New Meppershall Care Home

New Meppershall Care Home is a residential care home providing personal and nursing care to up to 81 people. The service provides support to older people who may be living with dementia, a sensory impairment or a physical disability. At the time of our inspection there were 72 people using the service.

New Meppershall 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 floor have access to outside garden space and each bedroom has en-suite facilities.

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

There had been a lot of improvements made regarding the safety and quality of care that people were receiving at the service since the last inspection. One person told us, ‘‘I could not be without the staff working here. They are all so kind and I feel so lucky to live here.’’

People felt safe living at the service and staff were knowledgeable about how to safeguard people from abuse. Risks to people were assessed in areas such as falls or pressure area care and measures were put in place to mitigate risks as far as possible. There were enough staff to support people safely and people did not have to wait long for their care needs to be met. People were supported safely with their medicines, and improvements to audit systems regarding medicines was ongoing. The service looked clean and good infection control measures were followed.

The registered manager assessed people’s needs when they started using the service to ensure these could be met. Staff had the training and knowledge to do their jobs well. People were supported to eat and drink according to their support needs and preferences and gave positive feedback about their meals. Staff supported people to live healthy lives and see health professionals if this was necessary. The service was designed to meet the needs of people living there. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were positive about the kind and caring nature of the staff team. Staff were compassionate and friendly and treated people with respect and dignity. They supported people to make day to day choices about their support. People were supported to maintain their independence.

Staff had got to know people as individuals and supported them in line with their preferences, likes and dislikes. People were supported to understand information in line with their communication needs. Staff supported people to engage in social activities and interests if they chose to do so. There was a complaints procedure in place and complaints were promptly responded to. People received respectful and dignified care at the end of their life.

There were still improvements in progress in areas such as auditing medicines, communication with relatives and audits resulting in effective actions. The registered manager was aware that the service still needed to make these improvements and had plans in place to do so. There was a positive culture at the service. Staff felt well supported by the registered manager and were proud to be supporting people living at the service. People, relatives and the staff team were asked for feedback about the service. Staff linked and worked with other professionals to help ensure good outcomes for people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 August 2021). We found breaches of regulation in relation to the safe care and treatment of people using the service and the way in which the service was being governed and managed. The 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

The inspection was prompted in part due to concerns received about the support people were receiving in relation to pressure area care and risk of falls. 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 this concern. We inspected and found there had been improvements made at the service, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led. Please see all sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

New Meppershall Care Home is a residential care home providing personal and nursing care to people aged 65 years and over. At the time of inspection 65 people were living at the service.

New Meppershall 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 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

Risks associated with care and support for people had not always been fully assessed and associated risk reducing guidance was not available to staff. People and their relatives told us they had not always been involved in the care planning process.

Staff had not received training in diabetes care, or end of life care, and staff competency was not being effectively monitored to ensure people received safe and effective care. We were therefore not assured that staff training reflected and addressed the health and care needs of all the people using the service.

Medication management processes were not always safe, and effective reviews were not always requested in response to health changes or missed medicines. People and their relatives told us they did not always know who to speak to at the care home and shared that communication could, at times, be variable.

We were largely assured of infection control processes in place. Areas which required review and action took place promptly at the time of our visit.

The providers quality assurance and governance systems had not identified our findings and did not always drive continuous improvements and developments.

Despite this, people said they felt safe and relatives told us staff were caring. People told us care staff were responsive to their day to day requests and they were happy at the home. People told us the food at the care home was good, choice was available, and drinks were provided. Staff spoke with people in a personalised and dignified manner.

A new manager had been recruited and had begun the registration process with the care quality commission (CQC). The provider continued to deliver additional management support to the service. Staff were recruited safely and in line with the providers policy. Staff told us communication methods were available within the service and they felt able to raise concerns.

The provider had procedures in place to review accidents and incidents and relatives told us these would be communicated with them. Healthcare professionals spoken to shared that in their experience, staff were responsive to their advice, and followed their referral processes.

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 requires improvement (inspection undertaken 9 July 2019, inspection report published 27 September 2019). There were two breaches of regulation. The provider completed an action plan following this comprehensive inspection to show us what they would do and by when to improve.

On 1 December 2020 we completed a targeted inspection to ensure the service had made the necessary improvements (inspection report published 18 December 2020.) The targeted inspection looked only at specific areas relating to the breaches and therefore a new rating was not generated. We found that improvements had been made at the December 2020 inspection and the provider was no longer in breach of those regulations.

Why we inspected

We received concerns relating to risk management at the care home regarding meeting people’s nutrition and hydration needs, pressure area care and the clinical identification and response to deteriorating health. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the care home. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the care home has remained as requires improvement. This is based upon the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

New Meppershall is a residential care home providing personal and nursing care to 73 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 and relatives spoke very highly of the care they received and told us staff treated them with kindness. One relative told us, “So far as I can see, [my family member] couldn't be in a better place.”

People and relatives told us they felt safe. They were safe due to being supported by staff who understood how to minimise risks and report concerns. Systems for identifying and reporting concerns were in place and monitored by the manager.

The manager had made changes to ensure there were robust systems in place to reduce the risks of spreading infection and COVID-19 to people.

People were supported to visit with their relatives safely using in person visits as well as video calls.

People told us they had plenty to do, choices were respected and there was enough staff to support their needs and preferences. Staff understood how to communicate differently where people had different communication needs and were observed to treat people with compassion.

People and relatives knew how to complain and were confident to do so. The manager had good systems in place for managing complaints openly.

The home was well managed and people were supported to access a variety of other health professionals to ensure their physical and mental health needs were met.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 27 September 2019) and there were breaches of regulations 9 and 18. The 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 9 and 18.

Why we inspected

We undertook this targeted inspection to check on the outcomes of the previous breaches and the safe management of the service due to the service not having a manager registered with the CQC. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

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

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.

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. People appeared well groomed and care records confirmed the support people received to maintain their personal hygiene and appearance.

People received care and support which was personal to them. Care plans and risk assessments gave clear guidance to staff regarding the needs and preferences of people and they had been regularly reviewed and updated.

There was an effective complaints procedure. People and their relatives knew who they could raise concerns with. Any complaints received by the service were logged, investigated and responded to appropriately.

It was clear from speaking with people and staff that the absence of a manager within the nursing unit in recent months had had a negative impact on the service provided. The operations manager had identified this and was taking action to address the concerns raised and ensure that feedback was being sought from people, relatives and staff to make improvements. A new manager was in post and plans were in place to ensure that systems were effectively used to drive improvements in the service in the future.

Within the acquired brain injury unit, staff felt positive about the support they received from the registered manager. Team meetings were frequently held and staff felt involved in the development of the unit. There was an open culture and the registered manager encouraged feedback to improve the care and support they provided.

Further information is in the detailed findings below.

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.