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Meadowview Nursing Home Good

Reports


Inspection carried out on 8 January 2019

During a routine inspection

This inspection took place on 8 January 2019 and was unannounced.

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.

Inspection carried out on 4 January 2018

During a routine inspection

This inspection was carried out on 4 January 2018 and was unannounced. At our last inspection on 7 and 11 August 2017 the service was rated as inadequate overall and was placed 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 provider 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.

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 ens

Inspection carried out on 7 August 2017

During a routine inspection

This inspection was carried out on 7 and 11 August 2017. At our inspections in March 2015, January 2016 and December 2016 we found the service was not always well led. Systems to monitor and improve the quality of the service were not effective. The consistency of the quality of the governance systems operated by this provider has been a concern since 2015. Improvements have not been made to ensure the provider is consistently able to meet the requirements of the regulations. As a result people have not received care that is safe, effective, caring and responsive to their needs.

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 canc

Inspection carried out on 6 December 2016

During a routine inspection

We carried out our unannounced inspection on 6 and 9 of December 2016.

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.

Inspection carried out on 17 May 2016

During an inspection to make sure that the improvements required had been made

We inspected Meadowview Nursing Home on 17 May 2016. The service provides accommodation with nursing and personal care for up to 42 people. At the time of our inspection there were 22 people using the service.

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.

Inspection carried out on 27 January 2016

During a routine inspection

We carried out our inspection on 27 January 2016. This was an unannounced inspection.

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.

Inspection carried out on 1 July 2015

During an inspection to make sure that the improvements required had been made

We inspected this service on 1 July 2015. This was an unannounced inspection.

Meadowview provides accommodation for up to 42 people who require personal or nursing care. At the time of our inspection there were 24 people living at the service.

At a comprehensive inspection on 10 March 2015 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with one warning notice and three requirements. The warning notice required the provider to meet the legal requirements of the regulation by 30 April 2015. After the comprehensive inspection the provider sent us details of how they would meet the legal requirements relating to the three remaining regulations.  

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. 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.

People's care plans contained up to date information and were regularly reviewed, this included risk assessments and risk management plans. However, there were still improvements needed to one persons care plan. People's medicines were being managed safely. The provider had taken action to ensure staff had the knowledge and skills to delivery care and support safely.

The registered manager had introduced effective systems to monitor the service and had an overview of all accidents and incidents.

People's best interest was considered where they were assessed as lacking capacity to make a decision. Some people's records were not clear about the decisions they were unable to make. We have made a recommendation about the Mental Capacity Act 2005.

Although we found most of the required improvements had been made we have not changed the overall rating for this service because we want to be sure that the improvements will be sustained and embedded in practice. We will check this during our next planned comprehensive inspection.

Inspection carried out on 10 March 2015

During a routine inspection

We carried out our inspection on 10 March 2015. This was an unannounced inspection.

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 (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.   

Meadowview Nursing Home is a care home providing nursing care for up to 42 people. The home supports people living with dementia. At the time of our visit there were 35 people living at the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had made appropriate referrals to the supervisory body. However, where people lacked capacity to make decisions the registered manager was not acting within the principles of the Mental Capacity Act (2005).

We found some areas of concern. People were not always protected from risk in relation to the management of medicines. Equipment was not always used and monitored safely.  

Some people's care needs were not met in line with their care plans. Care plans did not always contain accurate up to date information.

The service had some systems in place to monitor the quality of the service but these were not always effective.

There was a calm and relaxed atmosphere during our visit. Staff were kind and caring. We saw people being encouraged to interact with each other and staff. People were laughing and enjoying time spent in the communal areas of the home. Relatives described how people's lives had improved as a result of living at Meadowview.

Relatives told us the registered manager was open and approachable. We saw the registered manager interacting with people, relatives and staff in a friendly manner. The registered manager was knowledgeable about the needs of people living in the home.  

Staff were well supported by the registered manager and were happy working in the home. Staff had access to development opportunities and felt able to ask the registered manager for any support they needed.

We found several breaches of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 5 December 2013

During an inspection to make sure that the improvements required had been made

We carried out this visit following non-compliance regarding the care and welfare of people, management of medications and records at the last inspection in September 2013. At this visit we noted that people with dementia did not always benefit from meaningful engagement and care records did not always reflect peoples� needs. We also noted that the provider did not have appropriate systems in place for the management of medicines. The provider sent us an action plan to tell us how they would become compliant. We found that the provider had taken appropriate action.

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.

Inspection carried out on 3 September 2013

During a routine inspection

We spoke with five people and three people's relatives. We also spoke with four care workers and one nurse. At the time of our visit 32 people lived at 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.

Inspection carried out on 7 February 2013

During a routine inspection

Staff confirmed they always attempted to support people to understand their rights and to give their consent to care and treatment. We were told this was not always possible due to the extent of a person's illness and the impact on their capacity. We did not see any evidence that staff had used the Mental Capacity Act to guide them. There were no mental capacity assessments in the care plans we looked at.

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.