Meadow Park

Meadow Park is a 'care home'. Meadow Park provides care to a maximum of 61 older people in a purpose built home.

We found the following examples of good practice:

• Staffing levels were safe. Managerial staff had supported care staff with a hands-on approach to ensure people received safe care when staffing levels were in danger of falling too low.

• The premises allowed for good amounts of social distancing with multiple communal areas.

• The service worked well with external stakeholders such as commissioners and specialist health teams. They had reacted promptly to advice and made improvements to ensure the ongoing safety of people who used the service.

Further information is in the detailed findings below.

The inspection took place on 20, 24 and 25 July 2017. The first day was unannounced. This meant that the provider and staff did not know that we would be visiting.

We last inspected the service on 26 April 2016. We found the provider was meeting all of the regulations we inspected although we made recommendations with regards to medicines and staffing. We gave the service a rating of 'requires improvement.' At this inspection, we found improvements had been made and the rating was changed from 'requires improvement' to 'good.'

The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.

We checked the management of medicines and found improvements had been made in relation to record keeping and the management of topical medicines such as creams and lotions.

Suitable numbers of staff were on duty. Accidents and incidents had been analysed and staffing levels were adjusted to ensure staff were deployed in sufficient numbers at the locations and peak times accidents tended to occur. This had resulted in a reduction in unwitnessed falls.

Staff recruitment records we examined demonstrated suitable checks and procedures had been followed to support safe recruitment decisions and maintain the safety of vulnerable people.

Staff had received training in the safeguarding of vulnerable adults. They were aware of the procedures to follow. A safeguarding log was maintained with up to date information.

General risk assessments and checks were in place to monitor the safety of the premises and equipment. Individual risks to people had also been assessed and care plans were in place to address these risks.

The home was clean and well maintained. Infection control procedures were followed by staff.

Staff received regular training and supervision, and told us they felt well supported.

The service was operating within the principles of the Mental Capacity Act 2005. People had maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The health needs of people were met. Staff sought timely advice from care professionals and records confirmed that people had access to a number of these including GP’s, mental health and general nursing staff.

People were supported with eating and drinking. Records of food likes, dislikes and special dietary requirements were held. People’s weights were closely monitored and action taken in the event of concerns about their nutritional status.

The premises took into account ‘dementia friendly’ design in most areas but bathrooms did not always meet best practice guidance in this area. There was access to outdoor space which people enjoyed using.

Staff were caring, polite, warm and friendly in their approach. People and their relatives were complimentary about the welcoming atmosphere in the home.

People were involved in aspects of the running of the service. ‘Resident Ambassadors’ had been elected, and they contributed to promoting the voice of people using the service and supported the home when they hosted guests and visitors to open events.

Privacy and dignity was supported by staff. Improvements had been made to the storage of records which helped to maintain confidentiality of information, and staff described a variety of ways they maintained people’s privacy. They also ensured the independence of people was promoted.

Person centred care plans were in place which were up to date and regularly reviewed. They contained detailed information about individual needs and preferences.

A range of one to one and group activities were available. Activities were planned in advance and evaluated to assess whether they were beneficial and enjoyable to people.

There were no recent formal complaints and a log of complaints received by the service was maintained.

A new registered manager was in post. The registered manager and the deputy were praised by staff and relatives for their support. It was reported that morale had improved in the home, and that the registered manager had introduced a number of positive changes.

A number of systems were in place to monitor the quality and safety of the service.

We last carried out an inspection in September 2014, where we found the provider was meeting all the regulations we inspected.

Meadow Park provides care to a maximum of 61 older people, including those who have a dementia related condition who live in a dedicated unit within the home called Memory Lane. There were 54 people living at the home at the time of the inspection.

There was a manager in post, however, she was on long term leave of absence. A registered manager is a person who has registered with the 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. An interim manager was overseeing the management of the home. He was the registered manager from one of the provider’s nearby care homes and visited Meadow Park twice a week. A deputy manager was also in post. Staff informed us that morale at the service had improved since the interim manager had started to oversee the management of the home.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. The interim manager told us that there were two ongoing safeguarding issues which had not been concluded at the time of the inspection. We spoke with the local authority safeguarding officer who told us that there were no organisational safeguarding concerns regarding the service.

We spent time looking around the premises and saw that all areas of the building were clean and well maintained. There were no offensive odours in any of the bedrooms or communal areas we checked. Attention had been paid to the “dementia friendly” design in Memory Lane.

Safe recruitment procedures were followed. We received mixed comments about whether there were sufficient staff on duty. Some people and staff said that more staff would be appreciated. There were two or three senior care staff on duty through the day. Staff explained that when there were two senior care workers on duty, one senior care worker covered Memory Lane and the other oversaw the ground and first floors which meant they had to administer medicines to 37 people, complete care records and monitor their health, safety and wellbeing. We have made a recommendation that staffing levels are reassessed to ensure that suitable numbers of skilled and experienced staff are deployed at all times.

