Meadowview Care Home

We found the following examples of good practice

Family members spoke positively about the service and how risks associated with COVID-19 had been managed in order to keep people safe. One family member told us "They [the service] have done everything right. All the decisions they have made have been to keep our relatives safe. I couldn't ask for anything more than that." The registered manager and staff regularly communicated with family members to keep them informed of any important changes; particularly in relation to COVID-19.

The home was visibly clean and hygienic and regular cleaning schedules were maintained by house keeping staff to evidence regular cleaning tasks were being completed. Staff had received training in relation to infection prevention and control and were observed following current guidance in the use and disposal of PPE. The registered manager carried out regular spot checks and observations on staff to observe their practice.

Staff and people were supported to access regular COVID-19 testing and the provider had systems in place to ensure they followed current guidance in relation to COVID-19 vaccinations for staff and visiting professionals.

People were supported to maintain regular contact with family members through visits and other forms of communication. Systems were in place to prevent visitors from catching and spreading infections.

Meadowview Care Home is a care home that provides accommodation for up to 41 people who need assistance with their personal care. At the time of the inspection 41 people lived at the service. Some people at the home, lived with dementia.

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

People told us they felt safe and were treated well. Risks to people were assessed and their safety was monitored. People were safeguarded from the risk of abuse. Staff were knowledgeable about the different types of abuse and followed guidance in line with the providers and the local authority safeguarding procedures.

People and relatives were very positive about the staff and manager. They told us they were happy with the care provided.

Medicines were safely managed by staff with up to date training and necessary skills. Medication audits had been reviewed and actions taken where improvements had been identified.

Staff followed safe infection, prevention and control (IPC) practices. They had access to the required personal protective equipment (PPE) used to prevent infections and keep people safe.

Safe recruitment processes were followed to assess the suitability of staff to work at the service. Staff had received regular training to ensure they were able to meet the needs of the people they supported.

People were 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; the policies and systems in the service supported this practice.

Improvements were noted to the systems and processes for monitoring the quality and safety of the service. This included improvements to records, the management of medications and the environment. Further development was needed to continue the refurbishment and decoration of the home and continuation of the development of all care records.

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 good published 30 January 2019.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Meadowview Care Home' at website at www.cqc.org.uk

Why we inspected

We received concerns from the local authority in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well led only, We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained good. This is based on the findings at this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good overall. There were some areas where further improvements were required but no serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a new maintenance staff member in the home during our inspection who had begun to implement an action plan to improve the maintenance checks and records. They were also improving the fire safety according to the most recent fire inspection by Cheshire Fire Service.

There was an online staff training system in place which we viewed on the home manager’s computer. It highlighted where staff training had expired or was due to be completed. Not all staff were up to date with Safeguarding training but they completed their training during this inspection.

Staff understood what their responsibilities were in relation to safeguarding people from abuse and the different types of abuse. They were able to explain the process of safeguarding people.

We found there was a warm, homely, inclusive, calm atmosphere within the home. The environment was conducive to replicating aspects of a person’s home such as a lounge with a decorative fireplace, a phone with a dial, dolls for people to pick up and carry if they wished.

People were seen walking freely and being included such as one person we observed assisting staff to clean and tidy the tables after lunch. Staff treated people with dignity, compassion and respect. We observed people were being treated as individuals and were being supported in a person-centred way. The service had an equality and diversity policy in place.

Healthcare professionals we spoke with were complimentary about the service being delivered for people. People were being supported to access healthcare professionals when they needed them.

There were enough safely recruited staff seen on duty to meet the care needs of people. Staff and the home manager were seen regularly spending time with people in the moment when they needed reassurance.

We observed activities taking place within the home on both days. The activities coordinator knew people well and was skilled in grading the activities according to people’s individual needs to enable everyone who wished to take part to participate in a positive way.

Staff were overheard asking people what their preferences were, where they would like to sit and if they would prefer to be in their room. This demonstrated people were being supported to maintain choice and control of their lives. Staff supported people in the least restrictive way possible.

Care plans were in the process of being updated at the home. Risks had been identified, recorded and reviewed with improvements seen in the way risks were being recorded in new care plans.

People’s weights were monitored appropriately and people were offered a balanced diet. People were provided with a choice of drinks and food. Dietary requirements information held in the kitchen needed updating. This was actioned immediately during this inspection.

There was strong leadership at the home and systems were in place with quality checks undertaken to always seek continuous improvements.

Prescribed medicines were administered safely and medicines were managed appropriately within the home. There were no covert practices in place. We observed staff spending considerable time with individual people to enable them to take their prescribed medicines.

Further information is in the detailed findings below.

During our inspection we spoke with the registered manager, three staff, two relatives and fourteen people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Policies and procedures had been developed by the registered provider (Ashberry Healthcare Limited) to provide guidance for staff on how to safeguard the care and welfare of the people using the service.

The registered manager demonstrated awareness of the Mental Capacity Act and the circumstances when it was necessary to apply for authorisation to deprive a person of their liberty and to ensure the correct safeguards were in place.

