Meadowview Nursing Home

Meadowview Nursing 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.

Meadowview Nursing Home is registered to accommodate up to 42 people in one adapted building. At the time of our inspection there were 24 people using the service. The service supports older people with a range of conditions and includes providing support for people living with dementia.

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.

There was a relaxed friendly atmosphere throughout the inspection. Visitors were made welcome and people had developed positive relationships with each other and staff. Staff showed kindness and compassion and ensured people were treated with dignity and respect.

There was a person-centred culture promoted by the management team that ensured people were treated as unique individuals. Everyone was positive about the management of the service and the improvements that had been made.

Care plans were person-centred and gave clear guidance to staff in how people wished their care needs to be met. People and relatives were involved in the development of their care plans and regular reviews were completed.

People were supported by sufficient staff who understood their responsibilities to identify and report any concerns relating to harm or abuse. Medicines were managed safely and there were systems in place to ensure the equipment and the environment were safe.

Staff had the skills and knowledge to meet people’s needs. Staff were supported through regular supervision and were encouraged to improve their skills.

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.

The service worked in partnership with health professionals to ensure people had access to appropriate health care to support them to maintain healthier lives.

People enjoyed a variety of food and drink that met their individual dietary needs. Where people were at risk of weight loss this was monitored and referrals made to health professionals.

There were systems in place to monitor and improve the service. The registered manager was committed to continual development of staff and improvement of the quality of the service.

At the previous inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had made improvements and met the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although the provider was meeting the regulations we have rated the service as Requires Improvement as we need to be sure the service can sustain the improvements.

Meadowview Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to provide care for up to 42 people. On the day of the inspection there were 18 people using the service.

There was no 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. The home manager told us they were applying to CQC to become the registered manager. Following the inspection we saw this application had been submitted.

People, relatives and staff were positive about the significant improvements made in the service since the inspection in August 2017. The service was clean and bright and there was a welcoming atmosphere. Staff were friendly and approachable.

The provider and home manager had worked with people, relatives and staff to identify and implement improvements in the service. This had resulted in an open and inclusive culture that valued everyone and promoted a person-centred approach to care. Methods of communication had improved and relatives felt involved and informed about people’s care and what was happening in the service.

Leadership had improved and staff were clear about their roles and responsibilities. The home manager had implemented effective systems to monitor and improve the service. This included improved engagement with people, relatives and staff.

Improvements made had resulted in people feeling safe in the service. Risks were assessed and there were plans in place to manage the risks. People’s medicines were managed safely and people received their medicines as prescribed.

People’s needs were met by staff who were kind and compassionate. Most staff communicated well with people and it was clear people had developed meaningful relationships with some of the staff. Where staff did not have English as their first language the provider was supporting staff to access additional help.

The food in the service had improved and people were consulted about their likes and dislikes. The menu choices reflected people’s preferences.

The service worked closely with health care professionals and had developed positive relationships with them. This ensured people had access to healthcare support when needed.

Staff were well supported through regular supervision and were positive about the improved support from the current home manager. Appraisals had enabled staff to identify development needs and a training plan identified staff had access to training to ensure they had the skills and knowledge to meet people’s needs.

People had access to improved activities and had been supported to enjoy outings. The service had also arranged visits from outside entertainers.

Peoples’ care records had improved and included person-centred information that guided staff to ensure people’s unique needs were met. Regular reviews were completed and relatives and representatives were invited to be involved in reviews.

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.

Meadowview Nursing Home provides accommodation and nursing care for up to 42 people. At the time of the inspection there were 28 people using the service.

There was no 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. There had been three different managers since January 2017. The provider had recruited a new manager who was planning to make application to CQC to become the registered manager.

Medicines were not managed safely and risks associated with people's health needs were not managed effectively. Systems to reduce the risk of infection were not maintained. The environment and equipment were not always clean. Systems to reduce the risk of fire were not monitored.

People's needs were not met in a timely manner and staff were not deployed in a way that ensured people's needs were met. Staff did not have the skills to communicate in a meaningful way with people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

The quality of the food was not always good and people did not always receive food and drink to meet their needs.

Staff did not always treat people with dignity and respect. People told us staff were not always caring and people spent long periods without any interaction.

Care was not provided in a person-centred way. Staff did not always respond to people's requests for support in a timely manner.

People and their relatives were not confident to raise concerns. They felt that no action would be taken to resolve issues and were fearful of retribution if they complained.

Systems in place to monitor and improve the quality of the service were not effective. Where steps had been taken to gather feedback about the service no action had been taken to resolve the issues identified.

Staff felt supported through regular supervision and were positive about the training they received.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Meadowview Nursing Home supports up to 42 people who require personal and nursing care. This includes people living with dementia. At the time of our visit there were 32 people using the service.

There was a manager in post who had applied to the Care Quality Commission (CQC) to become the registered manager. 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 inspection 27 January 2016 we found systems to monitor and improve the quality of the service were not effective. At this inspection we found systems were still not effective as they had not identified the issues we found during our inspection.