We checked medicines management and noted that there were some gaps in the recording of medicines administration. In addition, there were shortfalls in the management of topical medicines such as creams and ointments. We have made a recommendation that medicines management follows national best practice guidelines.

The manager provided us with information which showed that staff had completed training in safe working practices and to meet the specific needs of people who lived there including dementia care training.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” Seven DoLS applications had been authorised by the local authority and the deputy manager was submitting further DoLS applications to the local authority to authorise in line with legal requirements.

We observed that staff supported people with their dietary requirements. Staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. People were supported with kindness and care.

Detailed care plans were in place which gave staff specific information about how the people’s needs were to be met. There was an activities coordinator employed to help meet the social needs of people. Most people told us that there was enough going on to occupy their attention.

There was a complaints procedure in place. Feedback systems were in place to obtain people’s views. Meetings and surveys were carried out.

The service had been through a period of change. Although the interim and deputy managers told us that improvements had been made in many areas of the service, we still found certain areas where further action was required; such as medicines management, the maintenance of records, staffing levels and communication. The interim and deputy managers were already aware of the issues we had highlighted and were taking action to address these.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home.

Is the service effective?

Improvements had been made to ensure that people's nutritional needs were met.

Is the service caring?

This was a follow up inspection that only focused on certain areas of previous non-compliance and did not relate to this question.

Is the service responsive?

This was a follow up inspection that only focused on certain areas of previous non- compliance and did not relate to this question.

Is the service well led?

The home had an experienced manager in place who was registered with the Commission in line with legal requirements . The manager had taken action to monitor the quality of the service for people who required support to maintain good nutrition.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe and clean. Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. There were insufficient staff on duty in the unit where people with dementia care needs lived to ensure their supervision and safety. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager had met with the officers from the Local Authority to discuss recent changes in the way these safeguards are applied and had made an application on behalf of one person living at the home.

Medication was stored and managed safely.

Is the service effective?

People told us they were happy with the care that had been delivered. One person said, "I am fine here, the girls are lovely, no problems." It was clear from our observations and from speaking with staff that they had a good understanding of people's care needs and knew them well. We found that the service was inconsistent in meeting people's nutrition needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people. A visitor told us, "I am very happy, it's tip top, no concerns at all." One person said,"I am fine here. The food is very nice, I really enjoy it. I can make my needs known; I get what I want really."

Is the service responsive?

People's needs had been assessed before they moved into the home. Care was planned and delivered in accordance with people's identifed needs. Records confirmed people's preferences, interests and diverse needs. People had access to activities and told us they enjoyed these.

The service had clear information about how people could raise concerns or make complaints. Complaints were recorded, acknowledged and investigated and complainants received a written response. People told us they were happy to raise any issues and said they were listened to. One relative said, "We did raise concerns at first but since then they have improved, the manager will listen and discuss things. I trust her experience."

Is the service well led?

People told us they felt listened to and could approach the manager. Quality assurance processes were in place. We saw these worked well for the safety and quality of the environment however, they were less effective in promoting and supporting good nutrition and safe staffing levels. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People had their care needs assessed before coming to live at the home and after their admission. Care was planned but not consistently delivered in line with care plans or professional guidance.

People told us they felt safe and the risk of abuse was reduced by the provider's policies, procedures, training and the manager's and staff responses to concerns.

Sufficient experienced and skilled staff were employed at the home, based on an analysis of people's needs and dependency.

People had confidence in the staff. Staff received training, supervision and appraisal to support them to deliver safe care in a competent manner.

We found records were, on the whole, secure, well maintained and accessible.

On this inspection we saw the provider had sufficient equipment for assisting people and shower facilities were being upgraded. Repairs to bath panels had been replaced by long term safer solutions. We concluded that improvements had been made and people were protected from unsafe or unsuitable equipment.

We found that people's needs were assessed and care was planned and took account of people's wishes and capacity to consent. Care was reviewed to take account of people's changing needs and care was adapted accordingly. People informed us that they valued the social activities at the home. One person described the activities as follows; "You can't fault it, there are plenty and really good."

People told us they liked their surroundings and they were comfortable. One person said, "I like my room I am very comfortable here, the staff help me and I feel safe." We saw the provider had sufficient equipment for assisting people and some shower facilities were being upgraded. However, temporary repairs to bath panels had not been replaced by long term safer solutions. We concluded that improvement was needed in this area.

We saw that the provider had informed people about the complaints procedure. People confirmed that they had seen the information pack and had been reassured by staff that they should tell them if they had any concerns. A visitor said, "I haven't needed to make any complaints because I let the staff know if I have any concerns and they sort things out straight away. These are just little things like laundry etcetera. No major issues."