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Meadow House Residential Home Requires improvement

We are carrying out checks at Meadow House Residential Home. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 13 September 2017

We carried out an unannounced inspection of Meadow House on 25 July 2017. Meadow House provides accommodation and personal care for up to 24 people, some of whom live with a cognitive impairment. Accommodation is arranged over two floors of a converted Victorian building with stair lift access to the second floor. At the time of our inspection 21 people lived at the home.

At the time of the inspection the registered manager was having a period of planned absence from the home and the deputy manager was providing cover in an acting manager role. 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.

This service was last inspected in July 2016 when we found the provider had not ensured there were sufficient staff available at all times to meet the needs of people; there was a lack of proper and safe management of medicines for people and there was a lack of systems and processes in place to assess, monitor and improve the quality and safety of the service. At this inspection we found that although some action had been taken to address these issues additional improvements were required.

Not all staff had received the training they required to support their role and meet the needs of people. The system in place to monitor the training that staff had received was not robust in identifying staff training needs.

Staff and the acting manager had received training in respect of MCA and were able to demonstrate an awareness of the principles. However they did not always able to apply this to the people they supported. For example appropriate systems were not in place when people were given their medicines covertly and consent from people was not always obtained before providing care and support.

People and their families told us they felt the home was safe. There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. However, the auditing system to check medicine stock was not robust.

Not all staff had developed caring and positive relationships with people. Some people felt that staff did not always speak to them nicely or provide them with choices about their care.

There were enough staff to meet people’s needs. Staffing levels enable staff with the time to engage with people in a relaxed and unhurried manner. There were safe and effective recruitment practices in place.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks. People’s care plans were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence. Environmental risks were assessed and managed appropriately.

People were supported to have enough to eat and drink. People were provided with appropriate support during mealtimes and supported to be independent. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff knew people well and responsive to people’s needs. Care plans were personalised and focused on individual needs and preferences. People were provided with a range of activities.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through six monthly questionnaires. They were also supported to raise complaints should they wish to.

People had mixed views on the management of the service, although all families felt that home was well-led. The acting manager understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

We found three 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 back of the full version of this report.

Inspection areas

Safe

Requires improvement

Updated 13 September 2017

The service was not always safe.

People received their medicines at the right time and in the right way to meet their needs. However, the auditing system to check medicine stock was not robust.

Not all staff had the knowledge and understanding of how to identify safeguarding concerns.

There were enough staff to meet people’s needs and recruiting practices ensured that all appropriate checks had been completed.

People and their families felt the home was safe. Most of the staff were aware of their responsibilities to safeguard people.

The acting manager had assessed individual risks to people and had taken action to minimise the likelihood of harm. Environmental risks were assessed and managed appropriately.

Effective

Requires improvement

Updated 13 September 2017

The service was not always effective.

Not all staff had received the training they required to support their role and meet the needs of people.

Staff and the acting manager did not always able to apply the principles of the Mental Capacity Act (MCA) to the people they supported. There was a lack of understanding around the administration of cover medicine and consent was not always obtain before providing care and treatment.

People were supported to have enough to eat and drink.

People had access to health and social care professionals to make sure they received effective care and treatment.

Caring

Requires improvement

Updated 13 September 2017

The service was not always caring.

Not all people felt that staff treated them with respect or spoke with them in a kind and caring way and this was observed during the inspection.

Staff understood the importance of respecting people’s privacy and took appropriate action to ensure that people’s privacy was respected.

Staff encouraged people to be as independent as possible.

People were encouraged to maintain friendships and important relationships.

Responsive

Good

Updated 13 September 2017

The service was responsive.

Staff knew people well and were responsive to people’s needs.

Care plans were personalised and focused on individual needs and preferences.

People were provided with a range of activities.

The acting manager and provider sought feedback from people using the service and had a process in place to deal with any complaints or concerns.

Well-led

Requires improvement

Updated 13 September 2017

The service was not always well led.

At this inspection we found some improvements had been made in the areas of concern previously highlighted during the inspection completed in March 2016. However, further improvements are still required around medicine management; ensuring systems to monitor staff training are robust; ensuring staff are managing their time effectively to allow more engagement and acting on times when people were not being treated respectfully.

Staff were supported by a manager who encouraged an open, honest and transparent culture in the work place.

People, their families and staff had the opportunity to become involved in developing the service.