Meadow View

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (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 clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand or respond to the challenges and the needs of staff and some wishes of people living at the home.

Some processes for communicating the direction and culture of the home still did not always work effectively. Whilst staff meetings were held every month, attendance depended on the staff team working that day. Whilst all staff were encouraged to attend, some staff were reluctant because their attendance was not recognised as part of their contracted hours and renumerated. "We have 2 separate ones [meetings], 1 month it is their team meeting and the next month it is our team meeting."

One person told us staff spent too much time recording their care, rather than anticipating their needs. A relative said they did not always feel the culture of the home meant their family member’s personal care needs were always met. They said, “There are some improvements needed. They could also be more thorough with his personal care. His shave also isn’t done correctly.”

However, most people were positive about the life at the home and the focus on the ways they were supported. One person said, “It’s difficult for me to do certain things that is why I’m here. To tell you the truth, I think it’s brilliant here. The staff are brilliant.” Another person said, “I like to talk to people and so when somebody new comes here, the staff introduced me to them, and I will talk to them as a friend.” A further person told us, “The staff are pleasant and helpful and they respect me.”

One relative said, “There have been a lot of changes to the staff, but the staff are good. We have a good rapport with the staff.” Another relative told us, “The place has a nice feel about it, it is friendly and I cannot fault any of the staff, especially the [registered] manager, she is really approachable.”

Staff told us there had been significant changes in the management and staff team within the home. Whilst this had led to a period of instability, staff told us teamwork had improved and there was now a more positive culture within the home. One staff member told us, “They (staff) are much more of a team. When I started there was arguing now there are conversations and resolution. If we are working as a team, it makes it an easier job. If the carers are calmer and happy it reflects on the residents." Another staff member told us there was a culture at the home which focused on people, and said, “The atmosphere is a lot better. [People] can pick up on the atmosphere and [people] seem more relaxed now.”

New staff completed an induction and probationary period in the home. Their work was regularly reviewed and assessed during the probation period to ensure staff were working in accordance with the provider’s policies and procedures. Probationary period were extended if a need for further support was identified. Senior staff monitored staff practice against, so they could be sure staff demonstrated the values expected.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

People told us staff knew how to care for them, and senior staff were visible in the home. One person said because of this, “It works well for me here.” Another person told us, “The new manager is just as nice as the old manager. This care home is very well run. I think the staff are happy and the manager pops in every day.” Most relatives said the manager was visible in the home. One relative said, “I know the manager. If ever we want to speak to the manager, we can.” Another relative advised us, “They, [staff], are down to earth the manager is nice.”

Staff felt supported by the registered manager who they described as being visible and available to them if they had any queries or concerns. Comments included: “I like her, she is nice, very approachable and she likes to come and say hello to all the residents, [people]. She likes to go round and see them all in their rooms" and “She is lovely, she is great, I can approach her with anything. I think she has worked so hard to change it and I can see the benefits." Another staff member said, “I feel [registered manager] would give guidance if anything was getting tricky.”

Most people felt there was a positive culture, where they felt they could speak up, but some staff did not feel their voice would be heard.

Not all staff were confident their views were listened to. One member of staff told us there were opportunities to shared their views but said, “Whether anything gets done about it is another matter. A lot of the time I feel we say stuff, but no one is listening." There was no staff representative or speak up guardian, but the provider had started regular well-being surgeries for staff. The provider representative told us they were well attended in the provider’s other homes, but staff from Meadow View had not chosen to attend these so far.

However, people and relatives told us they were comfortable to express their views and raise any concerns. Most staff told us they would not hesitate to speak up because they knew they would be supported and listened to. One staff member told us the registered manager was, “Approachable and if you have got a problem, her door is always open.” Another staff member told us, “I am 100% able to go to her. I am very comfortable with her, and I think she would try to help a situation. She always supports me.” A third staff member commented, “If you don’t speak up, nothing is going to change."

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff felt assured any adaptations they needed to meet their roles would be supported. Staff gave us examples showing how they had been supported to change their shift patterns, so their own caring responsibilities would be met.

Staff told us that whilst they had never witnessed discrimination, they would feel confident to challenge and report any discriminatory behaviours.

The registered manager provided examples of additional support to help staff whose first language was not English settle well at the home.

The provider now had clear responsibilities and roles. Some further development and embedding of systems of accountability or good governance were required. This will help to ensure the provider can identify and act on the best information about risk, performance and outcomes, and to share this securely with others when appropriate.

Some further development and embedding of governance systems was required. These included checks to drive through improvements in risk management, ensuring consistently safe storage of substances which may be harmful to people if ingested, medicines management, reviewing deployment of staff, medicines optimisation, and accuracy of monitoring records. Improvements were also required to governance systems relating to people’s capacity assessments, the level of detail within care plans to support person centred care and people’s end of life wishes. Further embedding of staff understanding of available support and continual refinement of processes for communicating the direction and culture of the home were required. The registered manager and provider had already recognised some of these areas required further development, such as consistency of care planning and capacity assessment, and agreed to further progress all areas identified for development.

However, most people and relatives were positive about changes at the home and the way it was led. One person told us, “This is definitely a well run home. I don’t know the manager, although I do recognise her. All I can say is I am very happy.” Another person said because of the care they received and the way the home was run, “Overall, it is pretty good. I wouldn’t fault this place." Records showed us relatives had been complementary about improvements in the running of the home.

