We carried out a review of the data available to us about Merafield View Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Merafield View Nursing Home, you can give feedback on this service.
The service can support up to 40 people. The service accommodates people in a purpose-built building set over three floors with lift access to each floor. All bedrooms have hand washing facilities. There is an outside patio area.
We found the following examples of good practice.
Visitors were prevented from catching and spreading infection. The registered manager had recruited an additional member of staff whose responsibility was to ensure people who entered the service were screened for COVID-19 symptoms. This included, providing them with personal protective equipment (PPE) and undertaking a lateral flow device (LFD) test. The member of staff was enthusiastic, put people at ease, and took their responsibility seriously.
The registered manager followed the current testing guidance and had a recording system in place. The COVID-19 status of the service was displayed so people and staff were well informed, and could have confidence in the infection, prevention and control standards.
People were protected by shielding and social distancing guidance. Staff supported and encouraged people to keep a safe distance, and shared areas (lounges/dining rooms) had been re-designed to facilitate more space.
People who moved into the service were prevented from spreading infection, because the provider followed current guidance. Handover processes ensured staff were well informed about people who were self-isolating.
The registered manager had considered the impact on people’s mental health and wellbeing, by tailoring social engagements. Innovative approaches had been taken, by a passionate activities co-ordinator to support people to continue to enjoy a fulfilled life, despite the current national restrictions. This included ensuring people remained connected with their friends and families via the use of technology.
Staff’s overall wellbeing was important to the registered manager, and steps had been taken to offer support through team meetings, one to one sessions, and the creation of an area in the service whereby staff could sit quietly. Free complimentary therapy sessions were also available for staff at the service, which included indian head massage.
Staff had received training about infection, prevention and control and wore PPE correctly. The provider had increased their clinical waste collections in response to the increase in PPE disposal.
People had their temperatures taken twice a day in line with guidance, and people and staff who were in high risk categories had risk assessments in place to help reduce risks to them. There was an external clinical lead assigned to the service, who visited on a weekly basis to review people’s clinical needs and offer guidance and support.
Housekeeping hours had changed, and additional staff recruited to enable cleaning routines at the service to be enhanced. For example, to ensure high touch areas, such as door handles, and light switches and the deep cleaning of people’s rooms could take place.
The registered manager had a good understanding of infection, prevention and control guidance and was confident in their decision-making processes, liaised with relevant agencies, and knew how to access local support. The infection and control policy reflected practices within the service.
To assess and monitor ongoing infection and control practices within the service, the registered manager had a variety of audits. Should an outbreak occur the registered manager had a robust contingency plan in place and staff were confident about what action to take.
People’s experience of using this service and what we found
People were supported by exceptionally kind and caring staff who knew them well. Staff went over and above expectations and told us how people were like their family and they enjoyed spending time with them. People’s equality needs were carefully considered, and people’s rich life histories were celebrated.
The service was efficient and effective at supporting people to achieve positive health outcomes. Staff training was tailored to meet the individual needs of people and staff felt very well supported by the management team. Best practise guidance was referred to and the service had built excellent relationships with professionals who regarded the service highly.
Medicines were managed safely, and the service had robust infection control processes. Safeguarding processes were robust, and staff knew how to support people to manage and mitigate risks around their healthcare needs. Recruitment processes were thorough, and staff were recruited safely.
Care was person centred and staff knew people’s needs in detail, though care plans did not always reflect this level of detail. People were having their care preferences met. The service considered people’s communication needs and supported people to combat loneliness and isolation through a tailored programme of activities and one to one time. Complaints were dealt with swiftly and people and relatives felt the culture was open and they would be comfortable to complain if they needed to.
The registered manager was praised by people, relatives, staff and professionals. Staff felt supported, and the management were visible in the day to day running of the service. Regulatory requirements were being met and the service worked well in partnership with key stakeholders.
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.
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 (published 22 June 2017)
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.
A registered manager was employed 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.
There was a very positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about ‘personalised care’ and ‘respecting people’s choices’ and had a clear aim about improving people’s lives and enabling opportunities where possible.
There was a management structure in the service which provided clear lines of responsibility and accountability. The registered manager was highly valued and well respected by people, relatives, staff and local professionals.. They were supported by an extremely knowledgeable, caring team of nurses and support staff who had designated management responsibilities. All areas of the home were exceptionally well managed including housekeeping and the kitchen. People told us they knew who to speak to in the office and any changes or concerns were dealt with swiftly and efficiently.
Staff were exceptionally thoughtful and kind. Their care and love for people at Merafield made them feel they mattered and staff and relatives gave many examples of going the extra mile to make someone feel special. Feedback we received about staff was superb.
End of life care was excellent. People’s last days were dignified, pain free and relatives were fully involved and supported at all stages.
Feedback received by the service and staff was exceptional. Outcomes of audits and incidents were used to aid learning and drive improvement across the service. Robust action plans drove further improvement. Training and networking by staff across the city improved the care and outcomes for people. The manager and staff monitored the quality of the service by regularly speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were excellent, visible and included them in discussions about their care and the running of the service.
The service had strong links with organisations in the local community including the local hospital, acute hospital and the local authority. The registered manager was well respected across these organisations and the service was involved in pilots with Plymouth University to trail technology within nursing homes and a pilot project to reduce falls.
People loved the homecooked food and lovely smells which came from the kitchen. Mealtimes were a positive experience, which people looked forward to. Meals were of sufficient quality and quantity and there were always alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought. Allergies and preferences were known. People at risk of poor hydration or nutrition were monitored closely and cared for well. This could move down as its from a good rated domain.
People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.
People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant that people’s needs were met in a timely manner. Recruitment practices were safe and robust to ensure staff with the right attitude and strong values and integrity were recruited. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people. Improving safety of residents was a goal for the home and the registered manager analysed and learned from incidents and accidents to improve people’s care.
Staff received a thorough induction and essential training to ensure they were skilled in their roles. Competency was monitored and staff were supported through a regular system of informal and formal supervision. Additional training in health and social care qualifications and enhanced clinical skills was undertaken to meet people’s needs. Staff all told us they felt supported and valued and loved their jobs.
People had their healthcare needs met. Robust handover processes ensured important information was shared quickly with staff. Prompt referrals were made to external professionals when required. People were supported to see a range of health and social care professionals including social workers, chiropodists, physiotherapists and doctors. Feedback we received from professionals indicated good working partnerships had been developed and were valued.
The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA).
Staff were knowledgeable about the Mental Capacity Act and how this applied to their role. Where people lacked the capacity to make decisions for themselves, processes ensured that their rights were protected. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. Independent Mental Capacity Advocates had been involved where there was disagreement about what might be in a person’s best interest; these processes ensure people’s rights are protected. Those who had capacity were involved in their care at all stages.