Meadbank Care Home

Meadbank Care Home is a care home providing personal and nursing care to up to 176 people. The service provides support to older people over five separate units, with adapted facilities. At the time of our inspection there were 132 people using the service.

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

People’s medicines were not always managed as intended by the prescribing G.P. The provider took swift action to address our concerns. Risks were managed to ensure people were protected against avoidable harm. Safeguarding training ensured staff could identify, report and escalate suspected abuse. Sufficient staff were deployed to keep people safe. Where possible lessons were learned to mitigate further incidents. The provider had effective infection control procedures in place, including those in relation to COVID-19.

People’s relatives spoke highly of the management of the service. People’s voices were heard through compliance systems and where appropriate action was taken in response to people’s views. Regular auditing was carried out to ensure issues were identified swiftly and appropriate action taken. The registered manager worked in partnership with stakeholders to drive improvement. The registered manager was aware of their responsibilities under the duty of candour and submitted notifications to the Care Quality Commission in a timely manner.

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

Rating at last inspection and update

The last rating for this service was Good (published 7 July 2021.

Why we inspected

We received concerns in relation to COVID-19 practices and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Meadbank Care Home was providing nursing and personal care to 146 older people at the time of our inspection. The service can support up to a maximum of 176 people. The care home accommodates people across five separate units, each with their own adapted facilities. Approximately half the people staying at the care home are living with dementia.

People's experience of using this service

At our last inspeciton we found the way the service was managed needed to be improved. This was due in part because we received mixed comments from staff about the leadership approach of the manager who was in charge at the time.

At this inspection we found progress had been made by the provider to improve how the care home was now managed. For example, a new suitably competent and experienced permanent manager was appointed in February 2021 who had applied to be registered with us at the time of our inspection. Furthermore, three qualified nurses had recently been employed to fill the vacant unit managers’ positions. Plans had also been agreed to re-register Meadbank Care Home by the end of 2021 to create two smaller services, which should be easier to manage. Progress made by the provider to achieve this stated aim will be closely monitored by the Care Quality Commission (CQC).

People received care and support from staff who were now suitably trained to effectively carry out their working roles and responsibilities. However, formal appraisals of staffs overall work performance are overdue and will need to be completed. We discussed this staff support issue with the new manager at the time of our inspection who assured us a time specific action plan was in place for all staff to have their annual work appraised within the next three months.

The provider had failed to notify us about one incident involving a person who had lived at the care home which had resulted in them being seriously injured. We discussed this notification failure with the new manager who understood their responsibilities with regard to the Health and Social Care Act 2008 and what they needed to notify us about without delay.

The provider had well-established governance systems in place to assess and monitor the quality and safety of the care people received however; we found these processes were not always operated effectively. This is because they had failed to pick up and/or take action to address the aforementioned issues we identified during our inspection. We discussed this matter with the managers who agreed to take appropriate action to improve the effectiveness of their governance systems.

Most people told us they were satisfied with the standard of care and support they or their loved one received at Meadbank Care Home however, we found evidence during our inspection that the provider needed to make improvements.

The service had effective safeguarding systems and procedures in place to keep people safe from the risk of abuse and neglect. People were cared for and supported by staff who knew how to manage risks they might face. People were supported by sufficient numbers of staff whose suitability and fitness to work in an adult social care setting had been properly assessed. Medicines systems were safe and people received their prescribed medicines as and when they should. We were assured the service was following safe infection prevention and control (IPC) procedures, including those associated with COVID-19.

People were supported to access to the relevant community health care professionals and services as and when required. The care home worked well with these community professionals and other agencies to provide effective care and support.

People received care and support from managers and staff who were clear about their roles and responsibilities. The new permanent service manager recognised the importance of learning lessons when things went wrong and were keen to continuously improve the care home. The views of people who lived at the care home, their relatives and staff, were sought by the provider, which now operated an open and inclusive culture at the care home.

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

Rating at last inspection and update.

The last rating for this service was good (published 5 October 2020). The overall rating for the service remains good.

Why we inspected

This inspection was prompted in part due to concerns we had received in relation to an increase in the number of safeguarding alerts raised about Meadbank Care Home during 2021, and the high turnover of managers. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

In addition, areas of specific concern were identified in relation to people accessing the relevant community health care professionals and services in a timely manner, which we looked at under the key question of effective. The CQC have introduced targeted inspections to check this which does not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We did not inspect the key questions of caring and responsive. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Meadbank is a care home providing nursing and personal care to 112 older people at the time of our inspection. The service can support up to a maximum of 176 people. The premises are divided into five separate units, each of which has their own adapted facilities. Most people using the service are living with dementia.

