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Inspection carried out on 30 July 2020

During an inspection looking at part of the service

About the service

Meadowbeck is a residential care home providing personal and nursing care to 52 people aged 65 and over at the time of the inspection. The service can support up to 60 people across three separate wings. One of the wings specialises in providing care to people living with dementia.

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

People were found to be safe at this inspection. However, a full record of the care people received, and assessment of risks were not always consistent. Oral health care assessments, care plans and risks were not completed for every resident. The registered manager and provider implemented new paperwork during the inspection and were looking at training for staff to enhance their skills and knowledge in relation to oral health care to ensure people’s needs were met and records were consistent.

We have made a recommendation about the management of oral health care.

At the height of the COVID 19 pandemic, bathing audits were not always completed making it difficult to identify the support people received with personal care needs. However, during the inspection daily records showed people had support with bathing and showering. The registered manager had also made changes to the documentation staff completed which identified people’s preferences.

Many of the residents using the service were affected by COVID 19 and records identified some people had lost weight due to lack of appetite. Staff used an appropriate tool to monitor weight loss and sought professional advice when needed to ensure appropriate diets were in place. Records seen on inspection showed residents were weighed regularly and highlighted weight gains. Relatives commented, “[Name of person] lost weight before they went in, they are now weighed every week and are on supplement drinks.” Another said, “[Name of person] has put weight on, they have what they want, the food is nice.”

There was a positive culture in the service. People were supported by a consistent group of staff who knew them well and enabled positive relationships to develop. The staff team were appreciative of the support they received and felt confident they could speak up and knew they would be listened to.

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.

Rating at last inspection

The last rating for this service was good (published 06 November 2018).

Why we inspected

We received concerns in relation to people’s oral health care, personal care needs and weight loss. As a result, we undertook a focused inspection to review the key questions of safe, effective 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.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and effective sections of this full report.

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

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

Inspection carried out on 29 August 2018

During a routine inspection

This inspection took place on the 29 August 2018. At our last inspection of the service on 20 and 21 June 2017, the registered provider had been in breach of regulation. This was because staff did not always respect people's personal preferences, lifestyle and care choices. In addition, we had made two recommendations about how staff were deployed and quality monitoring at the service. The regulation has now been met and improvements made to all areas of concern identified.

Meadowbeck is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides nursing care for up to 60 people including adults over the age of 18, older people and people living with dementia. The service is purpose built and offers accommodation over two floors with a separate unit for people living with dementia.

When we inspected the service the newly appointed manager was in the process of registering with CQC. They are now registered. 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. They have been referred to as ‘The manager’ throughout the rest of the report.

People told us they felt safe living at the service. Staff knew how to keep people safe from harm having received training.

We found the level of cleanliness in the service was good, with clear infection prevention and control practices.

Staff had completed training as outlined by the company and they were supported through supervision and appraisal.

People were supported to have 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.

People told us they could see healthcare professionals when they needed to and that they received care and treatment when necessary.

People's nutritional needs were met. People were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People told us they enjoyed the food at the service.

People were positive in their feedback about staff describing them as caring and kind.

End of life care and palliative care within the service was linked to advance care plans. People and their families, had been included in planning and agreeing to the care provided. People had risk assessments in their care files to help minimise risks whilst still supporting people.

People had access to external gardens and most participated in the activities provided in the service. We saw that staff encouraged people to join in with social activities. Families and friends were made welcome in the service and there were unrestricted visiting hours each day.

People knew how to make a complaint and where there had been complaints these had been dealt with in accordance with company policy and procedures.

The manager monitored the quality of the service, supported the staff team and ensured that people who used the service could make suggestions and raise concerns. We saw from recent audits and from feedback we had received that the manager was making progress in improving the quality of the service.

Inspection carried out on 20 June 2017

During a routine inspection

This inspection took place on the 20 and 21 June 2017. Day one was unannounced and we made arrangements with the manager to return on day two. At our last inspection of the service on 16 and 17 May 2016, the registered had been in breach of regulations relating to the way in which people's medicines were managed and record keeping. These regulations have now been met and improvements made to those areas.

