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Archived: Meadow View Inadequate

Reports


Inspection carried out on 3 December 2018

During a routine inspection

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 carried out on 16 April 2018

During a routine inspection

We carried out this unannounced comprehensive inspection on the 16 and 19 of April 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, four people were using the service. The service is provided from a single, two storey domestic dwelling.

We previously inspected Meadow View in July 2017 where the service was given an overall rating of Requires Improvement as we found the registered provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Shortfalls included, 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 provider did not ensure that person’s employed were recruited safely and trained appropriately to meet the needs of the people who used the service.

At this inspection we found a deterioration in the management of people’s safety and welfare. We found a continued breach 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 provider had failed to address all the issues raised at the previous inspection. There had been deterioration in the quality of care in other areas, which meant the provider was also in breach of other Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people’s safety associated with improper operation of the premises had not always been identified and action taken to reduce these risks.

There was a lack of a clear vison and credible strategy to deliver high quality care and support, and promote a positive culture that is person centred, open, inclusive, empowering, which achieves good outcomes for people.

Immediately following our 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 2008, to impose conditions on their registration as a service provider in respect of the regulated activity. This included placing conditions on their registration with immediate effect to restrict further admissions to the service. The commission is further considering its enforcement powers.

We requested the provider to tell us by the 23 April 2018 what actions they would take to mitigate the risks we identified at this inspection. For example, in relation to 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 relation to their ability to safely meet service users’ specific physical and mental health needs, substance misuse and safe moving and handling. We also requested evidence of action taken to ensure dependency assessments were carried out with appropriate numbers of staff available at all times to meet people’s needs. Other conditions included a request for written evidence of action taken to ensure a robust system in place for regular maintenance of the premises.

The service had a registered manager who is also the registered provider and who was also registered as manager at their other service. A registered manager is a person who has registere

Inspection carried out on 5 July 2017

During a routine inspection

The inspection took place on 05 July 2017 and was unannounced. Meadow View provides accommodation and personal care and support for up to four people, some who may have a mental health need. At the time of our inspection there were four people who lived in the service.

The service had a registered manager in post who was also the provider. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

People could be confident that they would always be kept safe at the home through effective risk management and appropriate processes being followed to safeguard people.

People were supported to receive their medicines as prescribed. People were protected by the use of best practice guidelines for safe medicines management.

People were not always supported by staff who had been deployed effectively or who were equipped with sufficient training and support in their roles. Staff had not had sufficient pre employment checks undertaken and supervision and appraisal support for staff had lapsed.

People told us that staff understood and met their needs and staff demonstrated awareness of people's healthcare needs.

People were not always supported in line with the principles of the Mental Capacity Act (2005) due to practices in place at the service.

People told us that they enjoyed the food at the service, and people's dietary needs were monitored.

People were supported to access healthcare support to ensure people stayed well and people had developed good relationships at the home with staff, relatives told us that staff were kind and caring and we observed caring actions in practice.

Staff practice at the home promoted people's privacy and dignity and reflected a person-centred approach. Relatives told us that they had been involved in care planning and people where they were able, told us they were supported to make decisions about their care.

People told us that they were happy with the care they received. Most people were supported to participate in activities of interest to them, although this was minimal and the provider is advised to explore the interests and needs of all people living at the service.

People and relatives we spoke with told us that they felt comfortable raising concerns, and there were some formal processes in place to empower people to do so.

The registered provider had failed to consistently implement systems and processes to monitor and improve the quality of care that people received. The registered provider had not established clear oversight of the service and we identified several examples where systems and processes had failed to be monitored to ensure the safety and care that most people received. The registered provider demonstrated their on going intention to provide people with person-centred care and to address areas of concern that had been identified during our inspection.

You can see what action we told the provider to take at the back of the full version of the report summary.

Inspection carried out on 8th July 2015

During a routine inspection

The inspection took place on 08 July 2015 and was unannounced. Meadow View provides accommodation and personal care and support for up to four people, some who may have a mental health need. At the time of our inspection there were three people who lived in the service.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

The service had appropriate systems in place to keep people safe, and staff followed these guidelines when they supported people. There were sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time. The provider also had a robust recruitment process in place to protect people from the risk of avoidable harm.

People’s health needs were managed by staff with input from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people’s healthcare needs were well managed. Staff interacted with people in a caring, respectful and professional manner, and were skilled at responding to people’s care and support needs.

People were encouraged to take part in interests and hobbies that they enjoyed. They were supported to keep in contact with family and develop new friendships so that they could enjoy social activities outside the service. The manager and staff provided people with opportunities to express their views and there were systems in place to manage concerns and complaints.

There was an open culture and the management team demonstrated good leadership skills. Staff were enthusiastic about their roles and they were able to express their views. The management team had systems in place to check and audit the quality of the service. The views of people and their relatives were sought and feedback was used to make improvements and develop the service.

Inspection carried out on 13 January 2014

During a routine inspection

We met two of the four people who used the service. One person told us about their college course and said that they were happy living in the service. We asked the other person if they were happy living in the service and they smiled and nodded.

We looked at the care records of two people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights. We saw that people's consent was sought regarding their care and treatment. We found that people's comments and concerns were listened to and acted upon. We saw records which showed that people were provided with their medication at the prescribed times.

Staff personnel records that were seen showed that staff were trained to meet the needs of the people who used the service. This was confirmed by two staff members who told us that they were provided with the training that they needed to support people effectively.

Inspection carried out on 18 March 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service. This was because the people living at the home had complex needs which meant that they were not all able to tell us their experiences. We spoke to some people living at the home and were able to observe staff supporting people.

We saw that the people living at the home were supported and encouraged to exercise choice in their day to day lives. Independence was also promoted and staff worked with people to achieve this. People received the care, support and treatment they needed and this was provided in an individual way.

During the course of our inspection we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s behaviours and their way of communicating their needs.

Staff looked after people's healthcare needs in a proactive way. The staff team were well trained and supported to carry out their role.

The provider had effective systems in place to monitor the quality and safety of service that people received.

Inspection carried out on 12 December 2011

During an inspection to make sure that the improvements required had been made

People told us that they were satisfied with the level of care and support they received

at Meadow View. One person with whom we spoke told us "I am happy here, they look after me and I like my room the way it is."

Those people with whom we spoke said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People told us when we visited that they liked the home and that they liked living there.

People told us that they liked their rooms and found them comfortable.

People told us that there were generally staff available to them whenever they needed them. People told us that staff were kind and caring and that, "It is very relaxed, I am very happy."

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.

Inspection carried out on 21 June 2011

During a routine inspection

People told us that they experience good care and are happy with the service they receive. One person told us “It’s very good here I can look after myself but if I need help it is good someone is there." People told us that they feel well looked after by the staff at Meadow View. One person with whom we spoke said, "This is a roof over my head and I can be myself." Where people were unable to provide a verbal response or tell us their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Meadow View to be positive.

Reports under our old system of regulation (including those from before CQC was created)