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

People using the service and their relatives spoke positively about the care home and how they continued to improve.

At our last two consecutive inspections we found the provider had made good progress against all the breaches of regulations. The service has also shown continuous improvement in the way they managed risk, ensured the service was adequately staffed and operated their quality monitoring systems.

At this inspection we found the provider continued to improve the way they managed risks people might face, staffing levels, staff training and operated their governance systems. This demonstrated the provider could maintain this progress over a sustained period of time.

People were cared for and supported by staff who knew how to keep them safe while respecting their human rights. The care home was adequately staffed and staff received the right levels of up to date training they required to effectively meet people’s needs. Managers had also significantly reduced the service’s reliance on temporary agency staff. This meant people were now supported by staff who were familiar with their needs, wishes and daily routines.

In addition, the provider’s governance systems continued to be effectively operated and there were systems in place to learn lessons when things went wrong to prevent similar incidents reoccurring.

Since our last inspection the provider has appointed a new manager who has recently applied to be registered with us.

However, further improvements were still needed to ensure the service was managed better. This was because we received mixed comments from staff about the new manager’s leadership style. We discussed this mixed feedback from staff with the provider at the time of our inspection. They told us an action plan had already been agreed to improve how the new manager communicated with her staff team. Progress made by the new manager to achieve this stated aim will be assessed at their next inspection.

Staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for their role. People continued to receive their medicines safely and as prescribed. The provider had effective systems in place to assess and respond to risks regarding infection prevention and control, including those associated with COVID-19.

The new manager consulted people, their relatives and staff as part of their on-going programme of improving the service they provided. The provider continued to work in close partnership with other health and social care professionals and agencies to plan and deliver positive outcomes for people using the service.

Rating at last inspection and update.

The last rating for this service was requires improvement (published 25 May 2019), although there were no breaches of regulation identified at that time. At this inspection we found the provider continued to sustain the progress they had made at their previous two inspections. This report only covers our findings in relation to the key questions; Is the service safe, effective and well-led?

Why we inspected

This inspection was prompted in part due to concerns received about the leadership style of the new manager and to check service had sustained all the progress they had made at the time of our last inspection. A decision was made for us to inspect and examine the risks associated with all the issues described above.

The Care Quality Commission (CQC) has introduced focused/targeted inspections to check specific concerns.

We used the targeted inspection approach to look at a specific concern we had about staff training associated with the key question, is the service effective? As we only looked at part of this key question, we cannot change its rating from the previous inspection. Therefore, the rating for this key question will remain good.

We undertook a focused inspection approach to review the key questions, is the service safe and well-led? This was because we had specific concerns about the way risks were identified and managed, how the provider’s governance systems were operated and the general management of the service.

As no concerns were identified in relation to the key questions, is the service caring and responsive? we did not inspect them on this occasion. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The home is based on four floors, each named after a different London bridge (Albert, Chelsea, Lambeth and Westminster). Each floor has a private wing and the private wing is collectively called "London Bridge". The number of people and staff on each floor varied in response to their needs.

This service has been 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 service 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.

People’s experience of using this service:

Following the last inspection, we asked the provider to show what they would do to improve the key questions Safe, Effective, Caring, Responsive and Well-Led to at least good. At this inspection we found the provider had made good progress against all the breaches of regulations and had improved the outcomes for people because:

The provider had taken appropriate steps to identify and manage risks to people using the service. Where risks had been identified, the care plans contained clear guidance for staff on how to manage these.

The provider had taken steps to ensure any risks to the environment and equipment were being assessed and managed well. This was helping to keep people, visitors and staff safe.

The provider ensured there were sufficient staff on duty to support people safely and to have time to engage and communicate with people.

The provider had installed and implemented a new call bell system, which was working well. Staff were responding quicker to people’s calls for assistance.

Staff records showed that the number of staff who had now completed the training they needed to effectively carry out their roles and responsibilities had increased since our last inspection. Where gaps were found in training the manager was able to give us the dates when this training would take place.

People were treated with dignity and respect because personal care and support took place privately and staff spoke to people in a respectful way and maintained people’s confidentiality.