At this inspection we found some concerns around how people were treated which is a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Dignity and Respect. You can see what action we told the provider to take at the back of the full version of this report.

Meadowbeck is registered as a care home with nursing for up to 60 people including adults over the age of 18, older people and people living with dementia. The service is purpose built; set in its own grounds and offers accommodation over two floors. The service is located approximately two miles east of York city centre and is close to public transport routes. There are a number of local shops close by.

There was a registered manager employed at this 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. They have been referred to as ‘The manager’ throughout the rest of the report.

People told us they felt safe living at the service. Staff knew how to keep people safe from harm but the way in which staff were deployed sometimes resulted in lack of support for people. The manager is reviewing this. Staff had been employed following appropriate recruitment and selection processes.

We found the level of cleanliness in the service was good, with clear infection prevention and control practices within the service.

Staff had completed essential training and staff received regular supervision.

People were supported to have 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.

People told us they could see a GP when they needed to and that they received care and treatment when necessary from external health care professionals.

People's nutritional needs were met. People were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals and said they enjoyed the food.

People reported that the service delivered effective care. Overall people were very positive in their feedback about staff but others were more reserved and indicated that their care was satisfactory depending on who was on duty. The manager was aware of this and the quality of care was being improved through on-going staff training and development.

End of life care within the service was appropriately recorded, and we saw the care and support being delivered to people was in accordance with their wishes and needs.

People and their families, had been included in planning and agreeing to the care provided. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions. We found that people’s care plans clearly described their needs but sometimes it was difficult to find information as it had not been linked in a logical way to each area of care.

People had access to newly refurbished external gardens and most participated in the activities provided in the service. We saw that staff encouraged people to join in with social activities. Families and friends were made welcome in the service and there were unrestricted visiting hours each day.

People knew h

Inspection carried out on 16 May 2016

During a routine inspection

This inspection took place on the 16 and 17 May 2016 and was unannounced. At our last inspection of the service on 7 August 2014, the registered provider was compliant with all the regulations in force at that time.

Meadowbeck is registered as a care home with nursing for up to 60 people including adults over the age of 18, older people and people living with dementia. The service is purpose built; set in its own grounds and offers accommodation over two floors. The service is located approximately two miles east of York city centre and is close to public transport routes. There are a number of local shops close by.

The registered provider is required to have a registered manager in post and at time of our inspection the position was vacant. The previous registered manager left their post in March 2016. There was a peripatetic general manager in place, who is referred to as ‘the manager’ in this report. Active recruitment for a permanent manager was taking 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.

During our inspection we found that the recording and administration of medicines was not being managed appropriately in the service. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

Record keeping within the service needed to improve. We saw evidence that care plans, risk assessments, food / fluid charts, turn charts and end of life plans were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. This is a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

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

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.

We found the level of cleanliness in the service was satisfactory, but the infection prevention and control practices within the service did not follow best practice.

We have made a recommendation about infection prevention and control within this report.

The manager of the service had made improvements to the number of staff completing essential training, but there remained work to be done to improve the number of staff receiving regular supervision. This had been identified by the manager and was part of their on-going action plan.

Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty; the manager had completed a standard authorisation application for each person and these had been reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.

People were able to talk to health care professionals about their care and treatment. People told us they could see a GP when they needed to and that they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.

People had access to adequate food and drinks, but this was not always well recorded by the staff. We found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals

Inspection carried out on 7 August 2014

During an inspection looking at part of the service

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We also wanted to check that the provider had taken action to improve one area that we found non-compliant at our last inspection of the service.

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?

At this visit we looked only at the way medicines were being managed. We found

medicines were safely stored in people's rooms, to protect the health and wellbeing of other people living there.

We spoke with four people about the way their medicines were managed. They told us they received their medication appropriately and at the times they needed it. They said the staff were kind and patient when helping them with their medication.

