Meadowbrook Manor

Meadowbrook Manor is a residential care home providing personal care to older people. Meadowbrook Manor accommodates 31 people in one adapted building. At the time of our inspection there were 23 people using the service.

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

Recruitment checks were carried out by the management team, but this was not always done robustly. 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 did not always support this practice. Risks associated with people’s care were managed safely and systems were in place for learning lessons when things go wrong. Most aspects of people's medicines were well managed. People told us there were always enough staff to give them the care they needed and they knew the staff who cared for them well. They also told us they felt safe. The provider followed safe infection, prevention and control procedures. The service had systems in place to safeguard people from abuse.

People received high quality person-centred care. Feedback about the standard of care, leadership and quality of staff was consistently positive. Staff felt valued and were proud to work at Meadowbrook Manor. Quality assurance was usually effective although some areas of risk, such as gaps in the recruitment process, had not been picked up through the provider’s system. The registered manager confirmed the provider was introducing additional governance support. Records showed people’s care was planned and reviewed. The service worked effectively with other professionals to support joined-up 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 11 September 2020). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an inspection of this service between 11 and 17 August 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance arrangements. We undertook this focused inspection to check they 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 and well-led which contain those requirements. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadowbrook Manor on our website at www.cqc.org.uk.

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.

Follow up

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

Meadowbrook Manor is registered to provide accommodation for a maximum of 31 people who require personal care to adults aged 65 and over. It is located in a residential area close to Garforth town centre, near Leeds and is near to local amenities. At the time of inspection 25 people. Living at Meadowbrook Manor.

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

There were sufficient staff available to meet people's needs and to socially engage with them, however staff were not adhering to the current government guidelines regarding to the COVID-19 pandemic. The deputy manager looked at this again after the inspection to ensure they were up to date with any changes to these guidelines to keep people safe.

We found shortfalls in areas of governance within the home. The registered manager had not been present in the home for some months. The deputy manager recognised these shortfalls. After the inspection the deputy manager received support any gaps identified at the inspection.

People were safeguarded from the risks of abuse, staff received training in this area and knew how to recognise and report abuse. Staff were confident that appropriate action would be taken to keep people safe. Risk assessments were in place to minimise risks. Staff were knowledgeable about risks associated with people's care.

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 happy with the quality of care and support they or their family member received. The management team supported staff to deliver person centred care to people. The deputy manager engaged people in the service and listened to their comments. People described staff as being, ‘nice and caring.’ Relatives felt involved in the care of their loved ones and felt staff were well trained.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 16 September 2017) At this inspection we found the service had deteriorated to requires improvement.

Why we inspected

We undertook this focused inspection due to concerns we received. This report only covers our findings in relation to the key questions safe and well-led which refer to those concerns.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadowbrook Manor on our website at www.cqc.org.uk.

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 to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance.

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

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. We have asked the provider to complete an action plan to show how they will improve the service.

Meadowbrook Manor is registered to provide accommodation for a maximum of 31 people who require personal care to adults aged 65 and over. It is located in a residential area close to Garforth town centre, near Leeds and is near to local amenities.

The home is an adapted three story building and there is a passenger lift to access all the floors. Externally there is parking for a limited number of cars. There was a large lounge and an open plan dining area on the ground floor. The home also had another lounge on the first floor which included a hair dressing salon and sofa’s to relax. This was a functional room for people to have their hair done or for when family’s had parties.

There was a registered manager at the home and a deputy manager. A registered manager is a person who has registered with the CQC 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 the last inspection in August 2016 Meadowbrook Manor were rated as requires improvement due to concerns over medicines management and issues in relation to the operation of the quality assurance systems as accidents and incidents were not being effectively monitored. At this inspection we found that these concerns had been addressed.

Medicines were managed effectively and all medicines stored correctly in line with the providers policy.

Accidents and incidents were managed well with actions taken when required and there was a policy with guidance for staff to follow should an incident occur.

People using the service felt safe and staff had a clear understanding of how to protect people from any harm. Staff were provided with annual safeguarding and whistleblowing training.

The provider completed appropriate checks to ensure the safety of the premises.

Staffing levels were adequate to meet people’s needs and recruitment checks were carried out to ensure people were not placed at risk.

People using the service were met by staff who clearly communicated with them on all aspects of their care.

Mental capacity assessments were completed for people however, we saw on one occasion documents had not been recorded in line with the MCA principles.