The provider had ensured that people’s rooms met people’s preferences for décor, music and/or television programmes.

Although we found the top floor which was mainly for people with dementia was not as bright or as aesthetically welcoming as the other floors, the manager has since written to us with a plan of improvements for this unit.

The service was much more responsive to the needs of people, including those who spent a lot of time in bed. The home had increased the number of activity team members and had improved the way it deployed this team. Activities were now scheduled over seven days per week.

People had person centred care plans that detailed the care and support they needed; this ensured that staff had the information they needed to provide consistent support for people.

The manager and staff demonstrated a commitment to provide meaningful, person centred care by engaging with people using the service, relatives and health and social care providers.

We found that the provider had taken a more proactive role in seeking people’s views and resolving any concerns or complaints.

The provider had improved the systems used to monitor and improve the quality of the service. Audits were carried out on a regular basis and action plans developed to ensure changes were made when needed.

We also found at this inspection that:

The provider had followed appropriate safe recruitment procedures when employing staff.

Medicines were managed and stored safely. People received their medicines from staff who were trained to do so.

People’s bedrooms, bathrooms, the communal areas and the unit kitchens were clean, well maintained and smelt fresh.

Incidents that had occurred were recorded on an electronic system and monitored by the clinical services manager and action take to mitigate further risks occurring.

Staff were adequately supported by their line managers and had the required knowledge, skills and experience to meet people’s nursing and personal care needs.

The service supported people nearing the end of life to have a comfortable and dignified death.

People told us they were supported by caring staff. People commented about staff, "The staff are very good, from the nurses to the manager. They’re lovely” and “They [staff] are lovely and kind and look after me so well.

There was a warm and welcoming atmosphere throughout the two inspection days. Staff presented as polite, helpful, happy, and motivated and had confidence in the way the service was managed.

More information is in the full report

Rating at last inspection: At our last inspection, the service was rated Inadequate and the home remained in Special Measures. It was first placed in Special Measures in January 2018. Our last report was published on 8 November 2018.

At this inspection the rating has improved to Requires Improvement in Safe and Well Led and Good in Effective, Caring and Responsive. The overall rating is Requires Improvement..

Why we inspected:

All services rated "inadequate” and placed in special measures are re-inspected within six months of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received, and check whether they had complied with their improvement plan following the findings at our last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

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.”

We have also taken the decision to leave Meadbank in special measures because since our inspection in August 2018 several serious safeguarding alerts have been raised which are being investigated by the local authority safeguarding team and the Police.

We carried out this unannounced comprehensive inspection on the 8 and 9 August 2018. At our last inspection in January 2018 we found five breaches of regulations and rated the service as 'Inadequate' and the service was placed in 'special measures'. Special measures provide a framework for services rated as inadequate to make the necessary improvements within a determined timescale. If they do not make the necessary improvements, the CQC can take further action against the provider, including cancelling its registration.

The breaches of regulations we found at the inspection in January 2018 were in relation to safe care and treatment, premises and equipment, staffing, receiving and acting on complaints and good governance.

This was because the provider did not have effective systems to assess, review and manage the risks to the health and safety of people and did not do all that was reasonably practicable to mitigate any such risks. They did not ensure that care and treatment was provided in a safe way for people in terms of preventing, detecting and controlling the spread of infections. They did not ensure the proper and safe management of medicines. They did not ensure the premises and equipment used by people was clean, suitable for the purpose for which it was being used, and properly maintained. Staff did not receive appropriate support, training, professional development and supervision as was necessary to enable them to carry out the duties they were employed to perform. They did not have an appropriate system in place to receive, respond to, and act upon complaints. They did not ensure that systems or processes were established and operated effectively to assess, monitor and improve the quality and safety of the services provided. They did not maintain securely an accurate, complete and contemporaneous record in respect of each person, including a record of the care and treatment provided to people or other records of the management of the regulated activity.

Two of the breaches, ‘safe care and treatment and good governance’ were so serious we issued ‘Warning Notices’ against these breaches and required the provider to ensure the breaches were met by 1st May 2018. The provider sent us a report to say how they had met these two breaches and we checked at this inspection that they had followed their action plan.

We also asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Safe, Effective, Caring, Responsive and Well Led.’ We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadbank Care Home on our website at www.cqc.org.uk.

