Meadway Court

Meadway Court is a residential care home providing personal care to up to 42 people aged 65 and over. At the time of our inspection there were 32 people using the service, many of whom were living with dementia. Care is provided across two floors with a variety of single person bedrooms, some of which are ensuite, and shared communal areas.

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

Medicines were not always being safely managed. Risks were assessed and equipment was in place, but checks were not always robust enough to ensure these were working and set appropriately. Suitable staff recruitment processes were followed but there was not always enough staff who knew people and their needs. The home was clean and tidy, although robust infection prevention processes were not always being followed. People felt safe.

The was no registered manager maintaining oversight of the service in post and a notification regarding this had not been submitted to CQC at the time. The provider and managers from other services had supported Meadway Court and completed various checks and audits. These were not always robust and had not always led to appropriate action. Families and staff felt that some areas of communication could be improved. A new manager had been recruited and was keen to drive improvement and engage people, families and staff. Feedback about the manager and deputy manager was mainly positive.

Staff had completed relevant training and the new manager had begun to look at supervision and support for staff. Good practice guidance was not always followed. Work to improve the environment was being undertaken. People had mixed views about the food, and the quality of support people received varied. Records did not always demonstrate that people who required specific types of diet were receiving these and people did not always have access to drinks.

People were generally 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; policies and systems were in place to support this practice. Oversight of people who were subject to restrictions was not sufficiently robust and improvements were needed regarding record keeping.

Care plans did not always contain the most up to date person-centred information about people, and this had been identified as an area for improvements. It was not always evident that people were receiving person-centred care as some staff did not know people or their support needs. Group activities were available for people to engage with. Records did not always evidence how people who chose to stay in their rooms were supported to engage in meaningful activities.

People generally spoke positively about staff and were happy with the care they received. Not all staff knew people well and we noted some shortfalls in how care was delivered during the inspection.

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 requires improvement (published 24 February 2020). The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the care people were receiving and a recent safeguarding concern. A decision was made for us to inspect and examine those risks. This inspection was also undertaken to follow up on action we told the provider to take at the last inspection.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines and systems for oversight and managing the service.

We have made a recommendation about staffing levels and the how people are supported to eat and drink enough for their wellbeing.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There was a plentiful supply of personal protective equipment (PPE) available. We saw PPE being correctly used by staff. Staff had completed training in infection control and hand washing.

Staff and people living at the home took part in a regular programme of testing for COVID-19 and the registered manager had clear oversight of this process. All staff and residents were supported to access COVID-19 vaccinations. All staff were vaccinated in accordance with legal requirements.

Outbreak principles were appropriately implemented to ensure the risk of the spread of COVID-19 was reduced.

There were regular checks in place to ensure that infection control standards were maintained.

The registered manager told us the provider was supportive and accessible for help and support if they needed it and had been in regular contact throughout the pandemic.

The home was clean and hygienic on the day we visited. Cleaning schedules and records were in place, however these did not always reflect that high touch point areas, such as handrails, had been cleaned in line with guidance.

Meadway Court is a residential care home providing personal care to 40 people aged 65 and over at the time of the inspection. The service can support up to 42 people. This included nine recovery beds to assist people transferred from hospital and three beds for people requiring short-term respite support.

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

On the inspection we identified concerns about safety, oral healthcare and governance. The provider and registered manager commenced immediate action to resolve the issues identified.

Medicines were not always administered as prescribed and staff did not have access to care plans for medicines given ‘when required’. Monitoring documentation was not completed consistently. Staff were recruited safely. People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People were happy living in the home and felt safe.

People did not always receive appropriate support with their oral healthcare. People had their nutritional needs met by the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were positive about the service. People told us staff were kind and caring. People were treated with dignity and respect and were involved in their care planning and delivery. People's right to privacy was upheld. The registered manager could provide people with information about local advocacy services, to ensure they could access support to express their views.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed. People were entertained and stimulated when activities provided were for them. People knew how to complain, and felt concerns raised would be listened to and acted upon.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the services provided. However, audits had not always identified risks to people’s safety and wellbeing. The management team were receptive to our feedback and started to make the required improvements immediately. They were committed to making improvements at the home, and ensuring effective systems were in place.

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 good (published 9 April 2018).

Why we inspected

The inspection was prompted in part due to concerns raised by Her Majesty’s Coroner. A Regulation 28 Report was issued to the service on 26 November 2019 relating to risks around falls. The Coroners and Justice Act 2009 allows a Coroner to issue a Regulation 28 Report to an individual, organisations, local authorities or government departments and their agencies where the Coroner believes that action should be taken to prevent further deaths. A decision was made for us to inspect Meadway Court and examine those risks.

