Archived: Meadow Bank Care Home

There was a manager in post who had submitted an application to the Care Quality Commission to be registered as the manager for the service. The registration requirements for the provider stated the home should have a registered manager in 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.

At the last inspection on 15 & 16 July 2014, we found the service was meeting the regulations that were applicable at the time.

During this inspection we found the service was meeting the current regulations.

People using the service told us they felt safe and well cared for. People had mixed views about the staffing levels but considered there were enough staff to support them when they needed any help.

The manager followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people.

The staff we spoke with were knowledgeable about the individual needs of the people and knew how to recognise signs of abuse. Arrangements were in place to make sure staff were trained and supervised at all times.

Medicines were managed safely and people had their medicines when they needed them. Regular checks on the management of medicines were carried out and action taken where shortfalls were identified. Staff administering medicines had been trained to do this safely.

Risks to people’s health and safety were identified and measures had been put into place to mitigate these risks. We asked the manager to carry out a risk assessment on the use of specialist high dependency easy chairs designed for people’s comfort as a safety precaution. These were being used by staff and relatives to the same effect as a wheelchair.

We found the premises to be clean and hygienic and appropriately maintained. Regular health and safety checks were carried out and equipment used was appropriately maintained.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

People using the service had an individual care plan that was sufficiently detailed to ensure people were at the centre of their care. Care files included ‘My day, My life’ profile of people’s needs that set out what was important to each person.

People’s care and support was kept under review, and people were given additional support when they required this. Relevant health and social care professionals provided advice and support when people’s needs had changed.

We found staff were respectful to people, attentive to their needs and treated people with kindness in their day to day care. Care plans were written with sensitivity to reflect and to ensure basic rights such as dignity, privacy, choice, and rights were considered at all times.

Activities were varied, interesting and appropriate to individual needs. Links with the local community were good and being further developed.

People were provided with a nutritionally balanced diet that provided them with sufficient food and drink that catered for their dietary needs.

People using the service and relatives told us they were confident to raise any issue of concern with the registered manager and that it would be taken seriously and the right action taken.

People using the service, relatives and staff considered the management of the service was very good and they had confidence in the manager.

There were systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being. Audits were completed regularly and the outcomes were monitored and reviewed.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with eighteen people using the service, looked at care records of eight people in detail and a selection of other records in relation to other people's care. We also spoke to eighteen staff on duty, and spoke with four unit managers/seniors and the deputy manager.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home arrangements were in place to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

The deputy and unit managers understood their obligation to apply the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

People told us they were treated very well by the staff. Risk assessments were completed and staff had been made aware of who may be at risk of falling, developing pressure ulcers or may not eat enough.

Staff had been trained to understand dementia care needs. People told us they never had any cause for concern. One person said, “They have so much patience. They treat me well and I have a lot of confidence in them. It’s just nice knowing they are around. I feel very safe here.”

The environment was kept clean reducing the risk of infections. Staff were trained in this topic and were issued with protective equipment such as disposable gloves and aprons. Arrangements were in place for the safe removal of clinical and sanitary waste. Infection control practice was routinely monitored. The kitchen was kept clean and hygienic.

Staff were trained in emergency procedures such as fire, safe moving and handling and first aid. Staff used safe ways of working, for example, when they used a hoist to assist them move people.

Privacy safety locks fitted on bedroom doors were not being used as routine. This affected people with dementia who are vulnerable and not always aware of their actions, and can be confused and disorientated.

Care had been taken to make sure people were kept safe by good recruitment procedures being followed. Staff contractual arrangements prevented them from gaining financially from people they cared for.

Systems were in place to make sure the provider continually checked the service was safe. Guidance was being followed such as health and safety in the work place, infection control, fire regulations and control of hazardous substances. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

We observed staff were attentive to people’s needs. They provided care and support in a dignified manner. People told us they were happy with the care they received and the staff team. They said, , “They have so much patience. They treat me well and I have a lot of confidence in them. It’s just nice knowing they are around. I feel very safe here.” “I have no worries as far as the way they treat us. Nothing is too much trouble for them. They are always willing to help when needed." A relative told us, “They seem to understand him and he is getting more settled by the day”

We saw staff treating people with respect and kindness while delivering appropriate levels of care and support. Where people required one to one support such as with eating this was given in a dignified manner.