Meadbank is a care home; people receive accommodation, nursing and 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. The home is registered for 176 people and 122 were receiving care on the days of the inspection. The home is based on four floors, each named after a different London bridge (Albert, Chelsea, Lambeth and Westminster). Each floor has a private wing and the private wing is collectively called "London Bridge". The number of people and staff on each floor varied in response to their needs. Two of the units specialise in providing care to people living with dementia.

Shortly after our previous inspection we received information that the registered manager was no longer working at Meadbank. The provider has since employed a new manager who has recently registered with CQC. 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.

With regard to the breaches of regulation we found in January 2018 we found the provider had acted to improve the regulations and the outcomes for people. However, there was still more progress that needed to be achieved to ensure people received the care and support they needed.

The only breach of regulation that had been fully met was in regard to complaints. The provider had established a new system to record and monitor complaints and concerns and had investigated historic complaints to ensure these had been fully dealt with.

With regard to the breach of regulation in relation to staffing, we found that the provider had not followed their action plan to meet the legal requirements of this regulation. Systems to support staff through one to one supervision, training, staff meetings and the need to ensure there were sufficient staff to meet people’s needs had not been established.

With regard to the breach of regulation in relation to safe care and treatment, we found that the provider had taken action to improve this regulation, the assessments of people’s needs, risk assessments and actions to control the spread of infection had all been improved. Staff were familiar with the different signs of abuse and neglect, and the appropriate action they should take to report its occurrence. However several very serious safeguarding concerns had been reported to CQC, the local authority and the Police, which may mean that people were still not being cared for in a safe way.

Medicines were managed safely and people who had behaviours that may challenge had better access to other professionals for the help they needed.

With regard to the breach of regulation in relation to premises and equipment, we found the provider had taken action to ensure the premises were cleaner and fit for use and had taken further steps to eradicate the long term vermin problem the home had.

With regard to the breach of regulation in relation to good governance, we found that the provider had employed a new manager and had established a home improvements team who were working with the registered manager and staff to improve the home. The systems that had been started were not sufficient to identify all the concerns that we found during this inspection.

Staff were familiar with the different signs of abuse and neglect, and the appropriate action they should take to report its occurrence. The service had carried out proper recruitment processes and checks with staff. These checks helped to ensure that people were cared for by staff suitable for the role.

People's nutritional needs were being met but there were still areas that needed to be improved. For example, ensuring drinks were always within reach of a person and offering snacks between the last meal of the day and breakfast the next day. Staff were aware of the different diets that people needed and people’s religious beliefs or personal preference for food were being met.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

We observed that most but not all staff greeted people warmly and by their preferred name. There were still occasions when people were not treated with as much respect and dignity as they should have been.

People and relatives were now more involved in the development of their care plans. Care plans had improved; most were written in a person-centred way and focussed on the person's care needs, abilities and choices.

During this inspection we found several continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These were in relation to safe care and treatment,

As part of this inspection we were responding to the high volume of safeguarding concerns the CQC had received from the London Borough of Wandsworth, Wandsworth Clinical Commissioning Group and the number of complaints we had received from relatives and friends of people who use the service.

Meadbank is a ‘care home’. People in Meadbank receive accommodation, nursing and 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. The home is registered for 176 people and 154 were receiving care on the days of the inspection. The home is based on four floors, each named after a different London bridge (Albert, Chelsea, Lambeth and Westminster). Each floor has a private wing and the private wing is collectively called “London Bridge”. The number of people and staff on each floor varied in response to their needs. Two of the units specialise in providing care to people living with dementia.

The service had a registered manager in place at the time of our inspection. 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. Shortly after our inspection we received information that the registered manager was no longer working at Meadbank.

Following the previous inspection, we asked the provider to complete an action plan, with a timescale, to show what they would do to address the breaches of regulations we found, and improve the areas of Safe, Effective, Caring and Well Led to a standard that was at least “Good”. At the previous inspection in July 2017 we did not look at the area of Responsive.

With regard to the breach of regulation in relation to safe care and treatment, we found that the provider had not followed their action plan to meet the legal requirements of this regulation. We found that the pre-admission assessments were insufficiently detailed to build a detailed care plan for a person and so to mitigate the risk to them of receiving inappropriate care. Where specific risks had been recorded we saw that there was insufficient detail to help mitigate against the risk occurring.

