Archived: Meadowbrook Care Home

People's experience of using this service:

•Overall people were satisfied with the quality of the service provided and people, visitors and staff all spoke of improvements that had taken place over recent months.

•The quality of the food remained an area where people expressed mixed views and the registered manager was working with the catering company to address issues.

•Staffing levels were under review. Overall people were confident that there were enough staff to meet their needs however some issues in relation to the allocation of staff were shared. The registered manager was actively reviewing staffing levels and liaising with people, relatives and staff to share progress.

•Risks to people were monitored and procedures were in place to help keep people safe.

•People received their medicines as and when they needed them.

•People were protected from the risks associated with the control and spread of infection.

•Staff understood the importance of ensuring people's rights were understood and protected.

•People's health care needs were monitored and understood by staff.

•People told us staff understood their needs and were kind, caring and compassionate.

•People had opportunities for social stimulation and more would be welcomed.

•People were confident that complaints would be addressed.

•Quality checks and audits enabled the provider to ensure improvements were being made within the service.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in December 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Meadowbrook Care Home is a ‘care home’. 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.

Meadowbrook Care Home accommodates up to 69 people across three separate units, each of which have separate adapted facilities. The Garrett Anderson Unit specialises in providing care to people living with dementia. The Agnes Hunt Unit specialises in providing care to people living with neurological conditions. The Mary Powell Unit specialises in providing care to people with general nursing needs. At the time of our inspection, there were 48 people living at the home, two of whom were staying there on a temporary basis.

There was a registered manager in post who was present during our inspection. 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 2017, we found five breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These breaches related to the provider's failure to provide dignified care; to deploy enough suitably trained staff; to ensure people’s rights were protected; to ensure that people received safe care and treatment and to ensure effective governance to drive improvements in the service. We gave the service an overall rating of ‘Inadequate’ and placed them in special measures. This meant significant improvements were required or further enforcement action could be taken. We asked the provider to complete an action plan to tell us what they would do and by when to improve the service and meet the regulatory requirements.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had developed and implemented an action plan to address the shortfalls in the service within set timescales and had worked hard to achieve improvement. Whilst we acknowledged the efforts made by the registered manager and provider, we found that systems put in place to address the shortfalls were not consistently embedded across the home and there were still areas that required improvement.

Staff were not always effectively deployed to meet people’s needs in a person-centred manner.

People and their relatives had raised concerns about the choice and quality of meals. The registered manager and provider were in continued talks with the catering staff to make the required improvements.

People were protected from abuse and discrimination by staff who knew how to identify and how to report signs of abuse and poor practice. Where concerns were raised, these were investigated and action taken to prevent reoccurrence.

Risks associated with people’s needs were assessed and measures were put in place to minimise them. The provider ensured the environment and equipment were maintained to ensure safe and effective care.

People were supported to take their medicines by staff who were trained and assessed as competent to administer them. Medicines were stored safely and accurate records maintained.

People were supported to access healthcare services as and when necessary to promote good health.

People’s needs were assessed and kept under regular review. Advice of healthcare professionals was incorporated into people’s care plan to ensure consistent and effective care.

People and their relatives were confident that staff had the skills and confidence to meet their individual needs. Staff were happy with the variety and quality of training available to them and were encouraged to better themselves.

Staff sought people’s consent before supporting them. Staff provided information to people in a way they could understand to enable them to make decisions about their own care. Where people were unable to make certain decisions for themselves these were made on their behalf by people who knew them well to protect their rights.

People were supported by staff who were kind and considerate. Staff treated people with dignity and respect. Staff had formed positive working relationships with people and their relatives.

People were supported by staff who knew their needs and preferences well. People were supported to do things they enjoyed doing and were provided with opportunities to try new activities. People were supported to express their plans and wishes for the future.

People and their relatives felt comfortable to raise concerns with staff and management as they arose and were confident they would be listened to and addressed.

People, their relatives and staff found the registered manager approachable and easy to talk with. The registered manager provided strong leadership and led by example.

The registered manager had a clear vision for the service which was shared with and worked towards by staff and management. There was an open an inclusive culture at the home where staff felt supported and valued in their role.

The provider and registered manager had a range of checks in place to monitor the quality of the service and drive the required improvements.

The home was last inspected on the 14 September 2016 where we gave it an overall rating of requires improvement. We had identified the provider was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to a lack of person centred care. We asked the provider to make improvements and send us an action plan. At this inspection we found that improvements had not been made and that further concerns were identified.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Meadowbrook Care Home is registered to provide accommodation with nursing care for up to a maximum of 79 people. There were 50 people living at the home during our inspection. People were cared for in three units. These included the Garrett Anderson unit which provides supports to people living with dementia. The Mary Powell Unit which provides support to people with physical health needs and the Agnes Hunt unit which supports people living with neurological needs.

There was a registered manager in post who was absent during our inspection. 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.

There were not enough suitably trained staff deployed to meet people’s needs in a timely and person centred manner. There were staff vacancies and a high turnover of staff. There was a reliance on agency staff to cover the gaps in shifts. This added additional pressure to permanent staff as they had to show agency staff what to do as well as doing their own jobs. Staff felt stressed and morale was low.

