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New Meppershall Care Home Requires improvement

Reports


Inspection carried out on 9 July 2019

During a routine inspection

About the service

New Meppershall is a residential care home providing personal and nursing care to 71 people aged 65 and over at the time of the inspection. The care home is split over two adapted buildings and two floors. One building is designed to support people living with dementia and the second building supports people who require personal and/or nursing care. Each building and each floor have access to outside garden space and each bedroom has ensuite facilities. The service can support up to 81 people.

People’s experience of using this service and what we found

People told us they felt safe and could call for staff if they needed help. Staff did check on people regularly but not all people were able to work their call alarms. This resulted in some people having to wait up to 20 minutes after shouting out for staff checks to occur, before they were heard.

Staff supported people safely, but it took a long time to complete tasks such as personal care and meal support as there were not enough staff on duty. Staff minimised the risk of harm as they had training and a good awareness of how to keep people safe.

Staff had assessed people’s needs and completed risk assessments. People received their medicines safely. People told us they had plenty to eat and drink but choice was sometimes limited. People’s mealtime experience was inconsistent across the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice. This was because there were not enough staff on duty to enable people to choose the time they got up or received personal care or meals. People did not have a choice about how they spent their time as there were not sufficient staffing levels to provide a range of activities and engagement.

People said the staff were very caring and kind and treated them well. They told us staff maintained their privacy and provided the care they wanted. Staff spoke to people politely and with respect

Peoples records and plans were very person centred and important details and preferences considered. However, these could not be delivered in practice as there was not enough staff on duty to meet everyone’s needs in a timely manner. People told us they felt bored and just sat around with nothing to do.

People felt the manager was doing a good job and they were aware of changes going on in the service. People did not have formal opportunities to give their views on the service but did feel confident to do so if needed.

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

Rating at last inspection

The last rating for this service was good (published12 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about poor care practices in relation to hydration, nutrition and skin care. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and caring sections of this full report.

Enforcement

We have identified breaches in relation to staffing and person-centred care. The service did not have enough staff to meet people’s needs in a reasonable time frame in-line with their preferences. People were not able to have control over how they spent their time and there was insufficient meaningful engagement. Please see the action we have told the provider to take at the end of this report.

Follow up

We will speak with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 8 March 2018

During a routine inspection

This comprehensive inspection took place on 8, 9 and 15 March 2018 and was unannounced.

New Meppershall Care Home 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.

New Meppershall Care Home accommodates up to 81 people in two purpose-built buildings. One building provides a service to people who require personal or nursing care, with a unit providing care to people living with dementia. The second building provides short term rehabilitation stays for people with acquired brain injuries. The buildings are managed and staffed separately, sharing catering and maintenance staff and facilities. Both buildings are registered with the Care Quality Commission as a single location (service) so this inspection looked at the service provided in both buildings as a whole. At the time of our inspection, there were 62 people living at the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service has two registered managers; however, one registered manager has left the service but not cancelled their registration. A registered manager is a person who has registered with the Care Quality Commission (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.

Why the service is rated Good

Prior to this inspection we had received concerns in relation to the care people were receiving and the meals provided at the service. We had also received concerns in relation to the staff working at the service. We found no evidence to support these concerns or found that the management of the service had taken appropriate action in response to issues raised.

People were complimentary about the service, staff and the care they received.

People were safeguarded from the risk of harm. There were effective procedures in place designed to safeguard people and staff had received training. The provider had responded appropriately to any issues raised about people’s safety and worked with the local safeguarding authority to investigate any concerns.

Risks associated with people’s care and support had been identified and planned for. The risk assessments and care plans in place gave clear guidance to staff on how individual risks to people could be minimised.

People received their medicines safely and as prescribed. There were effective systems in place for the safe storage and management of medicine and audits were completed.

There were sufficient numbers of staff deployed to meet people's needs. The provider had an effective recruitment procedure in place and carried out relevant checks when they employed staff.

Staff did not always receive regular supervisions and appraisals however most felt supported in their roles. An induction was completed by staff when they commenced work at the service followed by an ongoing programme of training. Staff were positive about the training, guidance and information they received.

Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent was gained from people before any care or support was provided.

People appeared comfortable and relaxed in the presence of staff. People told us they were treated with dignity and respect and that staff were kind and caring. P

Inspection carried out on 17 May 2016

During a routine inspection

This inspection took place on 17 May 2016 and was unannounced.

Prior to this inspection we had received concerns in relation to the staff working in the home and the care people were receiving. We had also received concerns regarding the environment and the management of the service.

New Meppershall Care Home provides accommodation and nursing care for up to 44 people with a variety of social and physical needs, some of whom may be living with dementia. At the time of our inspection there were 38 people living at the service.

Although the service previously had a registered manager, they have since left the service but not cancelled their registration. A new manager has been appointed and intends on completing their registration. 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. The absence of a registered manager for seven months was taken into account when making the judgements in the report.

People felt safe in the service. Staff understood their responsibilities with regards to safeguarding people and they had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

There were personalised risk assessments in place that offered robust guidance to staff on how individual risks to people could be minimised. Medicines were managed safely and audits completed.

There were sufficient numbers of staff on duty to meet people's needs and promote their safety at all times. Safe recruitment processes were in place and had been followed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Staff were trained and had the skills and knowledge to provide the care and support required by people. New members of staff received a comprehensive induction.

People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were supported to make choices in relation to their food and drink and a varied menu was offered. People's health care needs were being met and they received support from health and medical professionals when required.

Staff were kind, caring and respectful. People's privacy and dignity was promoted throughout their care. People received relevant information regarding the services available.

People's needs had been assessed and care plans took account of their individual needs, preferences and choices. Care plans and risk assessments had been regularly reviewed to ensure that they were reflective of people's current needs.

Staff knew people's needs and preferences and provided encouragement when supporting them. People were encouraged to participate in a wide range of activities.

The management team were approachable and staff felt supported in their roles. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff. Staff were aware of the vision and values of the provider and the overall development of the service. The manager completed quality monitoring audits and it was clear how these were used to drive improvements in the service.