Meadowfield House Home for Older People

We inspected this service as a proposed designated care setting. Whilst we were assured that the service met good infection prevention and control guidelines, at the time of the inspection the location was not ready to be set up as a designated care setting. The commissioners decided to put their plans on hold while they finalise their operating procedures. They informed us they would re-apply once they were ready to proceed. At which point we will revisit.

We found the following examples of good practice.

The premises were clean and hygienic and arrangements were in place to check visitors for symptoms on arrival. Adequate signage was in place for people and visitors.

Staff had received infection prevention and control training and were regularly supported to update their knowledge and skills in relation to best practice standards. Staff also received additional training specifically linked to COVID-19 to enhance their knowledge and understanding and identify areas of support.

Staff used technology such as video calling to support people with contact and at times when they could not get visitors including for making contact with health professionals.

There were arrangements to monitor staff welfare during the pandemic. Risk assessments were in place for people and staff deemed to be at high risk of infection. Staff who were deemed to be at high risk had been deployed in other parts of the service to reduce the risk of infection.

The provider had risk assessed and had contingency plans to manage COVID-19.

There were stocks of personal protective equipment (PPE) and staff were knowledgeable about what standard of PPE was needed and when. Staff were observed wearing PPE as required.

Further information is in the detailed findings below.

We found the following examples of good practice.

Staff had received infection prevention and control training and were regularly supported to update their knowledge and skills in relation to best practice standards. Staff also received additional training specifically linked to COVID-19 to enhance their knowledge and understanding and identify areas of support.

People were provided stimulation and supported to maintain contact with their friends and family when shielding or isolating. Visiting arrangements were person-centred to support those at the end of their lives while respecting local and national visiting guidance. A visiting pod had been built to facilitate safe face to face visiting. Visitors were also provided with PPE on arrival including a mask and alcohol gel.

Technology was used to support people with contact and at times when they could not get visitors including for making contact with health professionals.

Staff were included in daily and regular meetings to discuss the management of COVID-19 and other infectious diseases. There were arrangements to monitor staff welfare during the pandemic. Risk assessments were in place for people and staff deemed to be at high risk of infection.

Processes in place for putting on and taking off personal protective equipment such as masks, gloves and aprons and management of clinical waste were robust. Facilities had been provided for staff to put on and take off PPE. The environment was clean and domestic staff demonstrated good understanding of best practice standards for cleaning and decontamination.

The provider had risk assessed and implemented contingency plans to ensure an outbreak of COVID-19 was effectively managed. People and staff affected by COVID-19 were individually risk assessed including people who are more likely to be impacted by COVID-19 due to their ethnicity.

People were tested before admission and asked to isolate for a period of 14 days. Staff wore personal protective equipment (PPE) and were knowledgeable about what standard of PPE was needed and when.

Staff were deployed to work in designated parts of the home to prevent the possible spread of infection in the event of an outbreak.

Further information is in the detailed findings below.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

At this inspection we found that the provider had completed those actions and recommendations and we found the service was meeting the fundamental standards of quality and safety.

Meadowfield House Home for Older People is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is a modern two story building set in its own grounds with parking and a number of easily accessible, private and secure garden and seating areas. Accommodation and personal care is provided for up to 47 older people. On the day of the inspection there were 43 people accommodated across three units. Poppyfields is an 11 bedded residential care unit, Daisyfields is a 13 bedded unit mainly for residential care use and Rosemeadows is a 23 bedded unit designated as a community assessment unit that provides rehabilitation and reablement.

There was a registered manager in post. 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 saw improvements had been made to the systems used in the home to ensure effective assessment and monitoring of the safety and quality of the service provided.

People received their medications as they had been prescribed. Appropriate arrangements were in place in relation to the storage, care planning and records for the administration of medicines.

There were sufficient numbers of suitable staff to meet people’s needs. However, we noted that the use of agency staff in comparison to employed permanent staff had been at times excessive. The provider was actively recruiting for staff and we saw how this was an ongoing process.

Staff had received sufficient training to safely support and care for people. However, we noted that some elements of training, mainly for newly appointed staff, were still waiting to be delivered. We saw that the provider had a training delivery plan in place which covered these aspects.