We found the provider had not followed their action plan to meet the legal requirements in regard to the correct management and administration of medicine. A type of needle being used did not protect staff against the risk of an accident. The suction machine was not ready for use if a person was choking. Blister packs of medicine were not stored securely. The extended length of time taken to complete a medicine rounds meant that people may receive their medicine later than prescribed.

At this inspection we identified five fresh breaches of regulation in regard to Staff, Premises, Safe Care and Treatment and Good Governance.

With regard to Staff we found that there were insufficient staff on duty to meet the needs of people in a timely manner. Although we observed staff interacting with people in a kind and dignified matter, staff were rushed at times and there were periods when staff were not visibly present on the units and not available should a person require assistance.

We found further that the provider did not provide staff with appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out the duties they were employed to do. The provider acknowledged there were gaps in staff training and staff support.

With regard to Premises we found that people were not protected against the risk associated with the cleanliness of the building as the systems and processes in place to minimise those risks were not effective. The provider had not taken all possible action to prevent the control the spread of infections. We also found the premises were not maintained sufficiently to ensure people were living in a safe environment.

With regard to Safe Care and Treatment we found that staff did not always support people in a way that met their health needs. Although some of the evidence we saw showed there was good multidisciplinary working with people being referred to appropriate specialists, this was not always the case as was evidenced in the number of serious safeguarding alerts that we had received where people’s healthcare needs had not been met.

With regard to Good Governance we found that the provider did not have effective quality assurance and governance arrangements. The quality assurance systems the provider had established were not effectively operated as they had failed to pick up a number of issues we identified during our inspection. These included a high percentage of staff not having up to date training in some key aspects of their role, poor hygiene and maintenance throughout the home and gaps in their health and safety checks. There were also ineffective systems in place to gather the views of people, relatives, staff and healthcare professionals and act on their concerns, to improve the quality of care delivered at the home.

During our inspection we observed the majority of the environment had not been adjusted for the people who were living there, despite listing Alzheimer Disease as one of its specialist care categories on the home’s website. We felt that better signage, decoration and adaptations to the premises would help to promote people’s independence. For those people who required staff support better signage would be beneficial in avoiding potential distress to people who became disoriented. We recommend that the service seek relevant guidance and research on the design of the environment for people living with dementia.

The home had three activities co-ordinators who were responsible for planning and implementing activities that people wanted or would perhaps like to try. The type and level of activities on each unit varied. There was no external or internal support or training for the activities coordinators. We recommend that training and access to other, external, examples of how activities in care homes work well would help professionalise the practice of activities coordinators as well as supporting their existing commitment and work.

BUPA had introduced a new system for recording incidents and accidents in October 2017. This system was not yet fully operational at Meadbank.

Staff were familiar with the different signs of abuse and neglect, and the appropriate action they should take immediately to report its occurrence.

The service had carried out proper recruitment processes and checks with staff. These checks helped to ensure that people were cared for by staff suitable for the role.

People’s nutritional needs were being better met during this inspection than previously but there were still areas that needed to be improved. For example, drinks were not always available to people when they were in their bedrooms.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. People’s consent to receive care in accordance with the MCA had improved since the last inspection.

People were supported to eat and drink sufficient amounts to meet their needs and their dietary requirements were detailed in their care plans. Staff were aware of the different diets that people needed and were able to tell us about people that may need different food due to religious beliefs or personal preference.

Before the inspection we had received numerous complaints from visitors and relatives about poor staff care and interactions with their relative. We used this information to observe how people were cared for and to ask people and relatives what they thought of the staff at Meadbank and how they were treated. Our own observations were that most but not all staff greeted people warmly and by their preferred name. In the communal lounges, most but not all staff were friendly and encouraged people to join in conversations and with any group activities that were taking place.

People and relatives said they had some involvement in the development of their care plans but were unsure when or how often it was updated. Care plans were written in a person centred way and focussed on the person’s care needs, abilities and choices.

Meadbank was responsive to meeting the cultural needs of people from different backgrounds. We saw there was information about local advocacy services available, detailing which languages the service spoke and could assist with. Leaders from different religious orders visited the home either weekly or fortnightly and anyone was welcome to attend the services they conducted.

The service had arrangements in place to respond to people’s concerns and complaints. People and their relatives told us they knew how to make a complaint if they were not happy with the service provided at the home.

