Merseyview Residential Home

We found the following examples of good practice.

The service had an appointment system for visitors which ensured only one group of visitors arrived at any one time. The dining room was the designated space for visits, this was well ventilated, visitors used wiped clean seats and it was cleaned after every visit.

Every person had a COVID-19 risk assessment that included adjustments required to meet their individual needs. For example, staff used hand signals to communicate with a lady with additional needs and if they needed to verbally communicate maintained two metres social distance and temporarily lowered their mask and this had been risk assessed. The home’s cat ‘Bob’, also had a COVID-19 risk assessment.

People were supported to maintain contact with family and friends in creative ways. Staff supported people to use online video calling with relatives and friends. One lady had been supported to see her grandchildren by allowing them to visit and play in the garden whilst the nominated visitors visited indoors.

A local health centre had attended the home to offer vaccinations and boosters to all people and staff. This meant all staff and people living in the home had received two doses of the vaccine and their booster.

There had been no cases of COVID-19 in people living in the home throughout the pandemic.

Merseyview Residential Home provides accommodation with personal care, for a maximum of 12 people aged 65 and over at any one time. At the time of inspection, 10 people lived at the home.

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

The way in which some people’s medications were accounted for required improvement. This was because records relating to the amount of medication in the home were not always correct. We found that people received the medicines they needed and that their medication was reviewed regularly with their GP. This was good practice.

Health and safety checks were undertaken at the home to ensure the premises and the equipment in use was safe. An inspection of the home’s bath hoist needed to be undertaken and the home’s written fire evacuation procedure required greater detail. The manager told us they would address both of these issues without delay.

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. Where people had the capacity to make decisions for themselves, the manager and staff supported their ability to do so as much as possible and respected their choices. The principles of the Mental Capacity Act were upheld by the manager and staff. Further work was needed however to ensure that this legislation was followed in full when applying for deprivation of liberty safeguards to keep people safe. We discussed this with the manager and they were fully committed to improving this process.

People told us they felt safe living at the home and told us the support was good. A relative we spoke with confirmed this. They were very complimentary about the support provided by the manager and staff to their loved one during a period of ill-health. They told us that they had gone the extra mile to ensure the person received the support they needed. Everyone we spoke with said the manager and staff team were kind and caring and that they were well looked after.

People received enough to eat and drink and had a choice at mealtimes. During lunch we heard people openly praise the chef for the quality of the meal served and people told us the food was nice.

Staff felt supported and received sufficient training to do their job role effectively. The manager was hands on and worked alongside the staff team as a positive role model. Interactions between staff and the people they supported were respectful, patient and compassionate. It was clear that everyone knew each other well and had genuine affection for each other.

People’s care plans were person centred. Staff had guidance on what was important to people and how to communicate with them. This helped staff provide personalised support that met their needs and wishes were met.

There was a range of social activities to help people combat possible feelings of isolation and loneliness. People’s ideas and suggestions on the types of activities they would like to participate in where sought and acted upon. It was clear that people had a choice in how they lived their lives and that their support was tailored accordingly.

Records showed that proactive and prompt action was taken in response to people’s ill health or changing support needs. The manager and staff worked hard to ensure people received the care they needed and as a result people’s physical and mental well-being was supported by a range of health and social care professionals.

People’s feedback about the support they received was positive both on the day of the inspection and via a survey conducted by the manager. The culture of the home was open and transparent. The atmosphere warm and homely and everyone we spoke with felt the service was well led.

There were adequate systems in place to monitor the quality of the service. Where improvements were required, for example with regards to the fire evacuation procedure we found the manager to be responsive and committed to ensuring the service provided was a good one. We found the service to be well managed.

Rating at last inspection (and update)

The last rating for this service was requires improvement (22 August 2018).

At the last inspection we found that the governance arrangements in place were not effective enough to ensure the service was always well led. This was a breach of Regulation 17 (Good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After the last inspection, the provider completed an action plan to show what they would do to improve and by when. At this inspection we found that sufficient improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Merseyview Residential Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Merseyview Residential Home is registered to provide support for up to 12 people. At the time of our inspection 9 people were living there.

The home is a four storey property with accommodation provided on the ground and first floor. A stair lift is available to help people access the first floor. Six of the bedrooms have en-suite toilets, with shared bathrooms available throughout the home. People share a dining room, lounge and enclosed back garden.

The home has a registered manager who has managed the home for over 20 years. 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 2008 and associated Regulations about how the service is run. The registered manager is also the provider of this service.

At our last inspection of the home in March 2017 the service was rated Requires Improvement overall. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 12 and17.

