Archived: Meadow View

About the service:

Meadow View provides residential care services to older people with a range of support needs, including dementia. It can accommodate up to 47 people. The home is located in the Kilnhurst area of Rotherham, and has parking and public transport access as well as local facilities nearby. There were 26 people using the service at the time of the inspection.

People’s experience of using this service:

People we spoke with were positive about their experience of living at Meadow View. One person said: “They [the staff] are nice.” A visitor, talking about the care staff said: “They do their very best.”

Staff we spoke with, and those we observed, had a good understanding of people’s needs. They treated people with respect and upheld their dignity when carrying out care and support tasks. Care tasks were done at the pace people appeared to prefer, and in a person centred manner.

People’s needs were thoroughly assessed before they began to use the service. It was clear the service developed a good picture of people’s needs before devising their care packages. This was undertaken with as much input from the person, and where relevant their families, as possible.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions and told us they found this useful.

Staff knew how to raise concerns and had received appropriate training in safeguarding. Steps were taken to minimise risk, and this was managed in a dynamic way so that when people’s needs changed risk assessments were amended to ensure they continued to keep people safe.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.

At the last inspection, we identified the processes to assess people's mental capacity and to ensure decisions were made in people's best interest were not always recorded appropriately. At this inspection we found this had been addressed, and the provider now had appropriate processes in place.,

Managers were highly visible within the service and accessible to people using the service. People told us they knew the management team well and could speak with them whenever they wanted to. The registered manager followed governance systems which provided effective oversight and monitoring of the service.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 26 September 2018)T he provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up:

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

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

Meadow View is a 'care home.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was previously inspected in October 2017 and was rated requires improvement. We found there were two breaches of the regulations. These referred to risk assessments, management of medicines and the systems in place to monitor the quality of the service. We asked the provider to complete an improvement plan to show what they would do and by when, to improve the key questions of Safe, Responsive and Well-Led.

Meadow View is a care home for older people who require personal and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into three units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

The registered manager in post at our last inspection had recently left. The manager on the days of our inspection was registered at another service and was providing managerial support whilst the registered provider was recruiting a new manager. The recruitment had been successful and the new manager would be starting shortly and beginning the process of registering with CQC. A registered manager is a person who has registered with CQC to manage the service. Like registered providers they are 'registered persons.' Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found improvements in risk assessment and medicines sufficient to meet the previously breached regulation for safe care and treatment. However, we identified omissions and poor practice relating to consent, which the processes for governance had not identified. The registered provider informed us that this would be rectified in the immediate future with the introduction of a revised quality assurance system.

People were protected from harm by staff who were trained to recognise signs of abuse. Where risks to people were identified, staff acted to minimise them. There were enough staff to meet people's needs and staff were recruited safely. People were protected from the risk of infection by robust prevention and control measures. Analysis and reflective practice meant lessons were learned when things went wrong. People told us they felt safe living at Meadow View. Comments included; "Yes, I feel safe here. They (staff) look after me," and “Staff are kind, I'm safe enough.” The atmosphere was relaxed and friendly. Staff supported people to move around and encouraged people to be independent.

Medicines were given to people as prescribed and disposed of safely by properly trained staff. Auditing processes were effective in identifying and addressing any medicines shortfalls. The storage, recording and stock control was robust and in line with guidance.

There was a stable staff team in place who knew people well. New staff were required to complete an induction and initial training. Training was regularly refreshed. Supervisions, annual appraisals and staff meetings enabled staff to raise any issues or suggestions.

Processes to assess people's mental capacity and to ensure decisions were made in people's best interest were not always recorded appropriately.

People's needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with associated health needs. People were supported to have healthier lives by having timely access to healthcare services. People lived in an environment which was suitable for people living with dementia.

People received a service which was caring and, they were treated with dignity and respect. Staff were compassionate and caring, this was commented upon positively by people and their visitors. Staff treated people's private information confidentially. People, where possible, made decisions about how their care was provided and were involved in reviews of their care together with people important to them.

Care was personalised to people's individual needs and preferences. Some activities were available for people to participate in if they wished and people enjoyed spending time with staff, although activities were currently restricted whilst a new activities coordinator was recruited. Staff knew people's interests and needs well. There was a complaints policy available to people. Staff were open to any complaints and understood that responding to people's concerns was a part of good care.

People and staff were positive about the culture of the service and people felt the staff team were approachable and polite. The staff team worked with other organisations to make sure they followed current good practice. Maintenance records for equipment and the environment were up to date. Policies and procedures were up to date and available for staff to refer to. Staff said they were encouraged to suggest improvements to the service.