A new falls pathway was now in place at Meadway Court. recent risks had been safely managed. However, we found evidence that the provider needs to make other improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safety and governance 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.

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service. People received their medicines safely and as prescribed by their doctor.

Meadway Court is a care home standing in its own grounds. Accommodation is provided over two floors with a passenger lift as well as stairs between the floors. The home is situated in the village of Bramhall and is close to the local shops and other community facilities. Mead way Court is registered to provide care and accommodation for up to 42 older people some of whom may also have a diagnosis of dementia. All bedrooms are single and 25 have en-suite facilities. The service offers nine recovery beds to assist people transferred from hospital to continue receiving support. At the time of this inspection the service supported 41 people. Meadway Court is one of eleven care homes owned by Borough Care Limited, a not-for profit registered charity.

At the time of this inspection the manager was in the process of applying for registration with the Care Quality Commission (CQC). 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.

We saw the food looked and smelt appetising and was attractively presented with good size portions. People told us they enjoyed the food.

From our observations of staff interactions and conversations with people living at the service, we saw staff had good relationships with the people they were caring for. The atmosphere was relaxed and people told us they felt comfortable. We observed staff being kind, patient and caring to people. We saw that people's privacy and dignity was respected.

We saw that meaningful activities were provided by the Activities and Lifestyle Facilitator (ALF) a full time activity co coordinator who based a lot of planning on people's personal preferences. The service utilised the supply of games, visiting entertainers and activities to help provide access to regular events throughout the week.

Staff understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support.

Procedures were in place to minimise the risk of harm to people using the service. Staff understood how to recognise and report abuse. This helped make sure people were protected by well trained and informed staff. People living at the service and staff spoken with said they thought safe care was provided.

People were supported by sufficient numbers of staff to support them to participate in their daily activities within their home. Staffing levels had been recently revised by the registered provider to provide senior staff and deputies on duty each day. This initiative provided access for everyone to senior leadership and consistent management of the service over a seven day period. We recommended the registered provider reviews published guidance to help them to demonstrate how staffing levels are calculated to meet people’s needs.

Staff were recruited following a safe and robust process to make sure they were suitable to work with vulnerable people.

The building was clean and well maintained. We saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection for example disposal gloves and aprons

Risk screening tools had been developed to reflect any identified risks and these were recorded in people’s support plans. The risk screening tools gave staff instructions about what action to take in order to minimise risks for e.g. for falls.

People had access to healthcare services including from the district nurse, physiotherapy, optician and chiropodist. People were supported to attend hospital appointments as required.

Staff were receiving regular supervision sessions and appraisal. This meant that staff were being appropriately guided and supported to fulfil their job role effectively. Staff received regular training and support to ensure they had the necessary skills and updates to meet people’s needs.

We saw there was a concerns and complaint policy accessible to each person on admission to the home. Complaints, comments and compliments were encouraged by the manager and registered provider. People living at Meadway Court and visiting relatives we spoke with told us they had no concerns or complaints.

The manager and registered provider had systems in place to monitor the quality, including service user and relative surveys, to ascertain their views and opinions about their satisfaction of the service provided. Support plans were still being updated and developed and needed further monitoring to ensure records were appropriately reviewed.

Borough Care organised an annual company awards ceremony. This is an award designed to recognise staff achievements based on specific results and behaviours. Three staff at Meadway had won awards in 2017.

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We spoke with four people who lived at the home who all told us that they were happy with care and support provided.

We spoke with four family members who told us they considered the care to be good.

We found that there were systems were in place to monitor the quality of the service provided.

We found that systems were in place to ensure people were protected from the risk of harm and abuse and we saw evidence to show that people were able to make comments, suggestions and complaints with timely feedback provided by the service.

We saw that processes were in place to protect people from the risks of the unsafe use of medicines.

We spoke with six people who lived at the home who said they were happy with the care and support provided and how they were looked after. They told us that staff respected their rights, privacy and dignity. All six people we spoke with said they felt safe. Comments included "The staff are very kind, very helpful' and 'they are very respectful to me.' People told us that they liked their room and that staff attended to them quickly if they used their call bells. They said they had choice and were involved in the daily activities if they wished to be.

We spoke with four family members who regularly visit the home. All four relatives said that they considered the care to be good. Comments included,' I am confident that Mum is cared for' and 'It's very good here.'

We also looked at sample of care records. These contained up to date information regarding the needs and wishes of individuals and were reviewed regularly to ensure peoples wishes and needs were accurately reflected.

During the visit the manager told us that she will review the frequency of safeguarding training to ensure that staff knowledge of external reporting procedures remains up to date.

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.