Brendoncare Meadway

Brendoncare Meadway is a residential care home registered to provide care and support to up to 13 people. The service provides care for older people over two floors with access to all areas by stairs, lift and stair lift. At the time of our inspection there were 11 people receiving care and support at the home.

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

People told us they were safe living at Brendoncare Meadway. People had risk assessments in place for their care and support needs and staff knew people well. Staff had received training and understood their duty of care and legal requirement to report safeguarding concerns.

Medicines were not always managed safely. We have made a recommendation about medication practices within the home, the provider took action to address this shortfall during the inspection. People were supported to continue to manage their medications independently.

Care plans and risk assessments were person centred. People and relatives told us staff knew them well. Staff supported people in a kind and compassionate way, considering their dignity and privacy, one person told us, “I continue to be amazed that the dedicated staff can be, day by day, so friendly, kind, and patient. I am particularly grateful residents are not obliged to join in activities, even including at mealtimes.” The home and garden were accessible.

Infection prevention control procedures were robust. Feedback from people, relatives and staff identified people were protected due to a consistent response from staff when following guidance during the pandemic. Environmental safety checks were in place and fire safety was managed by the provider.

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.

People, relatives and staff spoke positively of the culture within the home. The registered manager explained that staff levels had been increased following feedback from people using the service. One person told us, “We are so lucky. Staff work together as a team so well and oh of course I am safe, absolutely. We're here, we're alive and we like it.” Another person stated, “We are a family here .”

The home worked well with other organisations; including the local GP surgery, district nurses and local colleges. The home understood the importance and benefit of links with the community by offering volunteering opportunities and maintaining ties with the person’s local church .

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

Rating at last inspection

The last rating for this service was good (published 28 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

Recommendation

The home had a medication policy in place, but this had not always been followed. We have made a recommendation about the safe storage of medicines within the home. The provider was responsive to address the shortfalls found within this inspection and took immediate action.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were suitable measures in place to prevent relatives, friends and professionals from spreading infection when entering the premises. The inspector was asked to demonstrate that they were fully vaccinated and had, on the day of the inspection, undertaken a lateral flow test which was negative.

There was a focus on washing hands and using hand sanitiser when moving around the home to help prevent transmission of the virus.

The home was visibly clean and smelled fresh throughout. The provider used enhanced cleaning schedules to mitigate the risk of spreading infection in high touch areas of the home.

There were detailed protocols for essential care givers which included a home induction checklist. There was also a visiting proforma providing clear information about the visitor’s responsibilities before and during visits.

Staff had sourced face masks which had a clear window across the mouth to help one person, who was hard of hearing, lip read thus reducing the level of stress and frustration for the person.

Alternative forms of maintaining social contact were used such as video calls and visits in the communal gardens. For some, access to the community was reduced and so the provider had undertook improvements to the garden. They had renewed the decking and created new pathways outside to make a safer outdoor space for people to enjoy walks. We saw that the outdoor spaces were being well used for this purpose.

The provider had identified which people and staff were more vulnerable to health complications as a result of Covid-19. Assessments had been undertaken to minimise these risks.

People and staff had regular access to the COVID-19 testing programme. A lodge had been built in the garden with donations. This was a warm and clean environment and was currently being used to facilitate staff and visitor testing before visits. The arrangements were well organised.

The service used well evaluated tools to help determine whether a person’s health was deteriorating, allowing concerns to be escalated to a health care professional in a timely manner.

The service had a detailed Covid-19 business continuity plan which considered how a number of challenges such as continuity of staff, medicines and the risks associated with visiting might best be responded to.

The registered manager reported good support from the local health professionals including the local GP practice and from the provider throughout the pandemic.

The provider and registered manager had workforce planning measures in place to mitigate the risks associated with COVID-19 related staff pressures. This included the development of a team of bank staff which had meant that agency staff had not been needed for some time.

The registered manager shared that there had been some anxiety amongst the staff team who were concerned about potentially bringing the Covid-19 virus into the care home. Staff had been supported through wellbeing initiatives and the registered manager spoke positively about the way in which staff had ‘stepped up’ by picking up additional shifts but also by moderating their behaviour when not at work in order to keep people safe as possible.

A registered manager was 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.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. Incidents and accidents were clearly documented and investigated. Actions and learning were identified from these and shared with all staff.

Medicines were administered, stored and ordered in a safe and effective way.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff deployed to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

People were encouraged and supported to make decisions about their care and welfare. Where people’s ability to consent to their care fluctuated, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

People received nutritious meals in line with their needs and preferences, in an environment which had been adapted to provide a calm and relaxing dining experience for them. Those who required specific dietary requirements for a health need were supported to manage these.

