality of service which had achieved positive outcomes for people. The provider was open and transparent about the challenges over the last 12 months and demonstrated a strong commitment to making the required improvements.

People felt safe because there were enough staff to respond to their requests for assistance and meet their needs. However, there was no effective system to monitor accidents and incidents. This meant safeguarding issues were not always identified and risk management plans were not updated. Improvements were needed to ensure medicines were managed in line with regulatory requirements.

Whilst staff were motivated and responsive to people’s needs, they had not always had the training and support they needed to fulfil their role. However, people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. People were supported to access healthcare professionals who confirmed staff worked with them to achieve positive outcomes for people. People’s nutritional needs were met.

The provider, staff and managers were extremely dedicated and passionate about people. People and their relatives told us staff were very caring and compassionate. Staff were exceptional at helping people express their views and respected their privacy and dignity at all times. Equality and independence was celebrated.

Staff knew people well and were able to respond quickly to support them. People were engaged in meaningful occupation and encouraged to maintain their hobbies, interests and skills. Staff had time to be with people and take them on trips into the community. People felt confident to raise concerns knowing they would be listened to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 06 September 2017).

Why we inspected

This was a responsive comprehensive inspection based on information we had received about changes in the management of the home. The overall rating for the service has changed from outstanding to requires improvement. Please see the safe, effective and well-led sections of this full report.

Enforcement

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service provides accommodation, support and personal care for up to 31people. There are three buildings at the location which provide specialist care for people living with dementia. Merevale House provides care for up to 14 older people living with dementia. Merevale Lodge provides care for up to 13 people living with early–onset dementia, and 5th Lock Cottage provides care for up to four people living with alcohol related dementia. On the day of our inspection there were 30 people living there.

At the last inspection in August 2015, the service was rated outstanding. At this inspection we found the service remained outstanding.

The home is required to have 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 and associated Regulations about how the service is run. At our last inspection the home had two registered managers who shared their time across the homes operated by the providers; Merevale Care Homes. Sadly, the long serving registered manager, who was also one of the providers, had passed away. At the time of this inspection the home had a registered manager in post, who shared their time between this home and another nearby care home operated by the provider. At the time of this inspection, the registered manager was on planned leave.

People were extremely happy with the quality of the care and support they received. They described their care as being given in a way they preferred and they were supported to be as independent as possible. People were supported extremely well with their personal hobbies and interests and to go out when they wanted to. Staff used their knowledge about people’s past to create opportunities to engage with people in a positive way and make new memories for the person and their relatives.

Staff received training in how to care and support people living with dementia, and this enabled them to support people to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The provider’s values in good dementia care and their policies and systems in the service supported this practice.

Living ‘care’ plans contained very detailed information about people. This enabled staff to take a person centred approach, which contributed to the positive culture. Staff had received excellent dementia care training which enabled them to provide a safe, supportive and homely environment for people.

The culture of the home was very positive and staff embraced the provider’s values. People described all of the staff as being calm and relaxed and saw them as ‘equals;’ there were no divisions between people that lived at Merevale and the staff that supported them.

People and their relatives’ feedback was sought by feedback surveys. The provider had systems and processes in place that ensured a very good service was given to people through regular quality assurance checks.

People felt safe living at the home and were supported by staff who were trained to protect them from risks of abuse. Risks were assessed and actions implemented to minimise those risks. Staff knew people very well and knew how to meet their individual needs.

People were supported to access healthcare professionals when needed, and felt staff were consistently kind to them. People had choices about what they ate and drank and their nutritional needs were met.

People felt there were always enough staff on shift to meet their individual needs in a person centred way. The provider’s recruitment processes had ensured workers were safely recruited through a series of checks on their character.

People had their prescribed medicines available to them and were supported by staff to take them when needed.

Further information is in the detailed findings below.

People and relatives we spoke with told us that the care planning was discussed with them regularly. We saw that people or their relatives were involved with the care planning of their care.

We found that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

We found that the care plans were person centred and reflected people's individual needs. We saw that staff supported people as detailed within their care plans. We observed that staff were compassionate and caring when supporting people.

People we spoke with told us that staff were friendly and supported their needs well. We spoke with staff who knew what people's care needs were and how they needed to be supported.

We spoke with five staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We found the service was well led and there was a system in place to monitor the quality of service being provided.

When we visited the care service on 24 January 2013 we checked four care records and spoke with the deputy manager. We found the care records we looked at were up to date and in good order.

We found the care records documented information about a person's capacity to give consent to their care or not. We saw that when people had been involved in the planning and reviewing of a person's care they had signed the relevant documentation to confirm this.

Staff members, (co-workers), had each been allocated time during the week to keep care records up to date and in good order.

Co-workers were in the process of receiving refresher training from the deputy manager on completing care plans.

People who lived at Merevale House told us they were happy with the way staff supported them with their care. One person told us, 'It is very good here. I can do what I want pretty well.' Another person told us, 'I am really happy here.'

When we spoke with a relative they told us. 'I chose Merevale House deliberately because it was 'small scale' and I saw there was a 'closeness' with the staff team.'

We saw that mealtimes were a relaxed and social occasion. We saw that people had a choice about what they wanted to eat and drink.

Staff told us they had regular training, which meant they could support the specific needs of people who used the service. Records we looked at showed that staff communicated people's changed needs to managers, so that care needs could be re-assessed promptly.

We found care records did not always have the information in them necessary for the planning of a person's care.