OSJCT Meadowcroft

There was a registered manager in post. 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.

At our last inspection in April 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated 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.

Why the service is rated Good.

People continued to be safe in the service. Risks to people were assessed and there were plans in place to manage those risks. People received their medicines safely. There was a robust recruitment and selection process in place. This ensures prospective new staff have the right skills and are suitable to work with people living in the home. There were sufficient staff to meet people's needs.

People were supported by an effective service that ensured staff had the skills and knowledge to meet people's needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People received food and drink to meet their dietary needs.

Staff continued to support people in a caring way, showing kindness and compassion. People were treated with dignity and their privacy was respected. People were involved in their care.

The service continued to be responsive to people's needs and valued them as unique individuals. The registered manager was planning to increase the scope of activities to ensure people’s individual interests were met. Staff understood the importance of supporting people to have a good end of life as well as living life to full whilst they are fit and able to do so. End of life care plans include people's thoughts, feelings and wishes to ensure their passing is comfortable, pain free and as peaceful as possible.

The service continued to be well-led. The registered manager and wider management team promoted a person-centred culture that was open and honest. People, relatives and staff were valued and listened to. There were effective systems in place to monitor and improve the service. Systems included gaining feedback from people and relatives about the quality of the service and drive improvements.

Further information is in the detailed findings below.

Meadowcroft is registered to provide accommodation for 71 older people who require nursing and personal care. At the time of the inspection there were 69 people living at the service.

The service had a registered manager in place. 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 had transferred from another of the providers locations. Their previous location had been well led and the registered manager had recently been recognised with a county award for 'Leader of the Year 2014'. People, visitors, staff and visiting health and social care professionals felt the service was well led and were very complimentary about the registered manager.

There was a calm, warm and friendly atmosphere at the service. People felt respected, cared for, valued as individuals. People benefitted from a wide range of activities and social interaction. Staff knew the people they cared for and what was important to them. Staff appreciated peoples unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records. Staff offered support in a way that promoted people’s independence

People had been involved in reviewing their care. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Care plans were detailed and reflected the care, support and treatment people were receiving. Staff followed guidance in care plans and risk assessments to ensure people were safe and their needs were met. Where required, staff involved a range of other professionals in people’s care. Staff were quick to identify and alert other professionals when people’s needs changed.

People were supported to have their nutritional needs met. People were complementary about the food. The menu offered people choice and variety and alternatives were available if people did not want what was on the menu. Mealtimes were flexible according to people’s choice and preference.

Medicines were stored and administered safely.

People felt supported by competent staff. Staff were motivated to improve the quality of care and benefitted from regular supervision, team meetings and training to help them meet the needs of the people they were caring for.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people these had been legally authorised and people were supported in the least restrictive way.

The building was well maintained. The service was clean and people were protected from the spread of infection. Equipment to support peoples care was clean, serviced regularly and stored appropriately.

A single inspector carried out this inspection. The focus of the inspection was to answer two of our five key questions in relation to this outcome; is the service safe and is the service effective?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Since our last inspection all care staff had received training in record keeping. All of the care records for people who used the service had been reviewed and updated. People had detailed risk assessments and care plans that meant they were protected against the risks of unsafe or inappropriate care and treatment.

Is the service effective?

People were effectively cared for because staff followed well developed and reviewed care plans.

On the day of our visit there were 69 people living at the home. We spoke with seven people who used the service, five relatives and twelve staff. These included nursing, care, housekeeping and kitchen staff. We observed care and treatment and looked at eight care records. We also carried out a short observation framework for inspection (SOFI). A SOFI is used to capture the experiences of people who use the service who may not be able to express this for themselves.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found;

Is the service safe?

There was no evidence that care was not safe. However, we found people's care records, risk assessments and care plans were incomplete. This meant that people were not always protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them.

People were treated with respect by the staff, their dignity upheld and their independence promoted.

There were arrangements in place to deal with foreseeable emergencies. There was emergency lighting and plans for managing the person's needs in the event of a power failure. Each person had an emergency evacuation plan for use in the event of a fire.

Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and would take appropriate action if a person required a DoLS.

Is the service effective?

Effectiveness relates to how well the planned care works for people. Because record keeping was not always complete it was not possible to assess if planned care was always effective. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We found that staff had received training to meet the needs of the people living at the home.

People received a well-balanced diet and were involved in choosing what they ate. The people we spoke with said they were happy with the meals provided. One person told us 'the food is good'. During lunch people said the food was 'lovely' and 'the carrots are very nice'. A relative told us 'the food is excellent'. Specialist dietary needs had been assessed and catered for. People were assisted to eat and drink if required.

Is the service caring?

The home was caring. People we spoke with were complementary about the care they received. One person said, "It's a lovely home I'm very well cared for'. Another said, 'I couldn't be better cared for, they are a smashing lot'. A relative told us, "very, very caring, absolutely no concerns. I know I don't have to worry about mum. Staff are so caring they make eye contact and 'capture' mum even if it's only for a moment'. Another relative said, 'first class, couldn't be better'. It was clear from what we saw and from speaking with nurses and care workers that they understood people's care and support needs and that they knew them well.

Throughout our inspection the atmosphere was calm and pleasant. We observed the way that nursing staff spoke with people was warm, friendly and polite.

Is the service responsive?

The home was responsive. People's needs had been assessed before and on admission to the unit. We saw evidence that nurses and care workers recognised when a person's condition changed or their health had deteriorated and sought the help and advice of the medical team or other professionals. This meant that the service responded to peoples changing needs.

Is the service well-led?

The service was well led. There was a registered manager in post who was visible and available for people and staff to raise any concerns. We saw that the provider took account of complaints, comments and feedback to improve the service. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.

We spend time talking with 10 people and four relatives. All expressed their satisfaction of the care provided at the home. One person told us "this is a nice place to live. I have nothing to complain about. I get on well with all the staff. The home is well run and I can do whatever I want to do". All nursing, care workers and support staff had received training in safeguarding vulnerable adults from abuse including mental capacity training and deprivation of liberty safeguards. This was documented in training records and included regular updates.

Medicines were safely administered. We spoke with 10 people who told us had no concerns about how their medication was managed.

People told us there were always enough staff to meet their needs. This meant that all people had a named care worker responsible for their care.

We saw that audits were carried out monthly. The area manager visited the home several days per month. We looked at a sample of accidents, complaints, care plans and medication. Each audit seen was compliant. If action had been needed then a short time scale is given to the manager to address the deficit .

We saw that regular staff meetings had taken place as well as resident and relative meetings. Both meetings had been well attended.

Staff were knowledgable about the needs of people who used the service. We were told that training, communication and support was good.

People told us that if they had a complaint, they would speak to their family or a senior staff member. One person said that they had " no complaints about anything or anybody ".

We found that the service was compliant with the outcomes we looked at during this inspection.