The Meadows Nursing Home

The Meadows Nursing Home is a care home providing personal and nursing care to 32 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

The Meadows Nursing Home is an adapted and extended building on two floors. Communal facilities were provided on each floor. The ground floor accommodated people with nursing care needs while people on the first-floor required care and support as a result of them living with dementia.

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

Improvements were needed to ensure safe medicine practices and procedures were acted upon to ensure people were safe from risk. Environmental and infection control risks were not always identified and actioned to ensure people’s safety.

People’s care was not always seen to be person-centred. People’s personal care needs to maintain individual’s appearance was not always upheld. Care plans and care records did not always detail the care required to provide the care and support people needed.

Sufficient staff were on duty to care for people who were seen to be kind and caring. People felt safe from abuse and harm and staff knew what to do to safeguard people. Recruitment processes were in place although some improvement to application forms was needed.

People were not always supported to have maximum choice and control of their lives. Staff were aware of the need to support people in the least restrictive way possible.

People’s needs were assessed prior to moving into the home and healthcare needs were met by visiting professionals. Staff were knowledgeable although some areas of training needed to take place. People were pleased with the food provided. The provider planned to make improvements to the environmental standards of the home.

People were complimentary about the registered manager and felt able to make a complaint if needed. Improvements were needed to ensure governance arrangements were fully effective to provide high quality and person-centred 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 Requires Improvement (published 01 March 2019).

The provider was found to be in breach of registration regulation 18 for not informing the Care Quality Commission about the authorising of Deprivation of Liberty. 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 improvement had been made and the provider was no longer in breach of this regulation. However, we identified other shortfalls.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

Enforcement

We have identified breaches in relation to ensuring people received person centred care and support and in the governance of the service provided.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The Meadows Nursing 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.

The Meadows accommodates up 36 people in a large adapted property with more modern extensions. The home is split into three units. The Pines and The Willows provide nursing care for people and are located on the ground floor. The Beeches provides care for people living with dementia and is on the first floor. Communal areas as well as bathrooms and toilets are provided on both floors. There were 34 people living at the home at the time of the inspection.

At our previous inspection on 04, 05 and 13 October 2017 we rated the service as ‘Requires Improvement’ in each of the five key questions as well as overall. We identified five breaches in regulation. These included people did not always receive care that met their care and preferences. People’s dignity was not always maintained. The provider had not consistently ensured risks to people had been assessed and the risks mitigated. People’s medicines were not always stored and administered safety. The provider did not always have effective arrangements in place to monitor and improve the quality and safety and welfare of people. The management and deployment of staff did not always ensure there were sufficient staff to safely meet the needs of people at all times.

Assurances were given following the previous inspection regarding staffing.

We undertook this inspection to see whether the provider had made the necessary improvements.

At this inspection we found some areas continue to require improvement.

The provider had a registered manager in place. 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 provider did not have effective systems to ensure all statutory notifications were sent to the Care Quality Commission. The provider had failed to notify us of Deprivation of Liberty Safeguard authorisations as they are required to do by law.

Since our previous inspection improvements have taken place in areas such as medicines, staffing, staff knowledge and governance. The registered manager showed a passion to make further improvements at the home.

We identified shortfalls in how medicines were managed. These were discussed at the time of the inspection. Personalised care was provided however care records did not always indicate what action staff had taken to meet people’s needs in monitoring documentation.

People were cared for by the staff who had knowledge of how to keep people safe and what to do if they believed people to be at risk. People’s wishes were taken into account to ensure people’s preferred life styles were met.

People who lived at the home as well as relatives and staff were complimentary about the care provided and were confident in the registered manager and the improvements made.

People had a range of fun and interesting things to do and were involved in deciding in these. People were able to take advantage of outings to interesting places.

People were supported to have maximum choice about their lives and were supported in the least restrictive way possible. Staff spent time with people talking about important things in their life and had developed a caring relationship. People were encouraged to make decisions about their day to day life. People’s privacy and dignity was respected.

People’s needs were assessed before they moved into the home and these were reviewed as to ensure they could be met. Staff ensured people had enough to eat and encouraged people to drink. People were complimentary about the food provided.

There were enough staff to meet people’s needs and staff worked as a team to support each other to ensure people’s needs were met. Healthcare professionals were consulted and involved in people’s care as needed to maintain their wellbeing.

Accidents and incidents were recorded and the registered manager analysed these to consider any trends and to look at any lessons learnt because of these.

The home was clean and tidy and staff had an awareness of infection control.

Full information about CQC’s regulatory response to the more serious concern found during inspection is added to reports after any representation and appeals have been concluded.

Further information is in the details findings below.

The provider of The Meadows is registered to provide accommodation with personal and nursing care for up to 36 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining rooms. At the time of this inspection 35 people lived at the home. The home is split into different areas The Pines and Willows provide nursing care for people and on the first floor The Beeches specialises in dementia care.

There was a manager who had just started their employment but was not yet registered with the Care Quality Commission. They were present at the three days of our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People did not always feel safe because there were insufficient staff to care for them. Many were agency staff who people felt did not always understand or know their needs. People's daily records were not completed promptly. People were not always given a choice of food. The monitoring of people’s fluid and food intake was not always completed in a timely manner.

Staff did not always receive supervisions, so were not given opportunity to reflect on their practice and identify their training needs. Not all staff had the skills or training to support people living with dementia. People were not supported to maintain their hobbies and interests. There was a lack of specialist activities available for people living with dementia.

People’s consent was sought by staff and where necessary people and their families had been consulted on their care.