The provider had introduced a series of regular checks so as to be satisfied people were getting their medication as it was prescribed to them. This helped to promote people's health and wellbeing. These checks need to be maintained and built on so that the provider can be satisfied that medication processes remain robust.

Is the service effective?

n/a

Is the service caring?

n/a

Is the service responsive?

n/a

Is the service well-led?

n/a

Inspection carried out on 9 April 2014

During a routine inspection

Meadowbeck is a care service that offers nursing and residential care and support to a maximum of 60 older and younger people, some of whom may have a physical disability. It is a purpose built home in the village of Osbaldwick near to the city of York.

We carried out this inspection to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 who used the service, the staff who supported 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?

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people�s choices and decisions. Care records were up to date.

People told us �We get our medicine on time and when we need it�, but we found that appropriate arrangements were not in place in relation to recording, handling and safely administering medicines to people who used the service.

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose. The doorways to bedrooms, communal spaces and toilet/bathing facilities were wide enough for wheelchairs or people with walking frames to mobilise comfortably through them. People who used the service were pleased with the facilities offered by the service. One person told us �I have a lovely room and the staff keep it nice and clean.�

People were protected from unsafe or unsuitable equipment because the provider had ensured the equipment used in the service was serviced and maintained and service certificates were available for inspection.

Robust employment and recruitment practices were in place which ensured that staff had the skills, experience and qualifications for the work to be performed. Discussion with people who used the service indicated they were satisfied with the competency of the staff employed by the provider.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe management of medicines.

Is the service effective?

People�s health and care needs were assessed with them and they were involved in the writing and review of their care plans. We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. People were supported to be able to eat and drink sufficient amounts to meet their needs and specialist dietary needs had been identified where required. Two people who spoke with us said they received regular baths and had access to a hairdresser if they wanted this.

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living. The equipment used in the service was serviced and maintained and service certificates were available for inspection. One person told us �I have confidence in the staff and I trust them, especially when they use the hoist and other equipment to get me from A to B.�

Is the service caring?

We spoke to three people about the care and support they received from staff. One person told us �The staff are lovely, I don�t have to wait long at all if I have to use my buzzer for assistance. I like to have my breakfast in bed and then the staff will come and get me washed and dressed and I sometimes go down to the lounge to chat with my friends.� We spoke with another person who spent a lot of their time in bed due to their medical condition. This individual received regular pressure care and needed assistance from staff with eating and drinking. This person said �I am well looked after by the staff, they are very good to me and I am very comfortable in my bed.�

When we spoke with staff it was clear they genuinely cared for the people they supported. We found that people�s preferences, interests, choices and diverse needs had been recorded and care and support had been provided in accordance with people�s wishes.

Is the service responsive?

People completed a range of activities in and outside of the service. The service shared a minibus with a sister home and during the summer months regular trips out into the community were arranged. Over the winter months more entertainers were booked to come in and engage with people who used the service. There was a weekly activities newsletter which ensured people were aware of any planned activities so they could choose whether or not to participate.

People were supported by the staff to fulfil their spiritual needs. People told us they could access the in house church services or church services in the community and were given support from staff to attend if needed. The manager also confirmed that visits from clergy could be arranged on request.

Individuals who spoke with us during the day said they were involved in their care and able to input to their care records. People we spoke with said they were confident of using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems. We saw that there were two complaints documented for 2014; both had been investigated and resolved by the manager. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well led?

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Feedback from these individuals was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was analysed by the provider and where necessary action was taken to make changes or improvements to the service.

The service had an open door policy so staff were able to discuss any concerns with the manager and there were regular staff meetings so that people could talk about any work issues. This meant that staff were able to provide feedback to their managers and their knowledge and experience was recognised and taken into account.

Inspection carried out on 31 December 2013

During an inspection looking at part of the service

At the previous inspection in September 2013 we identified that the environment and some equipment in use was dirty and not hygienically clean. We asked the provider to make improvements in these areas. They provided us with an action plan telling us how and when the home and equipment would be cleaned, and described what measures were in place to ensure that the cleanliness of the home and equipment was maintained to an appropriate standard.