The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

Governance systems were not always effective in ensuring shortfalls in service delivery were identified and rectified.

At this inspection we found significant improvements. The new registered manager had followed the action plan submitted following our last inspection. Although at this inspection we identified some minor issues and systems still required embedding into practice, the service has been removed form special measures.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Meadow View is a care home for older people who require personal and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into three units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

The provider had safeguarding procedures and staff were aware of these procedures. Staff had received training in the topic and people were protected from abuse.

We found there were sufficient staff on duty to meet people’s needs but deployment of staff could be improved.

Risks to people had been identified but we found these were not always followed. Systems were in place for safe management of medicines. However, we identified a number of errors that meant systems had not always been followed to ensure people received medications as prescribed.

The service was well maintained and clean.

We found that the recruitment of staff was robust and thorough. Staff supervision took place and staff told us they felt supported by the new registered manager. Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Most staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, we found two people who were admitted urgently for respite care had not been assessed and met the criteria for an urgent DoLS application; this was addressed by the peripatetic manager during the inspection.

A well balanced diet that met people’s nutritional needs was provided.

We found staff approached people in a kindly manner. They were kind, considerate and caring. We saw staff respected people and maintained their dignity.

Care records did not always reflect people current needs. We observed staff did not always follow care plans which could put people at risk.

People who used the service and their relatives we spoke with were aware of how to raise any concerns or complaints and felt listened to.

There were processes in place to monitor the quality and safety of the service. However, these were new and had not yet been reviewed. We found issues that had not been identified by the systems and they were also not fully embedded.

There was a culture of openness and transparency promoted by the registered manager. Staff told us they were well supported.

We found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report.

Meadow View is a care home providing accommodation for older people who require personal care and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into two units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

There was not a registered manager for the service in post at the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, there was a new manager who had commenced in post on 13 February 2017.

The provider had systems in place to protect people from abuse and staff were aware of the procedures to follow. However, we identified these had not always been followed. People had not been protected and we made safeguarding referrals to the local authority following our inspection.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not always followed.

We found there were adequate staff on duty to be able to meet people’s needs. However, the ineffective deployment and direction to staff meant people’s needs were not always met. We also found a high use of agency staff.

We saw that appropriate pre-employment checks had been carried out to ensure staff were of good character and suitable to work with vulnerable adults.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However we found it was not being carried out in practice and conditions were not being met.

A well balanced diet that met people’s nutritional needs was provided. However, we found people were not always supported appropriately to be able to eat and drink. We found best practice guidance was not always followed for people living with dementia in respect of aids for eating and adaptations to the environment.

Staff had undertaken training to give them the skills and knowledge to carry out their roles. However, as we found staff not always following best practice it was not clear if the training had been effective. The new manager had identified additional training was required and had booked more training for staff to attend.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. Some complaints had been raised and appropriate action had not always been taken. The new manager was aware of the need to take any concerns seriously and follow the appropriate procedure so people were listened to.

There were processes in place to monitor the quality and safety of the service. However, we saw these had not always been followed and the processes had not identified issues identified at the inspection.

We saw the process in place to ensure incidents were reported appropriately to the Care Quality Commission had not been followed and incidents had not been notified.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to 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 found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report. However, following our inspection the provider agreed to a voluntary suspension of any further placements until improvements had been made. They have also provided an action plan of intended improvements.

After the last comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We carried out this comprehensive inspection to check that they had followed their plan and to confirm that they were meeting all of the legal requirements.

This inspection was carried out on 13 and 19 April 2016 and it was unannounced on the first day. This was the third rated inspection for this service, which had previously been rated inadequate, and at the last inspection in May 2015 had been rated requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Meadow View’ on our website at www.cqc.org.uk’

Meadow View is a care home providing accommodation for older people who require personal care and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors. The downstairs unit provided care and support for people living with dementia. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham. At the time of this inspection there were 38 people using the service.

The service did not have a registered manager in post. However, there was a new manager who had commenced employment at the service six weeks prior to this 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.

We found improvements had taken place to the cleanliness of the home so that people who used the service were protected against the risks associated with inadequate infection, prevention and control measures. The home was being decorated throughout at the time of this inspection. The hospitality manager told us that new chairs had also been ordered which would improve the furnishings in lounge areas.

There were robust recruitment procedures in place, staff had received formal supervision. Qualified nursing staff had also received a monthly clinical supervision. Annual appraisals had been carried out before the new manager had taken up her position. These ensured development and training to support staff to fulfil their roles and responsibilities was identified.

