Archived: Little Meadows

Little Meadows is a small residential care home providing accommodation and personal care to 12 people at the time of the inspection who may have dementia, mental health needs or physical disabilities. The service can support up to 20 people.

People’s experience of using this service

People’s health and safety had been put at risk due to the poor oversight of the quality of care and safety of the building. Risks were not always assessed and planned for, so people were put at risk. People were not always supported or monitored in relation to their health conditions and health professional advice was not always sought. People were not always protected from the risk of infection. We could not be sure people were having their medicines as prescribed. Lessons were not always learned when things went wrong as there was not always oversight of these.

There were sufficient staffing numbers, however as the manager was having to work care shifts, this was impacting upon their time to manage and have oversight of the service. Staff had received some training although there were concerns relating to supporting people in relation to their health conditions and medicines. There were no training records available to confirm staff had received up to date training.

Staff understood their safeguarding responsibilities but as there was a lack of oversight for some incidents, we could not be confident that every incident was investigated.

People were not always supported to partake in meaningful activities of their choice. People were not always supported to plan for their end of life wishes, although no one was receiving palliative care at the time of the inspection.

People were supported to have enough to eat and drink, although there were concerns regarding the storage and management of food.

People were not always treated well due to the concerns we found in the service. Despite this, people were supported to remain independent. People were involved in decisions about their care.

People and relatives were able to complain and these were investigated and responded to. People were supported to access information in a way that suited them.

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

Rating at last inspection

The service was rated good overall. It was requires improvement in the well-led key question (published 24 June 2017). There had been multiple manager changes since the last inspection and the provider had no quality assurance oversight of the home so the rating has now deteriorated to inadequate overall.

Why we inspected

This was a planned inspection based on the rating at the last inspection. We found significant concerns during this inspection in relation to all key questions, resulting in an overall rating of inadequate.

Enforcement

We have identified breaches in relation to keeping people safe and managing risk, and the oversight of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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, 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 of 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.

There was no registered manager in post at this inspection. 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 were supported throughout by the head of care and the registered provider.

At the last inspection the service was rated good. At this inspection we found the service remained overall good.

Little Meadows required improvements in how services were managed. People were not fully involved in decisions about their home or informed about changes. There had been no registered manager since May 2014; although a manager had been recently recruited they were yet to start work or register with the Care Quality Commission. Quality monitoring systems and staff support systems needed to be improved to ensure good care continued to be provided overall.

People remained safe as staff knew how to recognise and respond to concerns of abuse. There were enough staff to support people to meet their needs as they wished. The provider followed safe recruitment procedures when employing new staff members.

People continued to receive care that was effective and personalised to their individual needs and preferences. They were assisted by a staff team who had the skills and training to effectively support people.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. Staff were aware of current guidance which informed their practice and people’s rights were protected by the staff who supported them.

People received support that continued to be caring and respectful. They were supported by a staff team that was compassionate, thoughtful and respectful.

People’s privacy and dignity was respected by the staff that provided assistance. People were supported at times of upset and distress.

People continued to be involved in developing their own care and support plans. When changes occurred in people’s personal and medical circumstances, these plans were reviewed to reflect these changes.

People’s individual preferences were known by staff members who supported them as they wished. People and their relatives felt comfortable to raise any concerns or complaints.

Further information is in the detailed findings below

People's care was planned and delivered to meet and respect their individual needs. Every person had a plan of care, based on their physical health and other care needs. People's plans described what people needed help with, what they could do for themselves and how they should be supported. A family member we spoke with told us, 'All the staff have patience and compassion ' all credit to them.' They also said, 'The staff are very caring people, they talk to dad like a person.'

During our inspection, everybody received unhurried care and support, at the time they needed it. Our review of the staff rotas at different times over the previous months showed that minimum staffing levels identified and planned for had been met.

We found there were effective processes to record and respond to complaints and other feedback received from people living at the home and their relatives. One family member told us they had previously raised concerns and told us, 'These were all taken seriously and responded to almost immediately and they did not happen again.'

People told us that they have choices of how their care is carried out and that staff providing care treated them with respect and dignity. Staff had received training to ensure that the care is carried out at an appropriate standard.

People were protected from harm and staff were aware of safeguarding procedures and how to act upon any concerns if people were being abused.

The home had systems in place to protect people from the risk of infection and staff were trained appropriately.

Staff had been recruited in an appropriate way and checks had been undertaken to ensure that they were suitable to care for vulnerable people.

The home had systems in place to gain the views and experiences of the people who use the service and had acted upon any suggestions that had been made.