CQC had also received a large number of complaints about the service from friends and relatives and although we do not investigate individual complaints we did look at the themes of the complaints at this inspection. The records we looked at

We undertook this focused inspection in July 2017 to follow up some information of concern which we received about the care of people using the service and potential neglect. This report only covers our findings in relation to the above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadbank Nursing Centre on our website at www.cqc.org.uk.

Meadbank Nursing Centre is a care home with nursing for up to 176 people, with a particular emphasis on providing palliative care. There are four units at the home each named after a famous bridge in London and each unit was supposed to have its own unit manager. At the time of our inspection, one unit had a recently recruited unit manager and another unit did not have a unit manager in place although the service was recruiting to fill this vacancy. Albert Bridge unit which is based on the ground floor is home to older people with some early onset dementia and Westminster Bridge unit which is on the first floor is a nursing unit. Chelsea Bridge unit which is located on the second floor is home to those with palliative care needs and Lambeth Bridge unit is home to those with advanced dementia needs. There were 157 people using the service when we visited.

The service had 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.

Procedures were in place to protect people from abuse. Staff understood how to recognise abuse and knew what to do if they suspected abuse was taking place.

Risk assessments and care plans varied in quality and we found some examples of risk assessments and care plans that did not fully explore and manage risks to people’s care.

At our previous inspection we found improvements had been made in relation to medicines administration. However, at this inspection we identified some concerns in relation to the safe management of medicines. We found medicines were not always stored appropriately. We found one fridge that was not working and therefore the medicines within it were not safe for administration and one controlled drugs cabinet was not in place in line with legal requirements. We found some ‘as required’ medicines were not accompanied with sufficient instructions for nurses to safely administer them and we found two medicines with a reduced expiry date upon opening were not marked with the date of opening for staff to monitor how long they remained safe for use. We also found some expired medical devises were available for use.

There were enough staff employed and scheduled to work to meet people’s needs and keep them safe.

People were not consistently supported to meet their nutrition and hydration needs. Food and fluid charts were used, but these were not consistently filled in. People were otherwise supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs, but staff understanding of people’s health needs was variable.

The provider was not meeting the requirements of the Mental Capacity Act 2005 (MCA). We found some examples of mental capacity assessments not being completed when they ought to have been.

People gave good feedback about care workers, but some people reported that their privacy was not always respected.

Accidents and incidents were reported as required. However, we did not see evidence of analysis of accidents and incidents and consequent action taken to minimise these.

Notifications were not always submitted to the Care Quality Commission as required. We identified one example of a notifiable incident not being reported when it ought to have been.

During this inspection we found four breaches of regulations in relation to meeting people’s nutrition and hydration needs, the provision of safe care and treatment, the need for consent and the reporting of notifiable incidents. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to the breach found. We also received some information of concern prior to our inspection which we followed up during this inspection. This report only covers our findings in relation to the above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadbank Nursing Centre on our website at www.cqc.org.uk.

Meadbank Nursing Centre is a care home with nursing for up to 176 people, with a particular emphasis on providing palliative care. There are four units at the home each named after a famous bridge in London and each had its own unit manager. Albert Bridge unit which is based on the ground floor is home to older people with some early onset dementia and Westminster Bridge Unit which is on the first floor is a nursing unit. Chelsea Bridge unit which is located on the second floor is home to those with palliative care needs and Lambeth bridge unit is home to those with advanced dementia needs. There were 157 people using the service when we visited.

There service did not have a registered manager at the time of our inspection. A new manager had been hired and was in the process of registering with the CQC. 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 previous inspection we found that there were some issues with regard to the safe administration of medicines. We found that people being prescribed medicines that were labelled ‘do not crush’ were having their medicines crushed prior to administration thereby placing them at risk of unsafe administration. Some PRN or ‘as needed’ medicines protocols were not detailed enough to adequately instruct care staff. We also found that some people with higher than expected blood glucose levels were not being referred for further medical advice or assistance as expected.

At this inspection we found that all people within the home who had their medicines crushed had specific instructions in place from their GP on how to do this and care staff were aware of these. We found people who had medicines administered ‘as needed’ had protocols in place which instructed care staff as to how and when these could be safely administered. We found people whose blood glucose levels were being checked had their levels recorded and there was an indication on the form as to what safe readings were for the person. Nursing staff were clear about what action to take if people’s blood glucose levels were not at a safe level.

