Meyer House Nursing and Residential Care Home

Meyer House Nursing and Residential Care Home is a care home service that accommodates up to thirty four people across two floors in one adapted building. There were twenty-eight people using the service at the time of our inspection.

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

People told us they felt safe. Staff were following current government guidance in relation to infection prevention and control and there were appropriate procedures in place to reduce the risk of spread of infections. People’s medicines were managed safely. There were safeguarding procedures in place and staff understood these procedures. Risks to people were assessed and staff were aware of the action to take to minimise risks where they had been identified. There were enough staff to meet people’s care and support needs. Safe recruitment checks took place before staff started work at the home.

Assessments of people’s care needs were carried out when they started using the service. Nursing staff and care staff received training and support relevant to people’s needs. People said they liked the food provided at the home and they were supported to maintain a balanced diet. People had access to a range of healthcare services when they needed them. The design of the premises was meeting people's needs. 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 service supported this practice.

There were effective systems in place to monitor the quality of service that people received. The provider took people’s views into account through residents and relative’s meetings and satisfaction surveys and feedback from these was used to improve the service. Staff said they received good support from the registered manager. The registered manager and staff worked with health and social care providers to drive improvement and to deliver an effective service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 December 2021). At that inspection we found breaches of our regulations in relation to infection control and failing to have effective systems in place for monitoring, assessing the quality of the service and driving improvement.

We carried out an infection, prevention and control inspection on 18 January 2022. We were assured the service was following appropriate infection prevention and control procedures to keep people safe.

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

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 were assured the service was following appropriate infection prevention and control procedures to keep people safe. We also found the provider had developed more effective systems for monitoring, assessing the quality of the service and driving improvement.

We found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider 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, Effective and Well-led. 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 changed from requires improvement to good. This is based on the findings at this inspection.

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

Meyer House Nursing and Residential Care Home is a care home service that accommodates up to 34 people across two floors in one adapted building. There were 25 people using the service at the time of our inspection.

At our last inspection of the service we were not assured that the provider's process for receiving visitors into the home was consistent or robust enough to prevent the spread of infections. At this inspection we found that significant improvements had been made and we were assured that this service met good infection prevention and control guidelines.

We found the following examples of good practice.

The provider screened essential visitors for symptoms of acute respiratory infection before they were allowed to enter the home. Visitors were supported to follow the government's guidance on hand washing, sanitising and wearing personal protective equipment (PPE) before entering the home and social distancing whilst on the premises.

The provider told us there were enough regular staff to meet people’s needs during this COVID-19 outbreak. Where required they block booked agency staff to ensure they only worked at Meyer House. The provider carried out checks on agency staff to make sure they had received training on infection control and they had been fully vaccinated.

All staff had received training on COVID-19, infection control and the use of PPE. Agency staff received the same training and supervision as regular staff whilst working at the home and they were being tested regularly for COVID-19. There was an enhanced COVID-19 testing program in place for people using the service and for staff. When people or staff showed symptoms of COVID-19 they were required to self-isolate.

We observed staff wearing appropriate PPE and socially distancing throughout our visit. The provider told us they had access ample supplies of PPE equipment. The home had a dedicated housekeeping team that facilitated a cleaning schedule at the home. During our visit we saw that the home was very clean throughout.

The provider was monitoring the health and wellbeing of people using the service and staff. Black, Asian and Minority Ethnic COVID-19 risk assessments were carried out with people using the service and staff to ensure they could live and work safely at the home.

The provider was working closely with the GP, health care professionals, the Clinical Commissioning Group (CCG), the Local Authority Commissioning Team and Public Health England. The provider told us the support they received from these health and social care professionals was very helpful to them, the staff team and people using the service.

The provider had a COVID-19 specific contingency plan in place which they had followed throughout the COVID-19 pandemic. The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against COVID-19. We were assured the provider was facilitating visits for people living in the home in accordance with the current guidance.

About the service

Meyer House Nursing and Residential Care Home is a care home service that accommodates up to 34 people across two floors in one adapted building. There were 25 people using the service at the time of our inspection.

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

We were not assured that the provider was preventing visitors from catching and spreading infections. The process for receiving visitors was not consistent and robust to prevent the spread of infections. The system in place for monitoring the quality of the service was not effective and did not identify the issues we found.

We made a recommendation about staff supervision.

The service had sought feedback from people, their relatives and staff; however, they did not have any improvement plans in place following these surveys.

People, their relatives and health and social care professionals were complimentary about the service. People received care and support that was personalised to their needs and they felt safe living at the service. People were protected from the risk of avoidable harm as potential risks to their health and wellbeing had been identified, assessed and they had appropriate risk management plans in place for staff to mitigate any potential risks. Medicines were managed safely. There were enough staff available to support people safely and people said they did not have to wait for long to be attended to. The provider followed safe recruitment practices and ensured staff were properly checked before they began working at the home.

Before people started using the service, their physical, mental, and social care needs were assessed to ensure their needs could be met. People received care and support from staff that had been supported through induction and training. People were supported to eat and drink enough amounts for their health and wellbeing. People were supported to access healthcare services where required. The homes design and decoration met people’s individual needs.

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.

