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Archived: Meadow View Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 15 March 2019

This unannounced comprehensive inspection took place on the 3 and 4 December 2018.

Meadow View is a residential care home providing accommodation and personal care for up to four people with mental health conditions. 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. At the time of this inspection, three people were using the service. The service is provided from a single, two storey domestic dwelling.

We previously inspected Meadow View in April 2018 where the service was given an overall rating of ‘Inadequate’. We found continued breaches of Regulations 11, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Oversight and management of the service was chaotic and disorganised. There continued to be insufficient governance arrangements in the service and therefore was still not effective in mitigating the risks to people's health, welfare and safety. We found the registered manager had failed to address all the issues raised at the previous inspection in July 2017 where the service was given an overall rating of Requires Improvement as we found ineffective systems for monitoring the quality and safety of the service, insufficient numbers of suitably qualified staff, a failure to ensure people's consent to care and treatment was obtained and their capacity to make decisions appropriately assessed in accordance with the Mental Capacity Act (2005). The registered manager did not operate safe recruitment systems and train staff appropriately to meet the needs of the people who used the service. Risks to people's safety associated with improper operation of the premises had not been identified and action taken to reduce these risks.

Immediately following our April 2018 inspection, we formally notified the provider of our escalating and significant concerns and our decision under Section 31 of the Health and Social Care Act 2014, to impose conditions on their registration as a service provider in respect of the regulated activity with immediate effect to restrict further admissions to the service. We requested the provider tell us by the 23 April 2018 what actions they would take to mitigate the risks we identified at this inspection. This included the immediate risks of scalding from un-covered radiators, exposed hot water pipes, un-restricted windows, staff training and competency assessments. We found shortfalls in the provider’s ability to safely meet people’s specific physical and mental health needs, substance misuse and safe moving and handling. We requested an action plan to ensure dependency assessments were carried out with appropriate numbers of staff available at all times to meet people's needs. We also requested written evidence of the action taken to ensure a robust system was in place for regular maintenance of the premises.

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.

The service has a registered manager who was also the provider and registered as manager at their other service. At the time of this inspection the registered manager was absent and not in direct day to day management of 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 continued not to have a clear understanding of the fundamental standards and regulations in relation to managing a care service. Since our last inspection in April 2018 the deputy manager had been promoted to a

Inspection areas

Safe

Inadequate

Updated 15 March 2019

The service was not safe.

Further work was needed to ensure risks were effectively monitored, managed and mitigated to ensure people's safety and wellbeing.

There was a lack of systems in place to ensure sufficient numbers of suitable staff to support people to stay safe and meet their needs.

Suitable procedures were not fully in place regarding the administration of anti-psychotic medicines.

Staff including the acting manager lacked understanding of when to raise a safeguarding alert with the local safeguarding authority when needed.

Further work was needed to ensure people were cared for in a clean, hygienic and well-maintained environment.

Effective

Requires improvement

Updated 15 March 2019

The service was not consistently effective.

Not all staff had received training in understanding the needs of people with mental health conditions.

We recommended further consideration was needed to consider potential fluctuating capacity for people to make decisions when heavily intoxicated under the influence of alcohol or illicit drugs.

People were not always encouraged to eat a healthy balanced diet because options were limited, and not all the food provided appropriate to maintain good health.

People had access to appropriate services to ensure they received ongoing healthcare support.

Caring

Requires improvement

Updated 15 March 2019

The service was not consistently caring.

The failure to maintain a clean and well-maintained environment did not promote the dignity of and respect for people living in the service.

People were supported by staff who they described as kind.

People were not supported consistently to maintain and develop life skills and their independence.

Responsive

Requires improvement

Updated 15 March 2019

The service was not consistently responsive.

Not all staff had received training in understanding the needs of people with mental health conditions.

Care plans were more reflective of people’s needs.

There was minimal evidence in peoples care plans to reflect any discussions with people as to their views, decisions and wishes for the end of their life.

Well-led

Inadequate

Updated 15 March 2019

The service was not well led.

The leadership and governance of the service remains ineffective and unstable.

The registered manager continued not have a clear understanding of the fundamental standards and regulations in relation to the regulated activity.

There was a failure to display the most recent rating for people and their relatives and visitors to review as required by law.

Further work was needed when working with other organisations when people transitioned from one service to another.