Archived: Mead Lodge Residential Care

Mead Lodge is a care home registered to provide accommodation and personal care to a maximum of 24 older people. At the time of the inspection there were 20 people living in the service.

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

We carried out this inspection in response to concerns about the safety and welfare of people using the service.

People didn’t always receive support from staff at the time they required it. Staff did not respond to people’s requests for support in a timely way and this compromised people’s safety, welfare and dignity.

People’s medicines were not always managed and administered safely. This led to some people not receiving medicines prescribed for them.

Risks to people had not always been identified and planned for. This meant staff did not always have access to information which could guide them on how to reduce risks.

The service did not have an adequate system in place to analyse accidents and incidents for trends. This meant they had not identified trends which they could have acted on to protect people from harm.

The support people needed to reach and maintain a healthy weight was not always documented.

The quality assurance system in place had not identified the shortfalls we identified during our inspection. The company directors did not have a quality assurance system in place to assess the quality and safety of the service at provider level. This meant they did not have adequate oversight of the service.

We were not assured that staff always received appropriate training for the role. Training records demonstrated staff had not always received training in subjects relevant to their role.

Improvements were required to ensure that people’s views about their care were reflected in care planning. Care plans were not always personalised to include information about people’s preferences and life history.

Improvements were required to ensure that people’s capacity to make decisions was consistently assessed under the Mental Capacity Act 2005 and that formal best interests’ processes were followed where appropriate.

Despite the concerns we identified, people told us they felt safe. Recruitment procedures were safe.

People told us care staff were kind and caring towards them.

You can see what action we have asked the provider to take at the end of this full report.

Rating at last inspection: The last rating for this service was good (published 1 February 2019).

Why we inspected

This inspection was carried out in response to concerns about people’s health, safety and welfare.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out an unannounced comprehensive inspection of this service on 15 August 2018. After that inspection we received concerns in relation to the management of people’s individual risks. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mead Lodge on our website at www.cqc.org.uk.

The individual risks to people who lived at Mead Lodge had been identified, mitigated and managed appropriately. The premises and equipment had been serviced and maintained and associated risks identified and assessed. A business contingency plan assessed the risks associated with adverse incidents.

Accidents and incidents had been recorded and assessed and appropriate actions taken to mitigate future risk. Analysis had been completed to identify trends or contributing factors.

During our inspection, we found some areas of the home a little cool and temperatures were taken that showed 21 degrees Celsius or above. We discussed with the registered manager and provider the importance of monitoring temperatures and ensuring they were of an appropriate level for people who were immobile.

Policies in place relating to staff recruitment mitigated the risks associated with employing staff not suitable to work with people who lived at the home. There were enough staff to promptly meet the needs of people and all of the people we spoke with confirmed this.

The provider had disciplinary procedures in place and we saw that these had been used appropriately to manage two incidents that had recently taken place within the home. We saw that incidents had also been used to improve the service and further mitigate risk although not all staff involved had received the support they required.

Staff had received training in safeguarding adults and the registered manager had referred incidents to the local authority safeguarding team. The service used stakeholders for advice in order to improve the service people received.

The service had a registered manager in post who understood their responsibilities and demonstrated accountability. Mead Lodge had recently changed providers who were making improvements to the service and premises.

We received mixed feedback from staff on whether the management team was fully supportive and approachable. People we spoke with were confident in the manager’s abilities and had been encouraged by the recent changes and commitment to further improvements.

Staff told us in the main that morale was good and that they found their colleagues supportive. They told us they worked well together as a team and this was observed during our inspection. We saw that the shift ran smoothly and that staff were in control of their workload.

Mead Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 24 older people, many of whom were living with dementia. At the time of our inspection 21 people were living in the home. People were accommodated in rooms with en-suite toilets, and there was one communal bathroom available for people to use, as well as further communal toilets, communal lounge and a further lounge and dining area. There was a large accessible and secure garden and patio.

At our last inspection in 2016 we rated the service Good. We carried out this comprehensive inspection in response to some concerns which had been brought to our attention. These concerns related to the culture within the home and the management of risks in relation to people falling. At this inspection, we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager working in the service. 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 registered manager had been in post approximately 19 months.

Why the service is rated Good:

Risks to people’s safety were identified and mitigated as much as practicable. Where required, equipment was in place to support people to move safely. Accidents and incidents were recorded and investigated and lessons learnt in an attempt to reduce them from re-occurring.

The feedback we received in relation to the culture within the home was in the main positive. Good leadership was in place. Staff worked well as a team and they communicated effectively with each other.

There were systems in place to ensure that enough staff were on shift to deliver care to people, and that there were safe recruitment practices in place. Where agency staff were used, the home sought information about these members of staff in terms of their backgrounds in care. Staff had knowledge of safeguarding and reporting concerns to keep people safe from the risk of abuse. Medicines were administered as prescribed.

Staff received training relevant to their roles as well as supervisions where they could discuss their role. They had knowledge of how to support people to make decisions according to their mental capacity, and asked for consent.

People were supported to eat a balanced diet and drink enough, and were supported with special diets where required.

