Meadow View

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Relatives told us they were informed if there had been any incidents. One relative told us, “We talked through what had happened, [registered manager] did a thorough investigation and I was satisfied.”

Staff told us any changes in people’s care because of an accident, incident or complaint were shared with them during the handover between shifts. One staff member told us, "The [registered] manager normally informs us. They will come and have a chat with us, and it is always handed over in the handover prior to your shift, so you know what has happened." Another member of staff commented, “We do it in the handover or on the PCS system, [Providers electronic care records system]. [Registered manager] usually comes down and tells us if there have been complaints or what has been going on if we have had days off as well."

Whilst staff told us information about changes was communicated, some staff did not describe a collaborative approach to problem solving. However, they did feel able to share any errors or mistakes so they could improve their individual practice. One staff member said, “Everyone makes mistakes, we are all human. It is like a learning curve." Another staff member told us learning had been following spot checks and audits on medicine administration practices. For example, to improve recording and reduce errors and to ensure secondary dispensing did not occur. The staff member said, “There’s less of a blame culture, it’s about confirming roles. We also discuss patterns of falls.”

Systems were in place to consider any learning with staff and expectations about their roles through staff meetings.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives told us they were promptly informed if their family members required care from other organisations, and they were able to either go with them, as they wished, or to receive updates from staff at Meadow View.

Systems were in place to communicate essential information about people’s care needs when they transferred to other health and social care professionals. One staff member told us this included ensuring people’s medicines and medicinal administration records, care observations and care plans were given to their new care provider. This helped to ensure people’s essential care needs were met when they transferred to other care providers.

The registered manager told us if a person lacked capacity, they would ensure a staff member accompanied them to hospital in an emergency. This ensured any risks around the person’s care, for example in relation to their mobility or nutrition, were shared with other healthcare professionals.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were positive about the arrangements in place to ensure they were safeguarded. One person said, “I do feel safe; [staff] look after me. It’s the way they [staff] look after me that makes me feel safe.” Another person told us, “I am safe here. I would talk to my favourite member of staff if I thought anything was wrong.” A further person said they felt safe because, “You have always got someone to talk to."

A relative told us, “[Person] is safe here, we had peace of mind when they came here. We know they’re well cared for here. If I was worried about their safety I would speak to the [registered] manager. If I ‘phone and say I want 10 minutes with the [registered] manager she’s very obliging.”

Staff kept people safe by reporting any concerns they had that people were at risk of discrimination, abuse or harm. Staff told us they would escalate any concerns to the provider if they felt the right action had not been taken by senior staff to maintain people’s safety. There was accessible information about the local safeguarding procedures which staff were aware of. Comments included: “I would go and report to my [registered] manager and the senior carer because it is abuse. You have your whistleblowing as well. There is a number somewhere on the board” and "I would go straight to the senior on duty and tell them what I have seen. Then I would go straight to the [registered] manager and then I would go to head office. I would also write a statement."

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Where people had restrictions in their care plans which staff felt they did not have the capacity to consent to, the provider ensured DoLS applications had been submitted to the relevant supervisory body.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found gaps in risk management plans. For example, 1 person was at risk of skin damage and was cared for on an airflow mattress to relieve pressure to vulnerable skin areas. There was no information in the person’s care plan about the mattress and what checks staff should carry out to ensure it was working correctly. On both days of our inspection, the pressure relieving mattress was not on the correct setting for the person’s weight. Whilst we found this had not impacted the person’s skin integrity, this may increase risks of poor skin health.

This person also needed to be transferred from their bed to their wheelchair using a hoist and sling. This was not referenced in the person’s care plan and there was no information about what size sling to use to transfer the person safely. Staff spoken with were unclear about the equipment they should use to transfer this person. We found staff were not always sure where the person’s sling was located. One staff member told us a person who had previously lived at the home did have an individual, named sling, but this person did not have their sling identified with their name.

One person living at the home was seen to enter other people’s bedrooms during our inspection visits. The registered manager assured us this was a new behaviour for this person, but there was no guidance for staff about how to mitigate any potential risks to the person or others. However, staff gave us an example showing the frequency of checks on people was increased throughout the following day, if they had expressed anxiety during the previous night.

However, 1 person told us they felt their risks were managed well because, “I’m able to come and go as I please, it is very controlled though, [staff] want to know where I’m going and who I’m with.” Another person said they managed their own medicines, with some occasional support from staff. The person told us how they had worked with staff to reduce any associated risks to themselves and other people living at the home. The person said, “My medication is in a locked cupboard in my room. I always keep my room locked. So, my medication is behind two locked doors.”

In some other instances, people’s risks were assessed, and some care plans included more detail about how staff should support people to manage their risks safely. In these instances, people’s care plans did give staff the information they required to manage their risks effectively. For example, in relation to their risks of choking, anxiety and falls management.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment and facilities supported the delivery of safe care.

Some further improvements were required in the safety of the environment. One relative told us, “[Person] has been waiting for that drawer to be fixed for a long time.” Where actions in relation to staff practice had been identified, these were followed up at staff meetings, so staff were clear what was expected of them. Despite this, and checks made on the environment by senior staff, some further oversight and changes to staff practice were needed. For example, we found some items containing chemicals which may be harmful to people if ingested were not consistently stored safely. We also found some items requiring maintenance had not always been reported or resolved quickly. This included a repair required to a dado rail in one person’s bedroom, and a hole in the ceiling of a room used by staff. We raised these issues with the registered manager, who took immediate steps to action these.