Daily records showed staff responded to people's needs as required day and night. Staff gave a good account of, and showed an understanding of, the varying needs of different people we had discussed with them.

People were able to make choices regarding their lifestyle. They had the opportunity to express their wishes for daily living and social activity. This supported people to be cared for in a way that did not inappropriately restrict their freedom.

Is the service responsive?

People were given plenty of opportunities to say what they wanted. People’s assessment of needs and care plans were reviewed regularly and professional help and support was sought from health and social care professionals when needed.

Good practice was followed to make sure people were admitted properly. A continuing assessment of need was on-going for people, including mental capacity assessment to support continuing care needs being addressed appropriately.

Staff had relevant training to support them in their role. Training in topics such as end of life care and dementia was provided in response to people’s needs.

Arrangements were in place to deal with emergency situations such as fire evacuation.

People using the service and their relatives had the opportunity to complete a satisfaction survey. People told us that they would know how to make a complaint, should they need to do so.

Is the service effective?

People told us they were happy with their care. There were no unnecessary rules to follow and no rigid routines. One person told us, “I can stay in my room. Sometimes I do just for breakfast. If I don’t go to the lounge they will pop in and say ‘Are you all right’. The staff are great, even those on nights.” All the staff seem to know what I can and can’t do. Once they get me to the sink I can manage. They put my clothes out for me. I get a jug of fresh water every day in my room. Nothing is too much trouble.”

People's health and well-being was monitored. Appropriate advice and support had been sought in response to changes in people's condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Staff training was on-going and included end of life care and dealing with health conditions people presented with such as diabetes and dementia. The service had links with a local hospice who provided support and guidance when needed.

People told us they were consulted with and listened to. They had no restrictions or unnecessary rules imposed upon them such as what time they got up or went to bed. Staff were flexible in their work to accommodate individual needs and preferences.

Is the service well led?

The manager is registered with the Care Quality Commission.

Staff and relatives told us there was an open culture with opportunities for them to share their views and make suggestions. Staff told us they were supported to develop their skills and given opportunity to progress with their career within the company.

The quality assessment and monitoring systems promoted the effective management of risks relating to health, welfare and safety of those living at the home.

Staff were clear about their responsibilities and duty of care and were able to raise their views and discuss work issues at staff meetings. Staff were encouraged to develop their skills and knowledge.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision about people’s care and support was made by the appropriate staff at the appropriate level.

Most people told us they were generally happy with the care and support they received from staff. One person said “I am well looked after, the staff are really good". People said staff were attentive to their needs. We observed staff being polite, helpful and showing a caring nature to people. One person however expressed the need for improvement in the way certain staff spoke to them. This was being dealt with by the unit manager. Staff knew how to care for people at risk of falling, developing pressure ulcers or may not eat enough.

Activities were good and age appropriate. People told us they were satisfied with the catering arrangements. There were safeguarding procedures to help protect people. People lived in a safe environment. They said they were comfortable and had everything they needed. Staff were trained and most staff supervised in their work.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We found where people were unable to make their wishes known they had an elected person to act on their behalf such as a relative.

Activities were made available for people both inside and outside of the home. These included, shopping, hairdressing, visiting artists, festive days, birthday celebrations and arranged outings.

People told us staff treated them well. One person said, 'I have no problems at all. I have a call bell I use to request help and of course if there was an emergency. Staff come immediately if I ring for them'. They also said there was no rules to follow and no rigid routines. Staff spoke to them properly and they were respectful.

People said there was enough staff about to support them. They described staff as being, 'Very nice', 'A bit of fun', 'Good' and 'Always at hand'.

People told us they were confident that if they complain their concerns would be taken seriously and dealt with properly.