Meadway Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to ways people’s medicines were managed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The organisation had established processes and procedures in place to promote and support a positive learning culture. However, inconsistent oversight and ineffective monitoring arrangements meant the provider did not always identify risks or recognise opportunities for improvement in a timely manner. While incidents were generally reported and reviewed promptly, lessons learned were not consistently embedded into practice. As a result, opportunities to drive service improvement and enhance outcomes for people were missed. This demonstrated that governance systems were not always operating effectively to ensure safe, high-quality care and continuous improvement.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

People were not always consistently supported through safe systems, pathways and transitions. People had risk assessments in place. However, some of the risk assessments were more detailed than others. This meant it was not always clear how risks were being managed in practice. There was limited evidence to demonstrate how people were involved in developing or reviewing their own risk assessment, which reduced the opportunities for people to understand their risk and make informed choices about their care.

People and staff knew how to raise and communicate concerns. One person told us, “I am comfortable talking to the manager and most of the staff.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had policies and procedures in place to help protect people from avoidable harm. Staff demonstrated a good understanding of safeguarding and were able to describe their responsibilities in keeping people safe. They knew how to recognise, and report concerns and expressed confidence that any issues raised would be acted upon appropriately. One staff member told us, “If there was anything I was worried about, I would go to the manager and speak to them.”

Staff told us they had completed safeguarding training and understood the importance of protecting people from abuse and neglect. However, this was not always reflected in the provider’s training records, meaning the provider could not always evidence that all staff had completed the required training.

People told us they felt safe using the service. One person said, “I definitely feel safe here.”

People were supported in line with the principles of the Mental Capacity Act 2005.We saw evidence that appropriate decision-making processes were followed to ensure care was delivered in people’s best interests when they were assessed as lacking capacity. Although not all staff had completed the provider’s mental capacity training, they demonstrated a good understanding of what capacity meant in practice and how to support people who were unable to make specific decisions for themselves. During the inspection we discussed with the registered manager the need to strengthen arrangements for recording information when advocates or other relevant representatives were acting on behalf of people using the service.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s individual risk assessments were completed. However, these did not always consistently provide the level of detail required to support safe and person-centred care.

People and their relevant representatives were not always involved in conversations and decisions about how their individual risks were managed. Records did not always show that discussions had taken place, nor did they always reflect how people’s views, preferences or goals were considered. This limited the extent to which risk management supported people’s independence, choice and control.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had undertaken appropriate checks to help ensure the environment was safe for people and staff. Environmental risk assessments were in place, including those relating to fire safety, and these were reviewed regularly to ensure risks continued to be appropriately managed.

During the inspection, we saw evidence that equipment used to support people's care, such as hoists and wheelchairs, was subject to regular inspections and servicing. This helped to ensure equipment remained safe, fit for purpose and available when people needed it.

These arrangements demonstrated the provider had systems in place to monitor the safety of the environment and equipment to reduce the risk of avoidable harm to people using the service.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

People, relatives and staff consistently told us there were not always enough staff deployed to meet people’s needs safely and effectively.

One person told us, “Most of the staff are helpful. I don’t think there are enough staff though.” A relative said, “They are completely understaffed though, certainly at night. And today aren’t the usual staffing levels. They seem to have brought more staff in because they know that you [CQC] are here.” Staff also raised concerns about staffing levels. One staff member told us, “There isn’t enough staff. Sometimes we have to leave people in the lounge on their own.”

During the inspection, we observed staff undertaking a range of non-care related tasks, such as cleaning and organising the dining room. As a result, staff did not consistently have sufficient time to engage people in meaningful activities, provide social interaction or respond promptly to requests for support. One staff member told us, “Mornings can be very stressful. We don’t have time to sit down with people and chat.”

Insufficient staffing levels had a direct impact on people's care and safety. During the inspection, we intervened to prevent one person from accidentally scalding themselves with a hot cup of tea as there was no staff member immediately available to support them. We also observed people experiencing delays in receiving assistance after using their call bells, with some people waiting extended periods for staff support.

These findings indicated staffing arrangements were not always sufficient to ensure people's needs were met in a timely manner or to keep people safe.

There was evidence staff received training. However, not all of staff were up to date with their mandatory training. We found staff sometimes lacked sufficient knowledge in key areas, such as moving and handling and how to respond to people who may communicate through their behaviour. Staff had completed Moving and Handling training, however, we observed that some staff did not support people with their moving and handling needs in a safe way. We told the registered manager about this, and they addressed this with staff. Records showed staff completed training in Learning Disability and Autism. Not all staff had received supervision and appraisal in line with the provider’s policy.

Staff was recruited safely. We saw evidence of completed DBS checks, right-to-work documentation, exploration of employment gaps, and obtained references. People and their relatives spoke positively about staff, describing them as helpful and caring. One relative told us, “All staff are so lovely. You only have to ask them once and it’s done.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were appropriate policies and procedures in place to support effective infection prevention and control practices. The home was clean, well maintained and generally free from unpleasant odours. Where any concerns relating to cleanliness or malodours had been identified, the registered manager had taken action to address them.

People spoke positively about the cleanliness of the service. One person told us, “They [staff] keep this place very clean.”

Staff demonstrated a good understanding of infection prevention and control principles and were able to describe the measures they took to reduce the risk of the spread of infection. We observed staff using personal protective equipment (PPE) appropriately and in line with current guidance.

Systems were in place to monitor infection prevention and control practices. Records showed regular checks and audits were completed to assess compliance with infection control procedures. This included observations of staff practice to help ensure standards were maintained and any areas requiring improvement were identified and addressed.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning. Not all the issues found during the last inspection were addressed.

Medicines were not always given in line with the manufacturer’s instructions. We saw medicines that should be given before food were given at the same time as medicines that should be given after food. This meant there was a risk the medicines might not work properly. The remaining quantities of medicines did not always match the quantities that should remain; therefore, we were not assured people were given their medicines as prescribed. We also saw one person had missed a number of doses of their inhaler as there was no stock available.

Staff had completed medicines training and competency assessments; however, we were not assured of the effectiveness of these given the concerns found during the inspection. The service completed medicines audits; however, they were not effective and had not identified the issues we found during this inspection.

Information around people’s medicines was not always accurately documented in their care plan, therefore there was a risk staff would not be able to safely care for people Information for ‘when required’ (PRN) medicines was not always available or accurate. Where information was available, it was not always person-centred. This meant staff may not know when to administer these medicines. When people were prescribed topical preparations, such as creams the records did not include sufficient information to provide assurance peoples’ skin was cared for properly.