Where risks to people had been identified they did not always receive care and support to manage the risk. Records did not always contain up to date and consistent information to ensure people received support to meet their needs.

People did not always receive support that was person-centred and in line with guidance in their care plans. People had limited access to activities that interested them.

Everyone we spoke with was positive about the manager and the changes they had made. Staff felt supported and listened to by the manager, who promoted a positive, person-centred culture.

Staff were caring and showed compassion when supporting people. Staff knew people well and supported people to develop friendships.

Medicines were managed safely and people received their medicines as prescribed.

There were sufficient staff to meet people's needs. Staff received training and support to ensure they had the skills and knowledge to meet people's needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible in line with the principles of the Mental Capacity Act 2005 (MCA).

People enjoyed the food. Where people were at risk of weight loss this was monitored and action taken to improve people's well-being.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We are considering what action we will take.

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.

We carried out an unannounced comprehensive inspection of this service on 27 January 2016. We found the provider was not meeting the legal requirements of two of the fundamental standards. After the comprehensive inspection, we took enforcement action and issued a warning notice to require the provider to meet the legal

requirements of one of the fundamental standards. This inspection in May 2016 was to check they had met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to people's safe care and treatment. This report covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadowview Nursing Home on our website at www.cqc.org.uk

Since January 2016 the provider had improved the system for the management of medicines. Staff administering medicines signed Medicine Administration Records (MAR) after medicines were administered. There were protocols in place to support people with specific requirements related to medicines and these were followed. However there were still improvements needed as handwritten entries on MAR were not always dated. There were not always protocols for medicines prescribed 'as required'.

People's care plans contained detailed risk assessments and where risks were identified there were management plans in place to mitigate the risk. However, risk assessments in relation to stair gates did not identify why they were in place or any risks to people for the stair gates being used.

The service had a registered manager who was responsible for overall management of the home. 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.

Meadowview is a care home providing accommodation for people requiring personal and nursing care. The service supports older people with a variety of conditions which includes people living with dementia. At the time of our visit there were 38 people living in the service.

Medicines were not always managed safely. People did not always receive their medicines as prescribed and staff administering medicines were not always competent to do so.

People enjoyed living at Meadowview Nursing Home. People and their relatives were complimentary about the registered manager and staff supporting them. There was a caring culture in the home and there was a relaxed, cheerful atmosphere. People spent their day as they chose and were able to take part in activities that interested them.

People were positive about the food and were supported to eat and drink in a respectful manner. People's specific dietary requirements were met and people were given a choice of food.

People had individual care plans which were written based on assessments carried out prior to them moving to the service. However, care plans were not always up to date and did not always contain up to date, completed risk assessments.

Systems in place to monitor the quality of the service were not always effective. Issues found during this inspection had been identified but had not been addressed.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the end of the full version of the report.

We spoke with seven people and three people's relatives. At the time of our visit 36 people were living at the home. Everyone we spoke with was highly complementary about the home. One person told us, "I'm okay, I've got no complaints'. One relative told us, "it's given me peace of mind. The staff are brilliant".

People benefitted from meaningful engagement with staff. We observed care workers assist people with eating, drinking and activities. Care workers and nurses treated people with dignity and respect.

Medicines were kept safely. For example, we noted that the home's medication room was securely locked. We noted that the nurses at the home maintained good records for the homes monitored dosage systems (MDS) and people's controlled drugs.

People's care plans were reviewed appropriately and reflected the current needs of people living in the home.

We looked at six people's care files and noted that the provider sought the consent of people and their relatives regarding care.

During our SOFI we observed that people with dementia did not benefit from meaningful engagement. We observed that there was limited engagement between care workers, nurses and people.

People and their relatives were complimentary about the food and drink people were provided. One person told us, 'Food here is very good'.

People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for monitoring medicines not administered through a monitored dosage systems.

We spoke with three care workers and a nurse. Everyone we spoke with felt supported. One care worker told us, 'I like working here. I feel very supported'. Another care worker told us, 'If we have any worries we can talk to the manager anytime'.

People and people's relatives we spoke with told us they felt able to raise concerns. One relative told us, 'no organisation is perfect, but when something is not right, we let them know and it's put right'.

People were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

It was not clear from the care plans seen, how people, their relatives or advocates, had been involved in the care plan development. None of the care plans seen were sufficiently personalised or signed by the person, their relatives or advocate.

Staff were clear about the procedure to take if they suspected abuse had taken place.

One relative told us they were "happy with the cleanliness of the home". Staff told us that the senior nurse on duty each day supervised the housekeeping staff. We were able to see evidence of daily cleaning routines having been completed and a plan of deep cleaning rooms.

People told us they could bring in their pictures, small items of furniture and pieces that "mean a lot to me".

There are always one registered nurse and six or seven care staff on duty throughout the day and one registered nurse and two care staff on night duty.

Relatives told us that if they had any concerns they would speak to the registered nurse on duty or the manager and would be confident that their concerns would be addressed as soon as possible.