There were enough staff employed and scheduled to work to meet people’s needs and keep them safe.

Care staff were trained in how to safely move and reposition people with mobility problems. Care plans included instructions for care staff about how to safely move and reposition people and care staff were aware of people’s requirements. We observed a person being moved safely in accordance with the details in their care plan.

We undertook an inspection of this service in November 2014. During that inspection we identified concerns in relation to infection control, people’s social and emotional needs being addressed appropriately, the recording of fluid intake and some issues with a lack of signage in the building to help people with dementia orientate themselves. The provider sent us an action plan after this inspection setting out how they were going to address these issues. We conducted this inspection to check that improvements were being sustained in accordance with the provider’s action plan. We found all areas had been addressed appropriately.

Meadbank Nursing Centre is a care home with nursing for up to 176 people, with a particular emphasis on providing palliative care. There are four units at the home each named after a famous bridge in London and each had its own unit manager. Albert Bridge unit which is based on the ground floor is home to older people with some early onset dementia and Westminster Bridge Unit which is on the first floor is a nursing unit. Chelsea Bridge unit which is located on the second floor is home to those with palliative care needs and Lambeth bridge unit is home to those with advanced dementia needs.

There was a registered manager at the 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.

We found that there were some issues with regard to the safe administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities. However, we found that people being prescribed medicines that were labelled ‘do not crush’ were having their medicines crushed prior to administration thereby placing them at risk of unsafe administration. Some PRN or ‘as needed’ medicines protocols were not detailed enough to adequately instruct care staff. We also found that some people with higher than expected blood glucose levels were not being referred for further medical advice or assistance as expected.

The provider had good systems in place for the prevention and control of infection. We found all previous issues with regard to the external storage of waste had been addressed. The provider maintained a clean home environment and staff members were aware of their responsibilities with regard to infection control.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these on people’s files. Where people were at risk of having their liberty deprived, applications were sent to the local authority for Deprivation of Liberty authorisations.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.

People were supported to maintain a balanced, nutritious diet. People at risk of malnutrition had appropriate assessments conducted and were referred to the community dietitian as appropriate. Advice was implemented by care staff and the kitchen staff who were also aware of people’s dietary needs. People were supported effectively with their other healthcare needs and were supported to access a range of healthcare professionals.

People using the service felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place. Care staff gave excellent feedback about the registered manager and gave us examples of improvements that had been implemented and sustained by her.

People were encouraged to participate in activities they enjoyed and people’s participation in activities was closely monitored. People’s feedback was obtained to determine whether they found activities or events enjoyable or useful and these were used to further develop the activities programme on offer. The activities programme covered five days a week and included a mixture of one to one sessions and group activities. There was limited provision for activities over the weekend, but special weekend activities were arranged every two months.

The organisation had good systems in place to monitor the quality of the service. Feedback was obtained from people through monthly residents meetings and we saw feedback was actioned as appropriate. There was evidence of auditing in many areas of care provided as well as significant monitoring from senior staff members within the organisation.

Since the publication of this report, the name of this service has changed to Meadbank Care Home.

During this inspection we found one breach of regulations in relation to medicines administration. You can see what action we told the provider to take at the back of the full version of this report.

They were also aware of the complaints procedure.

They did not tell us about the support staff received, medication administered or the quality assurance system in place. They did say that their views were asked for, they had filled in satisfaction surveys and generally staff were very good. In some instances individual staff were singled out with comments such as "Superb" and "Excellent".

We found that the home provided good care and support for people living at Meadbank, medication was appropriately administered and accurate records kept when this took place.

There was suitable support, training and supervision of staff to enable them to fulfil their roles competently and effectively.

There were effective quality assurance and complaints procedures in place to monitor the quality of care provided and satisfaction levels of people using the service and their relatives.

We spoke with people living at the home, their relatives and staff who worked at the home. The relatives we spoke with all told us that they felt staff treated their family member well and showed respect and empathy towards people. One person commented "staff are kind they help me when I call and make time for me". During meal times we observed many staff available to deliver meals to people's rooms and provide assistance to those who required more support. Staff sat with people both in their rooms and in the dining facilities to provide help and assistance where needed.

Someone told us "there are domestic staff on hand to help keep the home clean". Another person said "there's a nice maintenance chap, he sorts it all out". We saw domestic staff working on all floors and laundry staff fulfilling their roles.