Likewise, staff spoken with also demonstrated a sound awareness of the different types of abuse and the action that should be taken in response to suspicion or evidence of abuse.

A safeguarding log was in place. Records highlighted that there had been three safeguarding referrals since our last inspection. Two referrals concerned incidents between people using the service and the other concerned the standard of care provided to a service user. The provider worked in partnership with the safeguarding authority to ensure the welfare of the people who used the service was protected.

Discussion with staff and examination of training records confirmed staff continued to have access to a range of induction, mandatory and role specific training. Systems were also in place to monitor the outstanding learning needs of staff and when refresher training was due.

Staff spoken with confirmed they had attended team meetings periodically and received supervision and appraisal sessions.

Is the service effective?

People were observed to be relaxed and at ease, clean and well-presented. Those who were able to discuss arrangements made for their care told us that they were happy and overall very satisfied with the service.

We noted that the home employed activity coordinators and there was a programme of activities available for people using the service to access. On the day of our visit we observed a group of people enjoying a game of musical bingo in the dining room.

Is the service caring?

The atmosphere in the home was relaxed and sociable. We observed staff carrying out their duties and responsibilities with confidence and skill, in good humour and in a relaxed and positive manner. Staff were seen to be attentive to the needs of the people using the service.

Comments received from people using the service included: 'I am very happy and very well cared for'; 'I like it here. We have a good time and a great laugh'; 'I've been here a year. I've had a wonderful time and I think it's a marvellous place'; 'The staff are great. Always kind and very caring' and 'They look after me very well and understand the things I need assistance with. I think that's very important.'

Likewise, feedback received from relatives included: 'We are very pleased. We have no concerns'; 'The staff have involved us in the development of a care plan' and communication channels are excellent. The standard of care is exceptional and everyone is very dedicated and friendly.'

Is the service responsive?

We looked at the personal files of three people who lived at Meadowview during our site visit and found copies of assessments from social workers. This helped to provide evidence that the needs of the people living at Meadowview were being kept under regular review.

Files viewed also contained a range of assessment and care planning information that had been developed and produced by the provider. At the time of our inspection the service was in the process of introducing a new care planning system.

New care plans viewed had not been signed by the people using the service or their representatives and some information was brief. For example, information on the needs and support requirements of people living with dementia was limited. Other examples were discussed with the manager who informed us that action would be taken to improve records.

Is the service well- led?

The service has a registered manager in place to provider direction and leadership to the staff team. The provider (Ashberry Healthcare Limited) and the registered manager have always worked well with us and keep us up to date on any significant events via statutory notifications.

A range of internal auditing systems have been established to enable the registered manager to maintain an overview of the service. For example, we saw evidence of audits of: care plans; accidents and incidents and medication systems and processes. A new health and safety checklist was also due to be rolled out to improve environmental monitoring. Other auditing systems were also in place for other key areas such as infection control.

The provider had also established systems to involve and obtain feedback from people using the service and / or their representatives. We noted that easy read surveys had not been used to help people understand the information. We have raised this point with the provider to help develop and improve the quality of future consultation processes.

Periodic monitoring of the standard of care provided to people funded via the local authority is also undertaken by Warrington Borough Council's Integrated Commissioning Team. This is an external monitoring process to ensure the service meets its contractual obligations.

People living at Meadowview confirmed that they were satisfied with the standard of care and support provided and were of the opinion that staff understood their needs.

Comments received from people included: "It's a great place to live"; "I've never known a day to pass when we haven't had a good laugh"; "The staff do their very best to help each and every one of us"; "The staff are decent people who understand how to help us"; "There are always plenty of staff around to help out when needed and they have always responded quickly when I've needed help"; "There are activities most days. Today we played bingo and sometimes we have entertainment"; "I'm fine and I'm very happy here. I feel lucky to have found Meadowview" and "The food is great. It's well cooked and nutritious and we get a choice for each sitting."

Likewise, feedback received from relatives included: "The manager and staff are always approachable and helpful"; "I Have nothing but positive feedback and praise for this place"; "We feel very fortunate to have found Meadowview and the standard of care provided is excellent"; "I visit every day and I'm always given a warm welcome and a cup of tea"; "The staff who work here are amazing" and "I don't feel my mum could be in a better place than Meadowview."

For example, comments received included: 'On the whole it's a nice place to be'; 'I like living here. It's warm and comfortable and I get a choice of three good meals each day'; 'I am very well looked after. It's a smashing home in my opinion' and 'It's like a hotel. For me, moving in here has been a positive experience.'

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided. No concerns, complaints or allegations were received from the people using the service during our visit to Meadowview.

People spoken with confirmed they had confidence in the staff that provided care and that there were sufficient staff on duty. Comments received included: 'The girls [staff] are great. We have good banter together'; 'If I need any help or assistance the staff come quickly'; 'The standard of care is first class. The carers can't do enough for you'; 'Staff are lovely'; 'It's brilliant and the manager is fabulous' and 'I'm being looked after and I'm happy.'