This was because there were no systems in place to assess, detect and control the risk of Legionella infection and there were no effective systems in place to assess, monitor and mitigate the risks to the health, safety and welfare of people who used the service.

After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of regulation 12. We found that although the provider had made improvements they remained in breach of regulation 17 because systems and records were not always in place or consistently followed to audit the safety and quality of the service provided.

You can see what action we told the provider to take at the back of the full version of the report.

The environment and building at Merseyview were regularly checked and audited. This included regular maintenance checks and checks of fire, water and electrical systems. Other records and systems for checking the quality and safety of the service were not robust or consistently followed.

Training records were patchy and relied on either the knowledge of the registered manager or the time to scrutinise individual staff files. This meant that it was difficult to establish if training provided and planned was suitable to equip staff with the knowledge they needed to support people safely and well.

Similarly, systems for auditing medication were time consuming and findings were not always recorded. No clear system for auditing care plan information was in place. This meant that information staff held about people was not always recorded. Although the registered manager had a good knowledge of people and there was a stable staff team the lack of clear systems meant it was not always possible to audit the service and plan future improvements.

People were very positive about living at Merseyview and about the staff who supported them. Comments we received from people included, “I am in luxury,” “It’s very good, they look after me,” and “So friendly, they are like my on family.” This was echoed by a visitor who told us, “Fantastic care, owners fantastic, staff are brilliant they will do anything for you. [my relative] seems happy.”

People felt safe living at Merseyview and staff knew what action to take if they felt people were at risk of abuse. A system was in place for raising concerns or complaints and people living at the home and their visitors told us they would feel confident to raise a concern.

People’s medication was safely managed, they received it on time and as prescribed. Systems for auditing medication were not as robust as they should be making it difficult for us to assess how effective they were.

Staff worked with people to provide the support they needed with their health and personal care. They supported people to attend health appointments and followed the advice given from healthcare professionals.

Brief care plans were in place for people and these were followed, particularly in respect of supporting people with their health. Staff had detailed knowledge of people as individuals, including their choices and preferences. However, this level of information was not recorded within care plans.

Equipment and the building were monitored to ensure they were safe. The building had adaptations and equipment to support people with their mobility and personal care. This included a chair lift, bath lifts and call bells.

There was enough staff working at the home to meet people’s care needs. Systems were in place and followed to recruit staff and check they were suitable to work with people at risk of abuse or neglect.

Staff had received training to help them understand and meet the care needs of people living at the home. Staff felt supported and we saw that the registered manager acted as a good role model in supporting people as individuals.

People were supported to spend their time as they chose. Some people liked to sit in their room and read, others enjoyed socialising in the lounge and enjoying a musical film together. Visitors told us they always felt welcome and could spend time with people in shared areas or their bedroom as the person preferred.

Meals were planned daily and people had a choice of what they wished to eat. Staff had good knowledge of people’s nutritional needs and provided support and encouragement to people to monitor their weight and food and fluid intake.

Merseyview is a small home with an ethos of providing a homely environment. People told us that they appreciated this and felt like part of a family. We observed the atmosphere to be calm and relaxed throughout the day. Staff took time to talk with people in a way the person could understand. People told us that staff were consistently kind, caring and respectful towards them.

The provider met the requirements of the Mental Capacity Act 2005. People were supported to make choices and decisions for themselves. The provider took appropriate steps to protect people who lacked the capacity to make important decisions for themselves.

The home has a registered manager. 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 2008 and associated Regulations about how the service is run.’ The registered manager is also the owner (provider) of the home.

During our visit, we found breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014. These breaches related to the provision of safe care and the management of the home You can see what action we told the provider to take at the back of the full version of the report.

We observed that the practical administration of medication was not always safe. We also found that not all of the medicines at the home could be accounted for. Checks on the competency of staff to administer medication safely were not undertaken and staff were last trained in medication administration in 2015. This meant there was a risk this training was out of date. This placed people at risk of harm.

The home was well maintained and the home’s gas, electric and fire alarm systems were regularly inspected and were safe to use. A bath chair used by staff to lower people into the bath had not been checked in accordance with the Lifting Operations and Lifting Equipment Regulations 1998. (LOLER). This meant the manager and staff could not be sure it was safe to use.

The home’s fire risk assessment was out of date and had not been reviewed annually as recommended by Merseyside Fire and Rescue Service and there was a lack of suitable personal emergency evacuation plans in place for people who lived at the home. This meant staff and emergency personnel did not have important information on people’s needs and risks to assist them to evacuate people safely in an emergency.