We found that one of the DoLS applications had expired on 7 April 2017 but had not been renewed until 21 June 2017. This meant that the person may have been unlawfully restricted as there had been no DoLS in place for a period of 10 weeks and the application process had not been completed.

Maintenance logs were used to identify issues regarding the upkeep of the environment or premises, although dates were not always recorded for completion.

Staff were provided with adequate training to do their job. Supervisions and appraisals were also completed to ensure staff could develop their skills and be managed effectively.

People told us they enjoyed the food, were encouraged to make choices about what they ate and drank. Fridge temperatures were not always completed.

Monthly weight monitoring records were in place. Staff informed us nutritionists and dieticians were contacted should a person require further support. Other health care professional’s visited the home when there was a need.

People using the service and their relatives felt staff were caring and friendly. Staff had built positive relationships with people and involved them in all aspects of their care.

Staff respected people’s privacy and dignity. We saw people’s diverse needs were catered for and care planned for these. People using the service were encouraged to be independent and risk assessments completed to make sure people were safe.

People were included in the care planning process and initial assessments were completed with reviews of people’s care carried out. Activities were provided to promote peoples wellbeing.

Complaints were managed well and actions taken when needed. Staff and people using the service felt confident to complain if required.

People using the service and staff spoke positively about the management arrangements in place at Meadowbrook.

Policies and procedures were in place and updated to ensure staff followed relevant and up to date practice. The provider carried out a variety of audits to ensure people using the service were safe.

The provider used questionnaires, surveys and meetings to receive feedback about the service and to monitor the quality of the service provided to help learn and develop the service.

Meadowbrook Manor is a care home registered to provide personal care and accommodation for up to 31 people. At the time of inspection 29 people were living there. The service had a registered manager. 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 people were happy with the care they received. People felt staff were caring. We saw people received good support during the inspection and enjoyed the company of staff.

People told us they felt safe and didn’t have any concerns about the care they received.

We found the provider was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS) and of the Mental Capacity Act 2005 (MCA). Staff understood how to help people make day-to-day decisions and were aware of their responsibilities under the MCA and (DoLS).

We found staff had training throughout their induction and also received refresher training in areas such as dementia care, MCA, DoLS, safeguarding, health and safety, fire safety, first aid and infection control. This meant people living at the home could be assured staff caring for them had up to date skills they required for their role.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering, storage and disposal of medicines. However, two topical creams were not labelled so we could not determine when these had been opened. Specific times for medication were not on the medication of administration records (MAR). The assistant manager dealt with this straight away by liaising with the doctor on the day of inspection.

People enjoyed some social activities and had good experiences at mealtimes. People’s health needs were met.

People told us the food at the home was good and they had enough to eat and drink. We observed lunch being served to people and saw people were given sufficient amounts of food to meet their nutritional needs.

The assistant manager and registered manager had reviewed staffing numbers to help ensure there were enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff felt supported and had regular supervisions and appraisals.

There were systems in place to monitor accidents and incidents; however, there were no outcomes in relation to these to ensure what the service had learnt from incidents at the time of our inspection.

People told us they would feel comfortable raising concerns or complaints. People provided positive feedback about the assistant manager and registered manager.

People were treated with respect and dignity by staff and supported to maintain their independence. We found that care planning processes were good and people were involved in decisions about their care. We saw that there was a range of activities tailored to meet people's needs and people were involved in planning these.

We saw from records that there were different health and social care professionals working in partnership with staff and their expertise was called upon appropriately to meet the needs of people living in the home.

We observed that the home was well maintained and there were processes in place to ensure that equipment was maintained and in safe working order.

We looked at records and found that these described peoples needs and were reviewed and updated on a regular basis. Staff records showed that they had access to training and regular supervision to support them to undertake their role. One staff member describing her role as a carer told us, "We're in a privileged position".

'I like living here very much.'

'The staff are very good.'

'I'm very well looked after.'

'[My relative] regards this as home and gets on well with the staff.'

We observed care practices and people who used the service were treated with respect and dignity. We looked at three care plans and found that they were up to date, provided good information about how people's care and support needs were assessed. People said they were happy and felt safe living at the home. We saw evidence that demonstrated the provider had taken appropriate steps to ensure that staff were suitably skilled and experienced to carry out their roles. People told us that they were aware of the complaints process, knew who to speak to and felt confident that complaints would be investigated and responded to.