Meadow House Residential Home

We found the following examples of good practice.

¿ At the time of the inspection relatives were not permitted to visit due to a Covid -19 outbreak, though the provider had previously arranged visits for relatives and had facilitated garden visits with social distancing in place. The provider hoped to restore these visits when deemed safe to do so. People were able to communicate with family through alternative means such as video calls.

¿ Where people were in receipt of End of Life care, the provider had implemented visiting guidelines. These guidelines included visiting by appointment only, provision of personal protective equipment (PPE) and was for one nominated person for a period of 30 mins. All visitors were escorted directly to people's rooms and were requested to use the call bell for an escort at the end of the visit.

¿ All admissions to the home were carefully considered and planned to ensure people were admitted safely. The head of care confirmed people had tested negative for COVID-19 before they were discharged from hospital. New admissions and people returning from hospital were supported to isolate in their room for 14 days, in line with guidance. Due to the current outbreak of Covid 19 admissions to the home had been suspended.

¿ Staff used (PPE) in line with guidance, implementing training provided by the clinical commissioning group (CCG), to safeguard people using the service and staff. Arrangements were in place to refresh infection control and PPE training with the CCG

¿ Staff consistently engaged in conversation with people, to reiterate the reason for masks being worn. This provided reassurance to people when they were disorientated and confused.

¿ There were detailed risk assessments to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

¿ The registered manager had systems to ensure there was clear oversight in relation to infection prevention and control. There were comprehensive infection control audits and cleaning schedules in place.

Further information is in the detailed findings below.

Meadow House Residential Home provides accommodation and personal care for up to 24 people, including people living with dementia care needs. At the time of our inspection there were 24 people living in the home.

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

People were happy living at Meadow House Residential Home and told us they felt safe.

There were suitable systems in place to ensure that medicines were securely stored, ordered and disposed of correctly and safely and people received their medicines as prescribed. However, some areas of medicine management required more robust systems to be put in place to ensure the management of medicines remained safe.

Recruitment practices were effective and there were sufficient numbers of staff available to meet people’s needs. People were protected from avoidable harm, and infection control risks were managed appropriately. Systems were in place to monitor incidents, accidents and near misses. There were clear processes in place to monitor risks to people which helped to ensure they received effective care to maintain their safety and wellbeing.

People were supported to access health and social care professionals if needed, received enough to eat and drink and were happy with the food provided. Staff had received appropriate training and support to enable them to carry out their role effectively. They received regular supervision to help develop their skills and support them in their role.

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 were supported by staff who were kind, compassionate and caring and who understood their likes, dislikes and preferences. People had detailed and accurate care plans in place which were person centred. People told us that they were provided with person centred care and fully involved in planning their care and the support they received.

People, relatives and staff were positive about the running of the service and the support they received from the management team and providers. People and staff felt there had been improvements in all aspects of the service since the last inspection.

The management team were open and transparent. They understood their regulatory responsibilities. People and their relatives said the management team were open, approachable and supportive. There were effective governance systems in place to identify concerns in the service and drive improvement.

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 November 2018) and there was one breach of 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

This was a planned inspection based on the previous rating.

Follow up

There is no required follow up to this inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

Meadow House 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.

Meadow House Residential Home provides accommodation for up to 24 people, including people living with dementia care needs. At the time of our inspection, there were 24 people living in the home.

There was a registered manager at the home. 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.

When we completed our previous inspection of the service in September 2017, we found concerns relating to; people being treated with dignity and respect, gaining people’s consent in line with the Mental Capacity Act 2005, and a lack of effective quality assurance processes. At this inspection, we found the provider had taken action to make some improvements in these areas, however we identified they continued to lack effective systems and processes to assess, monitor and improve the quality and safety of the service.

Although most areas of the service were clean, we identified certain areas which posed a risk of infection and contamination due to ineffective cleaning in damaged areas.

People’s medicines were stored securely; however, they were not always stored at the right temperature. Medicine administrated records were not always completed effectively to ensure that people received their medicines safely.