Risks to people’s health and well-being had been assessed and guidance developed to advise staff on the equipment and support required to minimise risk. However, these were not always reviewed or followed by staff. The provider did not ensure that people’s environment was kept clean and hazard free.

People and their home environment were not always treated with respect and their dignity was compromised. People’s information was not always kept confidential.

People were not always provided with personalised care suited to their needs. Staff had limited time to spend with people other than when providing personal care and were task led. There was a lack of stimulation and many people sat doing nothing for most of the time.

The provider had not always followed the principles of the Mental Capacity Act and people were unlawfully deprived of their liberty. Staff did not always seek people’s consent before supporting them.

People did not always receive adequate support to help them eat their meals in a dignified manner. This placed people at an increased risk to their health and wellbeing. People had mixed views about the quality and choice of food available to them.

There was ineffective leadership at the home. People and their relatives did not find the registered manager approachable and lacked confidence in them and how the service was run.

Staff did not always feel that they were provided with the support and equipment they needed to enable them to do their jobs well.

The quality assurance systems the provider had in place to monitor the quality of care were not always effective in identifying and addressing concerns raised. The provider was keen to make improvements to the service and provided additional resource to achieve this.

The provider had systems to gather people’s, relatives and staff views on the service but their concerns were not always acknowledged or acted upon.

People were supported to take their medicines as prescribed. Only staff who had training on the safe management of medicines administered them.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. The provider had safe recruitment procedures which ensured that prospective new staff were suitable to work with people living at the home.

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

The home was last inspected on the 7 and 9 December 2015 where we gave it an overall rating of requires improvement. We had identified the provider was in breach of Regulations 9 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to not enough staff suitably deployed to meet people’s needs and a lack of person centred care. We asked the provider to make improvements and send us an action plan. We found that improvements had not been made and that the provider remained in breach of the Regulations.

Meadowbrook Care Home is registered to provide accommodation with nursing care for up to a maximum of 79 people. There were 66 people living at the home on the day of our inspection. People were cared for in three units. These included the Garrett Anderson unit which provides supports to people living with dementia. The Mary Powell Unit which provides support to people with physical health needs and the Agnes Hunt unit which supports people living with neurological needs.

There was a manager in post who was present during our inspection. The manager was in the process of applying to become registered manager for 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.

Although people felt safe there were not always enough staff to meet their health and social needs in a timely manner. There was a high turnover of staff and numerous staff vacancies. Staff felt fatigue and morale was low. Agency staff were used to cover staff vacancies but they were not always familiar with people’s needs. This placed additional pressure on permanent staff who were overwhelmed with their workload.

People were not always provided with support that was tailored to their individual needs and preferences. Support provided was task focused and placed people’s independence at risk. There was a lack of stimulating things to do to maintain people’s emotional wellbeing and people were bored.

The provider had a clear complaints procedure however, this was not consistently followed. The provider had a range of routine checks in place to monitor the quality and safety of the service but these had been ineffective in identifying shortfalls in the service. The provider had committed resources to make the required improvements and to change the culture of the service.

There was a lack of formal supervision to allow staff to discuss their training and development needs. Staff lacked knowledge and understanding of people’s complex illnesses as they had not received specific training on how best to support them.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. The provider had safe recruitment procedures which ensured that prospective new staff were suitable to work with people living at the home.

People received support to take their medicines as prescribed. Only staff who had received training on the safe administration of medicines did so. Staff monitored people’s health and arranged health care appointments when required. The provider employed their own physiotherapist to support people’s physical wellbeing.

People were provided with a choice of meals and drinks. People enjoyed the food and were offered drinks at regular intervals. People were supported to eat their food in a patient and dignified manner.

People were supported by staff who were friendly and caring. Staff had formed positive working relationships with people. Staff talked with and about people with respect.

People knew the manager and both they and staff felt they were approachable. The manager was keen to develop the service and had introduced meetings to gain feedback to improve the service.

People told us that they attended reviews to ensure that the care they received continued to reflect their needs. People were supported to meet their individual needs in ways that promoted their health and wellbeing. This meant that the care was responsive to people's needs.

The home was clean and hygienic. An odour issue within flooring in some bedrooms was known to the provider and plans were in place to address this.

Staff were knowledgeable about people's individual needs. Staff told us they had attended a range of training courses to equip them with the knowledge and skills to carry out their duties effectively. The staff had the opportunity to regularly meet with their line manager to review their performance and address any induction, training and development needs.

The provider had a suitable system in place to monitor the quality of the service it was providing. This meant the service was well led.

People were satisfied with the care they received from staff. People spoke positively about the staff that looked after them. Comments made by relatives included that they had "Total faith in the staff" and "The staff are brilliant". Visitors to the home were made welcome at any time.

People were treated with respect and courtesy by staff.

People who were able to were involved and consulted with the way that care and support was given and reviewed. People were supported to retain their independence as much as possible.

Care plans contained guidance for staff on people's needs and how these should be met. This was done in a way that reflected people's individuality and preferences.

Measures were not in place to protect people from the risk of healthcare associated infections.

People were protected from the risk of abuse because staff were trained to recognise and report any concerns.

Checks were made before staff started working at the home to make sure they were suitable.

There were systems in place to monitor and review people's complaints.