People received care and support from staff that were kind, compassionate, respectful and had developed a positive relationship with the people they support. People’s privacy, dignity and independence was promoted. Staff understood the Equality Act and supported people in a caring way and without any discrimination. People and their relatives were involved in making decisions about their care and support needs and their views were respected.

Care and supported was planned and delivered to meet individual needs. Information was presented in formats that met people's communication needs. The service had an effective system in place to manage complaints. There were appropriate systems in place to ensure people's end of life wishes were respected and met. People were supported to engage in social and leisure activities of their choice.

There was a new manager in post who had demonstrated a commitment to provide high quality

care and knew they had to be honest, transparent and open when things went wrong. The service worked in partnership with key organisations and health and social care professionals to deliver an effective service.

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 19 July 2019).

Why we inspected

This was a planned inspection based on the previous rating. 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to infection prevention and control in relation to Covid-19 protocols and good governance at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Meyer House Nursing and Residential Care Home is a care home service that accommodates 34 people across two floors in one adapted building. There were 24 people using the service at the time of our inspection.

People's experience of using this service People said they felt safe and that their needs were met. Risks were identified, and risk management plans were in place to manage these safely. Medicines were safely managed, and people were protected against the risk of infection. Assessments were carried out to ensure people's needs could be met. Accidents and incidents were appropriately managed and learning from this was disseminated to staff. Sufficient numbers of suitably skilled staff were deployed to meet people’s needs.

Assessments were carried out prior to people joining the service to ensure their needs could be met. Staff were supported through induction, training and supervisions. 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 service supported this practice. People were supported to eat a healthy and well-balanced diet. People had access to different healthcare professionals when required to maintain good health.

People told us staff were caring and respected their privacy, dignity and always asked for their consent before supporting them. People’s independence was promoted. Information was available to people in a range of formats to meet their individual communication needs if required. There was an effective system in place to respond to complaints in timely manner.

The service was not currently supporting people who were considered end of life, but if they did relevant information would be recorded in their care plans. There were effective systems in place to assess and monitor the quality of the service provided. The provider worked in partnership with key organisations to ensure people's individual needs were planned and met.

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 of the service was good (published on 01 December 2016)

Why we inspected: This was a planned inspection based on the previous rating.

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

Meyer House Nursing and Residential Care Home is a care home service with nursing for up to 34 older people. There were 28 people using the service at the time of our inspection.

We previously carried out an unannounced inspection of this service on 29 December 2013. At that inspection we found the service was meeting all the regulations that we assessed.

The service had 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 2008 and associated Regulations about how the service is run.

At this inspection we found that staff knew how to keep people safe. People who used the service told us they felt safe and that staff and the registered manager treated them well. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service which were up to date and included detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents, and to prevent them happening again. The service had arrangements in place to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff on duty to support to people when required. Staff supported people so that they took their medicines safely.

The provider had taken action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. However, we saw the provider had not completed the monitoring forms for the supervisory body as required. As a result of the inspection feedback, the provider reviewed systems and procedures to ensure any conditions placed on people’s DoLS authorisations were complied with and we noted that there was no negative impact on people who used the service.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

People or their relatives where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing. Staff prepared, reviewed, and updated care plans for every person. The care plans were person centred and reflected people’s current needs.

Staff supported people in a way that was kind, caring, and respectful. Staff also protected people’s privacy, dignity, and human rights.

The service supported people to take part in a range of activities in support of their need for social interaction and stimulation. The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

There was a positive culture at the home where people felt included and consulted. People and their relatives commented positively about staff and the registered manager. Staff felt supported by the registered manager.

The service sought the views of people who used the services, their relatives, and staff to help drive improvements. The provider had effective systems in place to assess and monitor the quality of services people received, and to make improvements where required. The service used the results of audits to identify how improvements could be made to the service. However, we found that the provider had not notified the Care Quality Commission (CQC) of the authorisations of Deprivation of Liberty Safeguards (DoLS) as required. As a result of the inspection feedback, we saw the provider had notified the CQC and reviewed their quality assurance systems and procedures to ensure any conditions placed on people’s DoLS authorisations and notifications to CQC were complied with.

People told us they were always treated in a respectful manner, and the staff knew them well and understood how to attend to their needs. Everyone we spoke with said that the staff communicated well with them, explained what they were doing and involved them in decisions about their care. People said they felt safe and well cared for.

The staff understood how to keep people safe and understood their responsibilities for reporting concerns if necessary. There had been concerns expressed by one family regarding the care of their relative. This had been investigated by social services and action had been taken by the provider to ensure that people were safe and well cared for. Staff were supported to provide care safely through training and supervision, and said they felt supported by the management. Record keeping was well maintained although some records such as signing of care plans were not up to date.

The people who use the service told us they enjoyed living at the home and that the staff were friendly and knew what they liked. They said that they could choose to be involved in activities if they wanted to and always had food that they liked. We saw staff being respectful towards people and talking to people in a friendly and caring way. Relatives and people who use the service said they felt there were enough staff to meet people's needs and the staff confirmed that there was good teamwork.

Risks to people were minimised through staff understanding of abuse issues and what actions they needed to take if they suspected abuse.