Actions had not been taken to ensure that there were adequate fire safety arrangements within the home.

There were quality assurance systems in place based on a range of audits. However, we found these were not always effective and had not identified the concerns raised during the inspection.

People felt safe living at Meadow House. Staff knew how to identify, prevent and report abuse.

Recruitment procedures were in place to ensure that suitable staff were employed by the service.

People received care and support from staff who were suitably qualified, skilled and knowledgeable to carry out their roles effectively.

New staff completed a comprehensive induction programme and all staff were suitably supported in their roles.

People praised the standard of care delivered and the quality of the meals. Dietary needs were met and people received appropriate support to eat and drink.

People were supported to access healthcare services when needed and to attend hospital appointments.

People were cared for with dignity and respect and were treated in a kind and caring way by staff. Staff knew people well and encouraged people to remain as independent as possible.

Staff protected people's privacy and responded promptly when people's needs or preferences changed.

They involved people in the care planning process and kept family members up to date with any changes to their relative's needs.

Staff interacted with people in a polite and positive way. They spoke about people warmly and demonstrated a detailed knowledge of them as individuals and what was important to them.

People received personalised care and support that met their needs. Care plans provided staff with detailed information about how they should support people in an individualised way.

Where people’s need changed, staff were responsive to ensuring they received effective care.

People had the opportunity to access to a range of suitable activities. There was an appropriate complaints procedure in place and people knew how to make a complaint.

There was an open and transparent culture in the home. Relatives could visit at any time and were made welcome.

Staff were happy in their work and felt supported by management of the service.

At the time of the inspection the registered manager was having a period of planned absence from the home and the deputy manager was providing cover in an acting manager role. 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.

This service was last inspected in July 2016 when we found the provider had not ensured there were sufficient staff available at all times to meet the needs of people; there was a lack of proper and safe management of medicines for people and there was a lack of systems and processes in place to assess, monitor and improve the quality and safety of the service. At this inspection we found that although some action had been taken to address these issues additional improvements were required.

Not all staff had received the training they required to support their role and meet the needs of people. The system in place to monitor the training that staff had received was not robust in identifying staff training needs.

Staff and the acting manager had received training in respect of MCA and were able to demonstrate an awareness of the principles. However they did not always able to apply this to the people they supported. For example appropriate systems were not in place when people were given their medicines covertly and consent from people was not always obtained before providing care and support.

People and their families told us they felt the home was safe. There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. However, the auditing system to check medicine stock was not robust.

Not all staff had developed caring and positive relationships with people. Some people felt that staff did not always speak to them nicely or provide them with choices about their care.

There were enough staff to meet people’s needs. Staffing levels enable staff with the time to engage with people in a relaxed and unhurried manner. There were safe and effective recruitment practices in place.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks. People’s care plans were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence. Environmental risks were assessed and managed appropriately.

People were supported to have enough to eat and drink. People were provided with appropriate support during mealtimes and supported to be independent. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff knew people well and responsive to people’s needs. Care plans were personalised and focused on individual needs and preferences. People were provided with a range of activities.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through six monthly questionnaires. They were also supported to raise complaints should they wish to.

People had mixed views on the management of the service, although all families felt that home was well-led. The acting manager understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

A registered manager was 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.

This service was last inspected in November 2014 when we found the provider had not ensured infection control practices in the home were sufficient to ensure the safety and welfare of people. The provider had addressed these issues at this inspection.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs. However staffing numbers were insufficient to meet the needs of people.

Care plans in place for people did not always reflect their needs and preferences. Risks associated with specific health conditions had not always been identified.

Medicines were stored and ordered in a safe and effective way. However the provider did not have effective systems in place for the administration of all medicines.

Systems in place to manage the cleanliness and infection control in the home were good. The provider had taken steps to address previous concerns in relation to the maintenance and decoration of the building.

Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005 however some records of decisions made in people’s best interests required improving. We have made a recommendation about this. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s nutritional needs were met in line with their preferences and needs.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Staff were caring and compassionate and knew people in the home very well.

