Archived: The Meadows Nursing Home

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 inspection we rated this key question inadequate. At this inspection the rating has remained as inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

We found the service was not well led and improvements we identified at our last assessment had not been fully implemented or sustained. Systems in place to assess monitor and improve the quality and safety of the service were not effective. Managers had a lack of oversight. Managers did not consistently complete checks of the quality of the service.

The service was previously in breach of the legal regulation in relation to governance. Not enough improvement had been made, and the service remained in breach of this regulation.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a clear shared vision, strategy and culture based on transparency, equity and equality. The providers objectives outlined in their statement of purpose were to ensure, the home and the services provided by the home were compliant with the relevant regulations and based on best practice and to provide, care and treatment in a setting that is accessible, comfortable, safe, homely and free from all forms of abuse. However, the lack of oversight and ineffective governance systems meant that leaders and staff were not able to demonstrate these aims and objectives. Leaders had not identified that the culture in the home was not always person-centred, inclusive or empowering. They had failed to identify and address safety concerns to ensure the environment was safe and they had not ensured all staff had received appropriate induction and training to safely meet people’s needs.

The service did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied 7the culture and values of their workforce and organisation. Whilst leaders were experienced, they had not utilised processes effectively to ensure people were consistently safe or that person-centred care was promoted. They had not demonstrated their ability to drive and sustain improvements. A new operations manager had been employed, since our last assessment, and was in the first week of employment when we carried out this assessment. Following our site visits the operations manager informed us a change in management was made to ensure the service adopted the vision and values of the wider organisation.

Staff were aware of how to raise concerns and felt these would be listened to and acted upon. However, we were not assured the manager promoted an open and transparent culture. Staff spoke positively about the manager and felt they had made improvements. However, we reviewed staff meeting minutes, notes taken from a meeting held on 7 October 2024 read, “You have plenty of avenues to air your grievances if you have any, rather than running to CQC”. This demonstrated leaders did not support staff to raise and share concerns outside of forums the provider had in place.

The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them. Leaders had not ensured that staff had undertaken training on equality to help them understand about protected characteristics, bullying and harassment. Only 2 out of 29 staff had undertaken training. Not all staff received regular supervision meetings with their designated supervisor where they could raise concerns. However, staff we spoke with did not raise any equality or diversity concerns.

There continued to be a failure to use governance systems in place to consistently identify and drive improvements at the service. Managers did not use audits effectively to ensure improvements and actions were undertaken. For example, a ‘Care Home Improvement Plan’ was in place, the manager had not updated this to reflect findings identified in the ‘Home Review Audit’ dated September 2024. Some issues identified did not have timeframes for actions to be completed or updates on progress. The manager did not have adequate oversight of delegated checks to ensure the environment was safe, we found gaps in monitoring records and audits. The manager told us that the wider leadership team supported them, and they had weekly visits from the operations manager following our last assessment. These visits reduced to fortnightly in September 2024 until the operations manager left in October 2024. Despite this level of input, we continued to find environmental safety concerns and shortfalls in care records. Leaders did not consistently seek the views of people, relatives, staff and external stakeholders. The manager told us they had sent out a relative survey in July 2024 but had not reviewed or published the results. The provider failed to display the ratings for the service which is a legal requirement. On the first day of our assessment, we saw the ratings on display were for the previous CQC inspection undertaken in January 2019 where the service was rated requires improvement. The provider had not displayed their rating of inadequate following the assessment carried out in February 2024.

Regular quality monitoring visits from the local authority quality team and external health professionals had taken place. We reviewed the resulting action plans and found whilst some progress had been made, many areas of concern still required action. There was limited evidence the service had engaged with the wider community. Staff told us some people had the opportunity to go out in a minibus once a month. One relative we spoke to said, “I would like them [staff] to take the residents out more”.

Managers did not always focus on continuous learning, innovation and improvement across the organisation and local system. The wider leadership team had not ensured improvements had been implemented and sustained following our last assessment and could not demonstrate they had effective processes for learning and improvement as we found concerns of similar themes during this visit.