Staff were also supported through regular staff meetings, supervision and appraisals.

We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people and identified lesson that had been learned.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People living in the home were supported to access activities that were made available to them and pastimes of their choice.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the home.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people's dignity and privacy were actively promoted by the staff supporting them.

Further information is in the detailed findings below.

The last inspection of this service took place over two days on 14 and 20 October 2014. The service was awarded a rating of 'Good’ and we identified no concerns at this inspection.

This unannounced inspection took place on 02 March 2017 and two follow up announced visits took place 06 and 31 March 2017. At the time of the inspection there were 46 people residing at the home. We undertook phone calls to staff 13 March 2017 as we were unable to speak to many of them on the inspection visits.

The registered manager of the service was present throughout our 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 reviewed the audit records during this inspection .When audits had been completed we found the audit process was not always robust, as it had not picked up some issues that we found during the inspection such as issues with the cleanliness of the environment and medicines storage.

The provider had not ensured the processes they had in place to monitor quality and identify areas for improvement were effectively implemented. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We found the service was using a high level of agency staff and people who lived at the home said there were not always enough staff on duty. We have made a recommendation about this.

We found there was a range of effective assessments, which assessed the risks to people and the actions to reduce the risks. However, we found that peoples personal evacuation plans (PEEPs) were not always indicative of individual needs and placed people at risk of harm. We have made a recommendation about this.

Assessments were undertaken by management prior to any person being accepted into the service to ensure that individual’s needs could be met. However, we did see examples where these had not been completed fully. We have made a recommendation about this.

We found some issues relating to infection control procedures within the home, we have made a recommendation about this.

We checked whether the service was working within the principles of the Mental Capacity Act. We found that mental capacity had been considered however, recording was not always thorough and decision specific, we have made a recommendation around this.

We looked at how medicines were being managed during this inspection. We observed medicines administration to be safe and in line with good practice guidelines. However, we found medicines storage was not always suitable. We have made a recommendation about this.

We reviewed how the service continued to ensure people were safeguarded from abuse during this inspection. We found that people were protected from the risk of abuse because staff understood how to identify and report it.

Staff we spoke with said the training was very good and was on going throughout the year.

We found that people were supported to meet their nutritional needs and people were able to make choices about what they wanted to eat. People had a choice of what they wanted to eat and staff were aware of people’s needs.

We observed positive interactions throughout the inspection Staff approached people in a caring, kind and friendly manner. We observed staff speaking with people who lived at the home in a respectful and dignified manner.

We observed activities taking place at the home during the day, people were observed to be taking part and appeared to be enjoying the session; there was lots of talking and smiling between people.

We noted there was a complaints policy and procedure in place and this was followed when complaints were raised. People told us they knew how to complain. We saw evidence that complaints had been dealt with and learning from them was implemented.

People's care plans contained information about people's care needs and actions required in order to meet them.

We observed the registered manager was visible within the service. People did raise concerns to us around clear line of leadership within the service.

We saw evidence of involvement of advocacy services and information was available on notice boards within the home.

Staff reported that morale was low with some staff feeling like there was no teamwork between the staff. We discussed this with the registered and area managers and they told us that there had been some staff changes lately and that this is being addressed.

We found that minutes of meetings were retained and staff confirmed they had meetings periodically, so that they could get together and discuss any relevant topics in an open forum.

We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

You can see what action we told the provider to take at the back of the full version of the report.

People using the service told us they were happy with the care and support they received. People described the staff as 'very good' and 'bang on.'

Feedback from relatives included; 'He is happy here and well looked after.' And 'My mother's health has improved since she came here.'

Staff training, written guidance and good practice helped to safeguard people against the risk of abuse.

We found that medicines were securely kept, handled appropriately and safely administered.

Staff received appropriate training, professional development, supervision and appraisal. This helped to ensure care was delivered safely and to an appropriate standard.

There were effective systems in place to gain feedback about and monitor the quality of the service provided. People using the service, relatives and staff were enabled to share their views and influence how the service was run.

Risks within the home were identified, monitored and managed. Safety checks were carried out on equipment and services at the home. These measures promoted the safety of staff and people living in the home.