Meadow View Residential Care Home

Meadow View Residential Care Home is a residential care home providing personal for up to 60 older people. It can accommodate people who live with dementia and younger adults with a physical disability. There were 52 people living at the service at the time of the inspection.

The service was provided over two floors with lift access. Each floor had its own lounge and dining room, and all bedrooms had an en-suite toilet. There was a well-tended garden surrounded the home.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: 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. Improvements had been in ensuring any conditions associated with authorised restrictions were continuously met.

Staff monitored and helped people to access specialist health. There had been an improvement in the detail of the guidance available to staff to ensure people’s needs were consistently met. Care plans included people’s individual choices, preferences and goals. Medicines management had improved so people could be assured they received their medicines when they were needed.

Staff supported people to take part in group and one to one activity, that included their interests. Relatives and people told us that the range and frequency of activities had improved. An initiative had commenced whereby all staff stopped what they were doing each day and went to spend time with people.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. Work was underway to refurbish areas of the home. People were able to personalise their rooms.

Right Care: Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Improvements had been made to assessing potential risks to people and providing guidance to staff to ensure these risks were minimised.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. There had been a significant decrease in agency staff at night-time to help ensure consistent care. Staffing levels were kept under review. People were supported by staff who had been trained in how to care for them. Relatives told us that staff were particularly at supporting people with dementia.

Right Culture: There had been significant changes to the culture of the service driven by the manager. As a result, people benefitted from an open and positive culture service where the management team was approachable and listened and responded to people’s views. The service had received a number of compliments about the positive culture in the service including the following: ‘The care is second to none. My family member has been cared for in the best possible way in all aspects of her life with many of your staff going way beyond their duty of care and I cannot thank them enough. I have always been made welcome when visiting Meadowview often arriving unannounced at various times. Thank you to all at Meadowview please keep up your excellent standards of care.’

People and those important to them were involved in planning their care. Staff knew and understood people well.

Quality assurance and monitoring systems had improved and were effective in identify shortfalls and driving through positive changes. People and their relatives’ views were regularly sought and acted on.

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 (published 11 August 2022). There were 2 breaches of regulation with regards to assessing potential risks, medicines management and oversight of the service. 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

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, effective, responsive and well-led and the associated breaches of regulation. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow View Residential Care Home on our website at www.cqc.org.uk.

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.

Follow up

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

Meadow View Residential Care Home is a residential care home providing personal for up to 60 older people. It can accommodate people who live with dementia and younger adults with a physical disability. There were 55 people living at the service at the time of the inspection.

The service was provided over two floors with lift access. Each floor had its own lounge and dining room and all bedrooms had an en-suite toilet. There was a well-tended garden surrounded the home.

People’s experience of using this service

People and their relatives said were satisfied with the level and quality of care they received at Meadow View Care Home. One person told us, “The staff are amazing. They will do anything for you”.

Comments from relatives included, “I think they give the best care possible. They have enabled me to be a daughter again, rather than a carer to my mum”; And “Meadow view is like a family home. They allow my mum to be herself but safe and cared for.”

The provider had identified a number of areas at the service where service delivery did not meet their expectations. The provider had a plan of action to address and work towards meeting these shortfalls. However, we found additional areas of concern in the management of medicines and potential risks. People could not all be assured they received their medicines as prescribed by their doctor. Risks were not always acted on or updated in people’s care records in a timely manner.

People’s care plans were inconsistent in providing guidance for staff on people’s support needs. Some people had holistic care records, for other people there was limited or no information about their past histories or interests. This information helps staff to engage in conversation with people and provide activities they enjoy.

Recruitment practices were safe to ensure people were protected from the risk of unsuitable staff. Staffing levels continued to be monitored so there were enough staff to meet people's needs.

People were protected from the risks of COVID-19 and other infection outbreaks. Staff wore appropriate personal protective equipment and were trained in infection prevention and control.

People’s health care needs were monitored and referrals made to relevant health care professionals. Mealtimes were social events where people eat and chatted with staff. People were offered choices at mealtimes and encouraged to eat regular meals.

Staff and relatives told us the culture of the service was improving. Lessons had been learned when things had not gone the way that they should have gone. This had included additional staff training and improvements in the delivery of care.

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 (published 24 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. It was also prompted in part due to concerns received about staffing levels, staff training, the management of complaints and the culture and management of the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow View Residential Care Home on our website at www.cqc.org.uk.

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.

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

We found the following examples of good practice.

¿ The registered manager had measures in place to reduce the risk of infection from transferring from one area of the home to another. For example, staff working on each floor of the service used different personal protective equipment (PPE) stations on arrival and staff had separate facilities.

¿ Staff wore personal protective equipment PPE, such as masks, aprons and gloves. Spot checks on staff PPE practice were completed to ensure staff were following PPE guidance. On the day of inspection, we observed staff were using PPE in line with guidance.