Staff worked effectively with other healthcare professionals and organisations to ensure people had good access to healthcare and received the care they needed. They followed recommendations from healthcare professionals.

There were aspects of the environment which were helpful for people living with dementia, such as coloured doors and light areas of the home, and some aspects which needed further work. These included bathroom facilities and covering any exposed pipes which may become hot.

People were supported with their individual needs and conditions, and there was associated guidance for staff in their care plans. People participated in some activities with staff, and were able to spend their time as they wished.

Relatives and people were encouraged to raise any concerns and complaints, and these were resolved appropriately.

People and their families were kept informed of any changes within the service and found the management team approachable. There were systems in place to monitor and improve the service.

Mead Lodge is a care home service without nursing for older people and those living with dementia. It accommodates up to 24 people. At the time of our visit, there were 24 people living in the home, all of whom were living with dementia.

Staff knew what to look for that might suggest people were at risk of harm or abuse. They understood their obligation to report any concerns. They had received up to date training in this area. Recruitment processes also contributed to protecting people from the risk of harm or abuse, and there were enough staff to meet people’s needs safely.

People’s records contained detailed risk assessments relating to the individual. These included risks associated with using equipment to support people to move, pressure areas, falls and risks associated with people’s physical and mental health. They contained clear guidance for staff on how best to mitigate risks. The environment in which people lived was kept maintained with the appropriate checks in place.

People received sufficient amounts to eat and drink, with assistance from staff when needed. The food was freshly cooked in the home and people were given a good choice every mealtime.

People had timely access to healthcare and were supported to see health care professionals if they required. Staff knew people well, and reassured them effectively when needed. Staff were caring, patient and compassionate towards the people and their families. They also had a good understanding of dementia care.

Staff asked people for consent before delivering care, and when people lacked capacity to make decisions, they were made in people’s best interests. People were supported to do things as they preferred, such as get up and go to bed when they wished, and were encouraged to make choices where they could.

People were supported to engage in activities which followed their interests, and staff responded to individual needs. The care plans also contained details about people’s lives, so that staff knew about them. Staff also responded to changing health needs in a timely manner, so that people received the support they needed.

There was good leadership in place, and staff felt well supported. The registered manager was approachable for families and people living in the home. There were many audits in place to check that systems were running effectively, and pick up where improvements were needed. Actions were then taken to make suggested improvements.

Below is a summary of what we found.

Is the service safe?

From our observations of people using the service, people were able to communicate in a way which showed they felt safe and liked the staff. The relatives we spoke with all stated they felt their family members were safely cared for at the service. One relative said, 'My family member is always kept safe.' Another relative said, 'They look after my family member very well.'

Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider was taking appropriate action to ensure that practices to protect a person from the risk of harm were lawful and in accordance with the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone's behalf is recorded, including the reasons why it has been made, how the person's wishes have affected the decision and how they were involved in the decision making process. Deprivation of Liberty Safeguards are a part of the Mental Capacity Act and ensure that protections are put in place for people who lack capacity and who may be deprived of their liberty.

Is the service effective?

The relatives we spoke with told us, and our observations confirmed, that people were well supported by the service. Staff we spoke with told us they enjoyed their job. It was clear from our observations, and from our conversations with staff and the manager, that staff knew people's needs well. Staff were able to demonstrate they gave thoughtful consideration as to how best to meet each person's needs.

Staff worked closely with professional health staff to ensure that people's needs were met by staff with the most appropriate, knowledge, skills and experience.

Is the service caring?

The relatives we spoke with all expressed the opinion that staff were caring. One relative said, 'Staff are very kind. They are very patient. They are marvellous. You can't fault them.' Another relative said, 'If I have a problem staff will always sort it.'

The staff we spoke with told us how much they enjoyed their work at the service. One member of staff said, 'I enjoy working here. It's just a lovely place to work. We work as a team.'

We observed that people were listened to and staff spoke to and interacted with people in a positive, respectful and kind way. Staff told us how they supported people and they spoke in a caring and sensitive way about each person's needs.

Is the service responsive?

People's needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people's likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

The provider engaged with a range of local and national research projects. People's care and treatment reflected relevant research and guidance.

Is the service well led?

The majority of staff had received regular formal supervision. All staff had received an annual appraisal. They told us they received guidance from the management team. Staff were offered an additional type of support in the form of dementia care coaching.

The relatives we spoke with told us they felt the service was well-managed. They said they were confident to raise any concerns or complaints they had with the manager. One relative said, "I have very little reason to complain, but when I do the management are very responsive.'

The provider had effective quality assurance and audit systems in place to monitor all aspects of the service and ensure improvements were made where necessary.

Care plans and assessments were reviewed regularly and detailed information was available for staff to help them support people in the way they wished to be cared for. People were supported to make decisions themselves, but where they were unable to do so decisions were made in their 'best interests'.

Staff encouraged and supported people to receive adequate nutrition and hydration and identified when people may have been at risk.

The home had systems in place to deal with comments and complaints. Where a complaint had been made the manager reviewed and revised the service provision and made improvements.