Staffing levels were sufficient on the day of our inspection but some staff had not been recruited robustly. This was because information on the staff member’s skills and abilities had not been properly gathered or assessed prior to employment. These staff did not have contracts of employment in place and there was no evidence that one staff member had received an induction into their job role. Checks to ensure staff were safe to work with vulnerable people were made, previous employer references and information relating to the staff member’s identify were also obtained.

There was no system in place to assess, monitor and manage the risk of Legionella bacteria occurring in the home’s water supply. We spoke with the manager about this and they said they would address this without delay.

People’s care plans contained person centred information to enable staff to understand their needs and respect their wishes. Risks associated with people’s care were assessed and staff had guidance on how to manage these risks. For some risks, this guidance was brief and required further detail to ensure that staff had sufficient information. We saw people had access to support from a range of healthcare professionals where specific risks were identified. Some records relating to the repositioning of one person had not been kept in accordance with professional advice. We spoke with the manager about this. They told us they would commence this immediately.

Staff received training and support to do their job role. Our observations of care were positive. The manager and staff had a good knowledge of people’s needs and were kind, caring and compassionate in their approach. People looked smartly dressed and well cared for and it was obvious that staff and people who lived at the home had good relationships that promoted their well-being. People we spoke with at the home and a relative were very happy about the care they received and spoke highly of the staff team and the manager. They told us the staff went out of their way to help them and that everyone was very kind. People felt safe and well looked after.

People told us the food was good and they had plenty of choice. People’s weights were monitored and their nutritional needs assessed. Some people lived with short term memory loss and we saw their care plans contained some information on how this impacted on their day to day lives. No-one at the home was subject to a deprivation of liberty safeguard. During our visit, we saw that people were able to choose how they lived their life at the home and that their consent was sought whenever support was to be provided.

Staff were knowledgeable about potential signs of abuse and the action to take to protect people from harm. Accident and incidents were recorded and managed. No complaints about the service had been received.

During our visit, we saw elements of good leadership. People were happy and liked life at the home. People’s well-being was managed and they had good relations with the staff team. Staff were patient and compassionate and the care provided was person centred. We found however, that improvements were required with regards to the way the service was managed in order to ensure compliance with the health and social care regulations.

For example, there were no auditing systems in place to ensure that issues in relation to medication; accident and incidents; infection control; staff recruitment and out of date policies and procedures were identified and acted upon. Concerns with these areas of management were identified during our inspection. This lack of effective quality monitoring systems meant that risks posed in the delivery of the service to the health, welfare and safety of people who lived at the home were not always picked up and addressed.

At the end of our visit, we provided feedback to the manager. We found them to be open and receptive to our feedback.

Say when the inspection took place and whether the inspection was announced or unannounced. Where relevant, describe any breaches of legal requirements at your last inspection, and if so whether improvements have been made to meet the relevant requirement(s).

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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 2008 and associated Regulations about how the service is run.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

The provider had implemented a suitable policy and procedures for dealing with complaints and had publicised a summary of the complaints procedure in the reception area of the home.

A complaints log was in place and lessons learnt meant improvements to the service would be implemented.

'They look after me very well',

'I love it here, everyone is friendly, it's like a family',

'I am happy here, it is my home'.

We found that people were asked their permission and consent gained to undertake care. People told us and we observed that they were treated well and with respect. People's choices were respected and they felt listened to.

Care needs were assessed, risks identified and care planned in order to meet people's needs. Staff were trained in emergency life support and were able to tell us what they would do in the event of an emergency.

People were cared for by staff who were suitably qualified and experienced and had the relevant checks undertaken for working at the home.

We found that there was not an effective complaint system in place. The complaints policy and procedure were out of date and inaccurate. The policy and procedure had not been brought to the attention of people who used the service or others, information was not available on the process and it was not publicised.

'It's good here',

'They look after me well',

'The carers are very good and help with everything, I couldn't ask for anything more'.

We found that improvements had been made since our last inspection. We found new care documentation was in place and generally reflected the identified risks and needs of the people who used the service. We noted that improvements were needed to ensure that written agreement to people's wishes and consent to care and treatment was recorded.

People told us that the food was very good at the home. We found that a nutritional risk assessment tool had been implemented and that dietary care was planned and delivered according to need.

Improvements had been made with respect to staff training, we found evidence that all staff had been trained within the last year in relevant core topics. However we found that staff records did not contain the relevant information required of them in respect of their recruitment and the appropriate checks required to be undertaken.

There had been improvements in quality monitoring and we saw that the provider had gained people's views on the service in the form of a quality questionnaire. Formal checks of environment and risk assessments had been undertaken. However there was no formal audit plan in place.