We re-visited the service to check that improvements had been made. We were accompanied on this inspection by a Community Infection Prevention and Control Nurse. We saw that improvements had been made, the home smelt clean and fresh, and most areas and equipment had been cleaned to a satisfactory standard. One person who used the service said "They are always cleaning, and washing my chair. They are continually cleaning my room."

Staff we spoke with during the inspection were aware of the importance of the control of infection and confirmed to us that they had received training in this. At the end of this inspection we were satisfied that significant improvements had been made and people were cared for in an environment that was clean and hygienic.

Inspection carried out on 5 September 2013

During an inspection looking at part of the service

People told us that they liked their rooms and were happy living at Meadowbeck.

When we looked around the home we saw some areas which were dirty and not hygienically clean. Some parts of the home smelt of urine.

We found that people were not protected from the risk of infection because appropriate guidance had not been followed and there were inefficient systems in place to reduce the risk and spread of infection. Standards of cleanliness within the home were poor and the home must take action to address this.

Inspection carried out on 19 June 2013

During a routine inspection

People told us they were able to make choices and decisions about their care. They told us that they were treated with privacy and dignity.One person said "I�m impressed."

People said they were well cared for not everyone felt that there was much to do. Comments included "We can watch television, oh and there is a fish tank we can look at" and "We have some good times."

Standards of cleanliness within the home were poor and the home must take action to address this.

The service had in place policies and procedures covering safeguarding and the protection of vulnerable adults. Staff were familiar with safeguarding and whistle blowing procedures and knew what to do in the event of abuse being suspected.

Records we looked at also confirmed that staff received good training in areas such as dementia awareness, infection control and safeguarding. Staff we spoke with told us that they received �really good support from the manager� and that they received useful/appropriate training. Some people felt that the staffing levels were insufficient to meet people's needs and we observed periods throughout our visit where people had to wait for their call bell to be answered or for their personal care needs to be met.

There were a range of effective quality management systems in place to assess and monitor the quality of service that people received.

Inspection carried out on 3 December 2012

During a routine inspection

People were supported to make decisions and choices regarding their care and treatment. They told us that they were treated with dignity and respect. People said "I can see a General Practitioner (GP) if I need to, the staff help organise this for me" and "I get up and go to bed when I like, they talk to me about my care."

People said they were well cared for and liked living at the home. One person said "I get exceedingly well looked after."

The home had systems in place to help safeguard people and people told us they felt safe. All of the people we spoke to said that they felt able to talk to the staff.

People told us that they liked the staff who supported them. Comments included "The people who work here are very nice" and "We have plenty of staff, they are good as well." Some people felt that call buzzers were not answered frequently enough. Comments included "If you ring the bell at night it usually takes about ten minutes to answer" and "The bells are not answered quickly but it's not too bad. They come and tell you they are busy and they do come back when free."

Staff told us they received regular training to help keep their knowledge and skills up to date. They also told us that supervision was provided.

All of the people we spoke with said that they would feel confident in raising any concerns. People told us that they could attend meetings and were asked for their views and opinions. They told us that staff were friendly and approachable.

Inspection carried out on 27 February 2012

During an inspection in response to concerns

People living at the home said they thought the care at Meadowbeck was good and that they were satisfied with it. An anonymous caller raised concerns that people were moved in hoists with insufficient staffing. On the day of inspection two people made comment about the way they were hoisted. One person said that there were always two members of staff when they used the hoist with her. Another person said that there were always two people to help move him into his wheelchair. The anonymous caller raised a concern that people were assisted to the dining room too early and that those who required help with their meal were not offered it. People living at the home said the food was good and that people received assistance if they needed it. None of the people spoken with said that they were assisted to the dining room very early. People generally reported that there were sufficient staff on duty and that they did not have to rush. However, some said it took a time for call bells to be answered.

Reports under our old system of regulation (including those from before CQC was created)