However, there had been improvements in the way many aspects of premises were now managed. For example, actions arising from fire risk assessments were now promptly completed and other checks on the premises were undertaken. This included checks by specialist external contractors, so the registered manager and provider could be sure people’s safety needs were being met. Areas required to be secured were now consistently locked. Staff had received further guidance on how to ensure people’s and others safety in the event of a fire and knew what actions to take should this happen.

The home was being refurbished at the time of our inspection to improve the facilities and make it more visually appealing. One person told us, “This place has been decorated, it has made a hell of a difference.” This view was reflected by relatives and staff.

The provider did not always make sure there were enough qualified, skilled and experienced staff deployed. However, they made sure staff received effective support,supervision and development. Improvements had been made to the way staff worked together to provide safe care.

Improvements were needed to ensure there were sufficient staff to support people at certain times. We were given mixed views from people about the number of staff available to support them. One person said, “A lot of the time staff are busy because they have got other people [to look after]." Another person told us, “Sometimes they are short staffed. I feel I don’t get the support [at] mealtimes.” Other people were more positive about the number of staff to care for them and relatives said if 2 staff were required to care for their family members, 2 staff were always made available.

Staff generally did not raise any concerns about staffing levels but said there were times they could be very busy, especially if there was unexpected staff absence. One staff member said, “It is good to a certain point. Sometimes we are short staffed, and we are here and there. It can be a bit like a football game when you are down to 10 men. We try and help each other out wherever we are." Another staff member told us, “Staffing is better now, it’s less chaotic than it used to be.” We saw staff working together to ensure people’s needs were met.

However, we saw occasions when there were 8 people in the communal dining room with no staff presence. One member of staff told us, “I would say you have to have a member of staff in the dining room if there was a lot of people in there." Senior staff told us ideally there would be a member of staff in the dining room at all times, and advised they would consider adjusting the deployment of staff to facilitate this if possible. Senior staff gave us examples showing how staffing had been increased, in response to people’s changing needs.

Systems to check the suitability of staff before they commenced employment were effective. The provider made sure all safe recruitment checks were made and recorded.

People were positive about the skills of the staff caring for them. One person said, “I think the staff are excellent.” One relative told us, “The staff are well trained and very caring”

Staff were able to access training to develop their skills further. One staff member told us they did not work full time at the home but were able to access the same training as full time staff. The staff member said, “We get the same training. I would be comfortable to ask for extra training and [registered manager] would organise it.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was clean and there were no unpleasant odours. Personal protective equipment, [PPE], was available and accessible to staff, together with guidance about maintaining good hand hygiene. Several people and relatives commented positively about the cleanliness of the home. A person told us, “I like my room. It’s nice and clean. I couldn’t have it better anywhere else.”

Staff told us any they were kept up to date with any infectious outbreaks at the home. One staff member said, “There are always notes on the door if there are any infections, and there’s no problems with [access to] PPE.” A member of the housekeeping team explained how they followed national guidance to ensure the correct cleaning equipment was used in different areas of the home, to mitigate the risks of any infections spreading. The laundry was well ordered with a clear workflow separating dirty and clean washing. This helped to reduce the likelihood of contamination.

The provider did not always make sure that medicines and treatments were safe and met people’s needs.

We found 1 example where a person’s medicinal patch, although rotated, had not been rotated in line with manufacturer’s instructions. Failure to rotate transdermal patches according to manufacturer instructions can lead to serious adverse effects, primarily caused byskin irritation and altered drug absorption rates. The most significant risks include skin damage, overdose (due to increased absorption), or reduced medication effectiveness.In addition, processes for the management of prescribed barrier creams and moisturising creams needed to be improved. There was a lack of information for care staff on where and how these should be applied, and records did not always evidence that they had been applied as directed. The dates the creams had been opened had not always been recorded. The registered manager and provider representative told us they would address these areas without delay.

However, people and relatives said they could rely on staff providing medicines as prescribed. People were able to access additional medicines when needed. One person said, “If I’m in pain, I would tell carers and get a paracetamol.” A relative told us staff had fully supported their family member when their prescription was changed. The relative told us staff had travelled some distance to obtain the medicines the person needed, so they would be free from pain.

Staff were not allowed to administer people’s medicine until they had received training and their competence to safely administer medicines as prescribed was checked. One staff member said, “I have just had my medicines training. It was very good and I was given guides and a helpline number for any follow up advice.”

People’s medicines were securely stored and disposed of. There were clear records confirming people had been administered their medicines. Where people had declined their prescribed medicines this was clearly recorded.

Some people required ‘as when required’ medicines. We found these were not administered excessively and information was available to guide staff to do this safely.

Some people managed their own medicines with occasional support from staff. Where this was the case, there were weekly checks to ensure people received their medicines safely, and staff were prompted within people’s care plans to ensure any changes in people’s needs were escalated.

Staff worked with people’s GPs to review their medicines regularly.