A health and social care professional told us there had been improvements in people’s care and said because of the way the home was run, “It’s a pleasure to come here. [Registered manager] knows people very well.” Another health and social care professional told us Meadow View staff had introduced additional checks on the currency of people’s key records, and now prompted the health and social care professionals, when they were required to be reviewed.

Staff told us their care practice was now more regularly checked. This included spot checks on staff practice and walk arounds undertaken by senior staff. A staff member said, “It is so much better. We were scared to go to the office, even to request annual leave. [Registered manager] is lovely, handovers are more efficient and it is safer for people as we are now picking up and identifying concerns.” Another staff member told us, “I can’t fault the new manager, she acts on concerns, a lot has improved, overall it is so much better.”

There had been improvements in systems and practices to check the quality and safety of the care provided, including increased falls monitoring, reflection with staff practice through regular supervision and “60 second learning”. This helped to support staff development in areas such as infection control and responding to people. There had also been improvements in the support from the provider to enable swifter premises improvements. Systems to ensure the provider had regular oversight of the quality and safety of the care provided had now been strengthened, with weekly visits from the provider’s representative and increased flow of reporting from senior staff at Meadow View to the provider. The provider also undertook internal compliance visits, with actions followed up by the provider representative.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Most people and relatives told us although they had not been involved in developing care plans, they did feel any suggestions they made about care would be listened to. One person said, “[Staff] listen to me when I speak to them.” Another person told us, “[Staff] respect me they listen to what I have to say.” One relative said, “The staff are very good. The staff do listen to me when I speak to them.” This view was echoed by other relatives, with comments such as “When I talk to the staff, they definitely listen to me.” One relative gave us an example of changes which she had requested during a resident and relative’s meeting. They had asked for improved access to the building. The relative told us this had been acted on, and a new process had been introduced, which helped all relatives to gain access to the reception area of the home.

Health and social care professionals described open and collaborative approaches from staff when undertaking joint working. One health and social care professional told us because of the approach taken by staff they had provided specialist upskilling training for Meadow View staff. This helped to ensure people recovered quickly from any wounds they may acquire.

Most staff now felt they were partners in people’s care. One staff member told us, “Your opinions are now listened to. [Registered manager] is really good and acts on things straight away.”

Some systems for involving people and staff would benefit from further development, to ensure opportunities for involving them in decisions about the running of the home were maximised. For example, people and staff had not been as involved as they could have been about decisions regarding the refurbishment of the home.

The registered manager gave us an example of increased participation in the running of the home from relatives. They said, “Relatives wanted to be involved in helping at the Christmas Fete.” The registered manager planned to use an area of the building once fully refurbished, to increase opportunities for community involvement, including through social coffee mornings.

The provider made opportunities available for staff to improve their skills but did not always recompense staff for the training undertaken in their own time. There had been improvements in the provider systems taking learning taken from feedback from people, staff and relatives.

Staff received regular training to ensure their skills were up to date and they worked in accordance with best practice guidance. Staff were positive about the training with 1 staff member who said, “Training is really good, I enjoy when [the trainer] comes down because they help whenever they can and the training is really good." Another staff member said they had recently changed their role. They told us, “I asked for support, supervision and training. [Registered manager and provider representative] come out regularly to support me.”

However, we received feedback that staff were expected to attend mandatory training outside their designated working hours. Comments included: "If you come in to do training on your day off, you don’t get paid", “We have to come in for training on our days off. I think it would be good if we got paid for our training because we are coming in on our days off and some people have to travel quite far" and "We don’t get paid to come in and do training. It is getting to a point when it should be when we are in work and not during my time off." Robust monitoring of training completed outside work hours should be in place to ensure legislative requirements around minimum wage are met. Mandatory training outside normal work hours counts as working time, meaning you must be paid at least the National Minimum Wage (NMW) for those hours. If total pay drops below the NMW, the employer must make up the difference, as failure to pay for compulsory training is an unlawful deduction and NMW violation, even if the training is "voluntary" but required by the employer.

The provider had taken some action to learn and improve since our last inspection. For example, the catering budget and menus has been reviewed to provide people with more freshly cooked food, fruit and vegetables. This had improved people’s dining experience. Investigations to support improvement were now more thorough, and the provider now compiled results of staff surveys more promptly and communicated findings to the registered manager. Action plans had been developed and ‘You said, we did’ information was shared with staff.

There was now more consideration of taking learning from people’s needs. A health and social care professional told us, “[Registered manager] thinks outside the box in terms of how to manage [people’s anxiety]. Before further organisations get involved, [Registered manager] will think of things that might work with that person, before we need to contact anyone else. They are quite proactive.”

Systems gained feedback and took learning from people, relatives and staff through meetings. Some suggestions had been adopted. For example, in relation to healthy menu and snack choices, and some staff now wearing identification badges.

Senior staff attended local care networks and adapted elements of best practice and upskilling of staff. This included in relation to dementia and improving staff confidence when using care recording systems. A nationally recognised dementia specialist had delivered upskilling sessions to staff, so they would better understand some of the needs of the people they cared for. The registered manager met with the provider’s other registered managers and gave us an example of sharing learning with other registered managers, to improve care across the provider’s other locations.

The provider representative and registered manager acknowledged these development areas, and gave us assurances they would review these.