Staff told us they felt supported and they could raise any concerns with the manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it

The manager was aware of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. We found some improvements were still required to ensure mental capacity assessments and best interest decision records were more detailed and decision specific.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. The home involved dieticians and tissue viability nurses to support people’s health and wellbeing.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. However, on the first day of this inspection we found the meal time experience could still be improved for people who used the service. On the second day of this inspection we found the dining experience was much more relaxed and organised.

We found staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were encouraged to make decisions about their care and how staff were to support them to meet their needs.

People were able to access a variety of activities, although some people told us that they preferred to spend time on their own. Signage around the home had improved to ensure people living well with dementia could orientate their way around the home. However, more improvements were needed to ensure contrasting colours distinguished bedrooms from bathrooms and toilets. Handrails were painted the same colour as the corridor walls which made them difficult to stand out for people who were visually impaired.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, more detailed information needed to be sought to ensure medication administered covertly [hidden in food or drink] was suitable for crushing. Protocols were in place for administering ‘as required’ medication for pain, but we found one person’s medication for low mood did not have a protocol for its administration.

There were systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the manager. The reports included any actions required and these were checked each month to determine progress.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff.

We found inadequate monitoring systems were in place to record people's food and fluid intake, when they had been identified as at risk of poor nutritional intake. This did not ensure the risks to people were managed.

Is the service effective?

People's health and care needs were reviewed, and they were involved in the reviews.

Is the service caring?

Due to the complex needs of the some of the people who used the service we were unable to gain some people's views. Therefore we used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and visitors, and checking records.

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

We spent time in the dining room observing during lunch. We saw the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were given choices and their preferences were respected. However there was a long wait for the meal to arrive. One person told us, 'It varies every day it should be 12.15 but it comes anytime between 12 and 13.15hrs.'

Relatives we spoke with told us they were happy with the home, and that they had been involved in planning their relative's care. They praised the activities available for their relatives to participate in.

We observed staff giving appropriate sensitive support when required. We observed that staff made the effort to communicate with people living with dementia while at their level physically for example kneeling down beside their chair to talk to them, or sitting next to their bed, rather than standing over them.

Is the service responsive?

The provider had employed a peripatetic manager to oversee the service until a permanent manager could be recruited. The peripatetic manager is applying to register with CQC. The provider has made a number of improvements over the last few weeks since our visit in March 2014. The choice of meals and variety of food had completely changed. The menus had been drawn up with the involvement of the people who used the service. The cook told us that they were still work in progress as she was trying different meals to determine what people preferred. One person told us, 'The meals changed overnight following our last visit and they have improved tremendously.'

The environmental works identified at our visit in january 2014 were in progress at this visit. The provider told us they were on target to meet the dates of the action plan submitted to CQC.

Is the service well-led?

The provider has provided a manager and a new deputy to oversee the service. The deputy is supernumerary so is able to look at improvements required and review and update all plans of care.

The provider had a registered manager from another service overseeing the home for three days a week and the operations manager was also visiting regularly.

People's needs were assessed and care and treatment was planned in line with their individual assessed needs. However care was not always delivered in line with their individual needs.

We observed activities ongoing during our visit. People were engaging in the activity and enjoying it. We observed people laughing and joking together during activities.

We observed lunch. We found the experience for people who used the service was extremely poor and people's nutritional needs were not met.

There was little choice and the presentation of food was unappetising. People were sat for over an hour and a half waiting for lunch to be served.

One person said 'I think you have forgotten to put me any meat on my plate.' But the cook did not acknowledge the persons comment.

Relatives told us, 'The lunch is the best meal, you ought to see the dreadful sandwiches they dish up at tea time.' Another relative said, 'The food is like slop and never any choices.'

People we spoke with said most care staff were very good they worked very hard and were always busy. One person said, 'They try their hardest but they are always very busy.'

People we spoke with told us they were well looked after. They told us the staff were good and looked after them. One relative told us, 'The staff are amazing they look after my relative and everyone extremely well, they understand the needs of the residents.'

People also told us that staff treated them with respect, listened to them, and gave them choices.

We found people were not always cared for in a clean, well maintained environment. Infection control procedures were not always followed. The new acting manager had identified the need for improvement.

We found there was an effective recruitment and selection process in place. Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed. Staff we spoke with told us the training was good.

There was an effective system to regularly assess and monitor the quality of service that people received. However some of the infection control quality monitoring had not identified shortfalls that required action.

Staff told us they felt proud to work at the home now it had been redecorated as it had been in a poor state. We observed the service was well maintained and the manager had employed a gardener to also improve the grounds.