Background to this inspection
Updated
6 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. Inspection activity started on 27 January and ended on 6 February 2020. We visited the office location on 27 and 30 January 2020.
What we did before inspection
Before the inspection, we reviewed all the information we had received about the service including information about important events which the service is required to tell us about by law. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with 13 people who used the service and three relatives about their experience of the care provided. We spoke with four members of staff including the regional manager, registered manager, two team leaders.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with a further three care staff over the telephone.
Updated
6 March 2020
About the service
Meadow Green is an extra care housing scheme registered to provide personal care, consisting of 53 one or two-bedroom flats. People who live at Meadow Green have their own tenancies. The service also includes Meadow Green Lodge, a separate building of 10 flats which delivers specialist support to people living with Dementia. The extra care scheme has on-site care staff 24 hours a day. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. 34 people were provided with a personal care service.
People’s experience of using this service and what we found
There was a lack of quality assurance systems to monitor service delivery which meant areas which needed to improve had not been identified or actioned. There had been an emphasis on recruiting and managing staff at the service, which had limited the time available to ensure other aspects of quality was monitored. For example, care plan audits had not been completed by the registered manager, so improvements had not been made where required.
Staff were supporting people 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. However, the requirements of the Mental Capacity Act were not met, as mental capacity assessments were not routinely completed for specific decisions such as, consent to medication. All staff we spoke with ensured they acted in people’s best interests but without the necessary assessments in place to support their practice.
People told us they felt safe at the service and staff were responsive to their needs. Some of the documentation around the management of risk needed to improve to ensure all risks were identified and recorded risk reduction measures were in place.
Staff were recruited safely, although references were not always obtained from the last employer. Staff received the induction, and support they needed to fulfil their role.
People’s nutritional and healthcare needs were met. Staffing was organised to make sure people received their calls within an acceptable timeframe. Staff stayed the full length of the call, people weren’t rushed, and staff had time to chat with people, which positively benefited their wellbeing.
People and relatives said staff were kind and caring. People received support from regular and consistent care staff who knew them well. Support plans showed the support people needed on each call although improvements were required in some sections of the care plans.
Staff really understood and were supported to work in a person-centred way. They enjoyed their roles and felt well supported by the management team. They described a positive culture at the service where all staff worked together for the benefit of people using the service. Activities were also offered to people to avoid social isolation and improve mental wellbeing, and people really valued this.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 29 January 2018 and this is the first inspection. There was an inspection on 23 and 30 January 2019. However, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.
Why we inspected
This is a planned re-inspection because of the issue highlighted above.
Enforcement
We have identified breaches in relation to governing arrangements and mental capacity assessments (consent to care) 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 for 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.