Staff were calm, kind and gentle in their interactions with people and supported them to remain independent whilst maintain their safety and welfare. People’s privacy and dignity was maintained and staff were caring and compassionate as they supported people. Staff knew people in the home very well and involved them and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. External health and social care professionals were involved in the care of people and care plans reflected this.

The registered manager promoted an open and honest culture for working which was fair and supportive to all staff. Staff felt supported in their roles and people and their relatives spoke highly of all staff. People and their relatives spoke highly of the registered manager and all their staff team.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The registered provider had a robust system of audit and review in place to ensure the safety and welfare of people.

At our last inspection of Brendoncare Meadway in April 2016 we found this service to be Good although improvement was required in the well led domain with record keeping. At this inspection the home remained Good and record keeping had improved.

Brendoncare Meadway is a care home providing accommodation and personal care for up to 13 older people. When we visited there were 10 people using the service. The service is located close to the town of Winchester.

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 service is required by a condition of its registration to have a registered manager.

Records relating to people’s care and treatment were not always accurate, complete and up to date. This included the decisions taken in relation to the care and treatment provided. A plan was in progress to review people’s care plans and provide training for staff in the completion of new care planning documentation. However, although staff knew people well, there was a risk if people were cared for by staff unfamiliar with their needs where people’s records were not accurately completed there could be a risk of people experiencing unsafe or inappropriate care and treatment

People told us they felt safe living at Meadway. People were safeguarded as staff understood the indicators of abuse and how to act on any concerns. Staff had completed relevant training and had access to written guidance on reporting procedures. The registered manager acted on concerns raised.

Risks to people had been assessed and action was taken by staff to ensure identified risks were managed safely in line with people’s preferences and decisions. The provider took action to address risks to people from environmental hazards and emergency situations such as evacuation in the event of a fire. Staff practised how to support people safely in accordance with their individual needs should an evacuation be necessary.

There were sufficient staff to meet people’s needs. Additional staff were being recruited to support people at the busier times of the day to ensure people’s needs were met promptly. Recruitment procedures were in place and followed to protect people from the employment of unsuitable staff.

Some people managed their own medicines. People who were supported with their medicines by staff told us they were satisfied their medicines were properly managed. Staff completed training in medicine administration and procedures were in place and followed to ensure people’s medicines were managed safely.

Staff received an induction into their role and supervision and annual appraisal of their work. Staff completed training including professional development training to enable them to meet people’s needs competently. People received their care from staff who received appropriate support to carry out their role.

Staff had undertaken training on the Mental Capacity Act 2005 and understood the principles of the Act. All of the people accommodated had the capacity to consent to their care and treatment at the service. Restrictions were not in place and people could leave the service if they wished to go out. Entry to the service was restricted by a keypad for the security of people and premises.

People and their relatives were very complimentary about the chefs and the quality of the food provided. People confirmed their preferences and dietary needs were catered for. People were asked to give their feedback about the food provided and the chefs acted on this to provide a varied and individually tailored menu.

Staff arranged for people to be seen by a variety of health care professionals to meet their healthcare needs as required.

People and their relatives told us staff were kind and caring and ‘bright helpful and cheerful’. People enjoyed the relaxed atmosphere in the home and felt they had choice and control in their daily lives. Staff respected people’s decisions and treated people respectfully. People used residents meetings to express their views and to make suggestions which they told us were acted on.

People told us they received care that was responsive to their needs and preferences. People were supported to maintain their independence and confirmed they received the level of support appropriate to their needs. Activities were provided in the home and people also enjoyed their own hobbies and interests. People were involved in planning activities and outings and told us they were satisfied with the level of activities provided.

The provider’s complaints process was displayed in the home. Although no written complaints had been received, people and their relatives told us they were confident the registered manager would listen and respond.

There was a positive, open and inclusive culture, staff’s views were sought and they felt listened to. This enabled staff to feel they could raise issues if they needed to in order to ensure people received good quality care. The provider’s values were shared with staff through training, leading by example and a recognition scheme. People confirmed that staff treated them respectfully and their individual needs and preferences were met in line with the providers’ values.

There were processes in place to enable the provider and registered manager to monitor and audit the service for the purpose of identifying any areas for improvement for people. Records demonstrated that actions resulting from audits were not always identified and fully completed. The registered manager took action to remedy this during our inspection.

An accident and incident system was in place and analysis of incidents reported resulted in improvements to people’s care and their environment.

People experienced effective, safe and appropriate care. People's needs had been assessed and staff followed plans of care that had been devised to ensure that they provided suitable and consistent support.

There were effective policies and procedures regarding infection control. Staff understood and followed the procedures.

There was an established staff team who knew the people who lived at Meadway well. Staff were provided with regular and appropriate training and were led by an experienced and competent manager.