Complaints had been responded to in an effective and timely manner and this work needed to be sustained.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People, their relatives and staff spoke highly of the registered manager and felt able to raise any concerns they may have with them. They were sure these would be dealt with effectively.

Whilst there were adequate systems in place to monitor the quality of service and ensure the safety and welfare of people, these had not always been kept up to date.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of this report.

One inspector carried out this inspection and spoke with a manager and three members of staff. We toured and reviewed the cleanliness of the premises, and looked at policies and procedures in place to support the management of infection control.

At the time of our inspection a registered manager was not in post to manage the regulated activities at this location. A new manager was due to begin the week following our visit.

At this inspection we found that the provider had not completed the works necessary to ensure people were protected from the risk of infection. Whilst systems had been put in place to ensure people were cared for in a clean, hygienic environment, these were not monitored and completed effectively.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, caring, responsive, effective and well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe in the home and we saw staff had a good awareness of their needs. People were cared for by people who had the appropriate skills and experience to ensure their safety and welfare. Risk assessments and plans of care held information to ensure staff were able to support people in a way which ensured their safety and welfare.

However, we found some areas of the home were not clean and the provider did not have adequate processes in place to ensure people were protected from the risk of infection. We have asked the provider what they are going to do to address this.

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and provided care which was in line with their agreed plan of care. People told us staff were kind and responsive to their needs at all times. We saw that people's needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind and respectful manner.

Is the service responsive?

People's needs were assessed and reviewed regularly to ensure their needs were met. People and their representatives were encouraged to participate in care planning and review. Staff spoke with people and their representatives to ensure their needs were being met. A new system of key workers was being introduced at the time of our visit to ensure people were involved in planning and implementing their own plans of care. This meant that people were able to express their views of the care they received and have them acted upon.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received the care they needed to maintain their independence and dignity.

Is the service well-led?

The new manager for this service had been working for eight weeks at the time of our inspection. They told us they had identified areas to develop at the home and were working closely with the provider to ensure the service met the needs of the people who lived there.

People told us the manager and provider for this service were very approachable. Staff told us they received support from the management to develop their role and improve their skills. Records showed that staff had regular meetings and opportunities to express their concerns to the manager and provider. Supervision sessions for staff had been completed. Complaints, comments, accidents and incidents had all been responded to in a timely way and actions taken to prevent these recurring. This meant that staff and people who lived at the home were supported to raise concerns and have them dealt with.

We spoke with one relative who said that the care and support their relative received was very good. We were told that if they felt that anything was wrong they would speak to the manager. The relative confirmed that they knew how to make a complaint if they needed to and said they were confident that any complaints would be dealt with appropriately.

We spoke with the registered manager and three members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.

During our visit we also used our SOFI (Short Observational Framework for Inspection) tool to help us see people's experiences of the care and support they received. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that was given to them by the staff.

We used a range of methods to help us understand people's experiences. These included our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences were. The SOFI tool allowed us to spend time watching what is going on in a service and helps us to record whether they have positive experiences.

We spoke with three people who lived at the home. However due to their dementia we were not able to have detailed conversations about their experiences. All of the people spoken with said they were happy at the home. Comments included; “Its fine, I am quite happy” and “The staff are very good”

We also spoke with the home's owner, the registered manager and three members of staff who told us that the felt that the care provided for people was good.

We identified one area of non compliance. We found that although there were assessments of peoples individual needs the assessments did not take into account the combined level of support that staff were required to provide. This meant that the home could not show how staff could meet the needs of everyone at the home to ensure people’s welfare and safety.

At our last visit to the service in June 2012 we spoke with people who lived at the home. All of the people spoken with said they were happy at the home. We also spoke to visitors who were at the home during our inspection visit. They told us that their relatives were supported by staff to receive the care they needed.

At this visit we spoke with the manager and also a new member of staff who had been employed as the quality and improvement manager. They told us that they had been working with social services to improve the quality of the service provided and that they were reviewing an updating documentation in the home.