People told us they didn’t always enjoy the food on offer. A care staff member was standing in for the cook, as there was a staff vacancy. The food offered was sometimes difficult for people living with dementia to eat. The monitoring of people's fluid and food intake was not always completed in a timely manner.

People liked the staff that cared for them; however people felt the inconsistency of staff made it difficult for staff to understand their care needs. People’s privacy and dignity was not respected.

People and their relatives knew how to make a complaint.

Staff reported accidents and incidents to the office however; the management team did not review them to ensure appropriate action had been taken and to reduce the risk of incidents happening again.

Frequent changes in the management of the home left staff feeling unsupported. Staff changes meant that regular checks of the home did not happen. Systems in place to assess and monitor the quality of the service provided were not effective. The provider failed to identify risks and keep people safe.

During this inspection we found significant shortfalls in the quality of the care being provided. We found the registered provider to be in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider of The Meadows Nursing Home is registered to provide accommodation and nursing care for up to 36 people. The facilities within the home are arranged over two floors and divided into three units, Pine, Willows and Beeches. Pine and Willow units are on the ground floor and care for older people with mainly nursing care needs. The Beeches unit is located on the first floor and cares for people with dementia related care needs. At the time of our inspection 20 people lived at the home.

The provider is required to have a registered manager in post. Since our previous inspection a new manager had been recruited and is currently in the process of applying to become registered with us. 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 risks to people’s safety had been reduced by the improved measures which had been introduced since our last inspection. The home environment was checked and action was taken to identify any hazards to people’s wellbeing and safety so these could be removed.

People were supported by staff that knew how to identify harm and abuse and how to act to protect people from the risk of harm. Staffing numbers had been assessed to make sure they were available to support people’s individual needs and keep them as safe as possible. The manager actively listening to where staffing arrangements needed to be reviewed to ensure they were enough staff on all shifts including during the night shift.

People had their prescribed medicines available to them and staff followed safe medicine practices. This included staff always signing to show they had applied people’s prescribed cream and this now needed to be sustained by staff checking this was consistent practices.

Staff had received the training they needed to fulfil their roles and had improvements had been made to their caring practices which had positive impacts for people. Staff were supported to have opportunities of more specialised training to assist them in continuing to improve their practices for the benefit of people they supported.

Staff respected people’s rights to make their own decisions and choices about their care and treatment. People’s permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well. Where people may have restrictions on their liberty and freedom in order to keep them safe applications had been made to the local authority to make sure people were not unlawfully restricted.

Staff were knowledgeable about people’s needs and how to meet those needs and care records were in the process of being improved to accurately reflect the care people received. The care records showed the personalised care people required to help staff consistently meet people’s needs and we saw staff followed these.

People were provided with appropriate food and drink to meet their health needs. People were happy with the food offered. Mealtime experiences had improved to assist people in meeting their eating and drinking needs. Staff showed they were eager to continue to develop and enhance their mealtime practices. This included focusing upon the needs of people with dementia so people’s personal preferences could be met.

Staff were caring and respectful towards people with consideration for people’s interests and life histories when chatting with people. People’s right to private space and time to be alone with their relatives and friends was accepted and respected.

People were supported to have interesting and fun things to do. Further work was in hand to ensure staff practices promoted quality of life for all people by offering social opportunities on a daily basis.

People knew how to make a complaint and felt able to speak with staff or the registered manager about any issues they wanted to raise. People were encouraged to give their views and experiences of the home through meetings and by speaking with staff and the manager who had an ‘open door’ policy.

The manager was keen to develop their staff team and showed they listened to their suggestions. This was evidenced by the on-going developments staff had made to the home environment to make sure it meets the needs of people with dementia as well as making it a nice place for people to live. The manager was dedicated, open and responsive to making further improvements so people consistently received good standards of care and treatment.

During our inspection we found that many of the people were not able to tell us about their experiences of living on Beeches. However we were able to speak with two people, one family member and we received 11 comment cards where people gave their views about the care and treatment that people received.

We found that the people who lived on Beeches that we spoke with were happy with the care that was provided. One person told us: 'It's nice here the staff are very good to me, they support and care for me.' One family member gave us their views about the staff: 'They are patient, caring and compassionate and they interact well in talking and trying to stimulate and get my relative to relax.'

We saw that before people came to live at the home their health and social care needs were identified. This included information about people's dementia care needs and what their daily routine preferences were. This was completed with people themselves as far as possible and with people's representatives to ensure that they felt part of the person's care. However we identified some examples where the risks to people's care and wellbeing were not always being reduced in practice.

The care records that we looked at showed that staff were responsive to the changes in people's needs. We saw that health and social care professionals were consulted with and staff worked with other providers. This made sure that people received the right care at the right time to meet their individual needs.

We found that the registered manager had some systems in place to enable the quality of care to be assessed, monitored and improved.

We were not able to hold conversations with most people. To obtain more information about people's experiences about living at the home we used our Short Observational Framework for Inspection (SOFI) tool. We used SOFI to observe how staff interacted with people. We found that staff treated people with respect and responded to them in a helpful and courteous way.

During our inspection we looked at the arrangements for staff training and how staff were supervised in carrying out their roles. Since we last inspected the service in August 2012 we found that improvements had been made in providing training for staff and in making sure that staff supervisions were carried out regularly. Some staff had received specialist training and some had been booked to undertake extra training so that they were equipped to care for people with specialist needs. We spoke with two staff who told us that the range of training courses provided for them had improved.

We checked the systems for monitoring the quality of the services that were provided to people. We found that the registered manager made sure that there were monitoring processes in place so that improvements could be made when necessary.