¿ Staff supported people to keep in touch with their friends and relatives though phone calls and video calls. There were processes in place to reduce the risk of the spread of infection for essential visits, such as end of life visits. A new pod was being built in the garden to provide a safe space for people to receive visitors once these could be facilitated again.

Meadow View Residential Care Home is a residential care home providing personal and nursing care to 58 people older people at the time of the inspection. The service can support up to 60 people.

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

People were supported by caring and kind staff, who tailored their interactions to each person. People and their loved ones were encouraged to express their wishes at all times and staff were focussed on listening to people. People were treated with respect at all times.

People’s care was based on their needs and preferences. Visitors were welcome at any time and could join people for meals. People were supported to do things they enjoyed, and which were designed around their needs, such as dementia friendly and interactive activities. Complaints were responded to appropriately and people could remain at the service for the whole of their life.

Staff supported people in a way which kept them safe from abuse and helped them to manage risks. People were supported by staff who had the right values and were recruited safely. People’s medicines were well managed and staff minimised the risk of infection. Lessons were learned and shared with staff.

People’s needs were assessed, they had enough food and drink to stay healthy. Health professionals were contacted as needed. Staff had the training and support needed to carry out their role. 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.

There was an open and transparent culture at the service. All staff were committed to the values of the provider and giving people person centred support. The registered manager and provider understood their regulatory responsibilities. There was a focus on continual improvement and the providers quality assurance processes supported this. Feedback was sought from people involved with the service and staff worked with other agencies as required.

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 13 June 2018) and there were multiple breaches of regulation. 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

This was a planned inspection based on the previous rating.

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.

Meadow View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Meadow View accommodates up to 60 people in one purpose built building. All room had en-suite facilities and there was an enclosed garden. There were 54 people living at the service at the time of the inspection.

There was a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission to manager 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 last inspected the service in February 2017. We found two breaches of regulations, the provider had not provided staff with detailed guidance to mitigate potential risks and maintain accurate, complete and up to date records for each person. At this inspection, some improvements had been made, however, this had not been sustained and embedded and there were continued breaches of regulations and an additional breach.

At this inspection, improvements had been made regarding the guidance that staff were given to mitigate risks when people were living with health conditions such as diabetes. However, not all potential risks had detailed guidance for staff. Some people displayed behaviours that may challenge and had additional health conditions that affected them during the night, staff did not have detailed guidance to be able to support people consistently and keep them safe.

Previously, accidents had not been recorded accurately and analysed to identify trends and patterns. The registered manager had recorded all accidents and there was detailed analysis including what action had been taken and lessons that had been learnt. The registered manager had not transferred this practice to the recording and analysis of incidents. Incidents involving people, who had displayed behaviours that challenge, had not been recorded consistently and there was no overarching analysis to identify triggers and create a management plan.

The provider and registered manager completed audits of the quality of the service. These audits had not been effective and had not identified the shortfalls found at this inspection. Some records such as care plans did not always contain accurate information. Some people’s care plans contained contradictory information about how people mobilised and the consistency of the diet they should eat. We observed staff not providing equipment to support people to eat independently, the need for the equipment was written in their care plan.

The registered manager attended meetings with registered managers from the providers other services to share ideas, learning and best practice. Staff received training and this was up dated as required, staff had not received training in specific health conditions such as Parkinson’s disease and had not received training in managing behaviours that challenge.

People, relatives and staff told us there were sufficient staff on duty to meet people’s needs, agency staff were used to cover any shortages. However, during the inspection, we observed that one person appeared not to have received the care they needed. The registered manager agreed that the person had not received a good standard of care and would investigate the incident.

People, relatives, staff and stakeholders were asked about their opinions of the quality of the service. The responses had been mainly positive; however, concerns had been raised about the lack of activities. People and relatives told us that there were not enough activities to take part in. Some analysis of the surveys had been completed and the registered manager had requested additional funding for activities. But there was no action plan in place to improve in response to the issues raised in the surveys.

The provider’s complaints policy was displayed in the main reception; it was available in an easy read format that it made it more meaningful to people living with dementia. The activities for the day were displayed in pictorial form, however, other information such as menus and people’s care plans were not available in additional formats for people. People and relatives told us they knew how to complain and complaints had been investigated in accordance with the provider’s policy.

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. When required Deprivation of Liberty Safeguards had been applied for and authorised.

Staff were recruited safely and received regular supervision and yearly appraisals to discuss their practice and development needs. People received their medicines safely and when they needed them. People were referred to healthcare professionals when their needs changed, staff followed the guidance provided. People were supported to access dentists, opticians and chiropodists when needed and to take part in exercise, to remain as healthy as possible. People were supported to eat and drink enough to keep healthy.

People’s needs were assessed using recognised tools following current guidance. People met with the registered or deputy manager before they came to live at the service to ensure staff were able to meet their needs. At the time of the inspection, no one was receiving end of life care. People’s end of life wishes and preferences were not consistently recorded. The registered manager told us they recognised that this was an area for improvement and would be putting guidance in place for staff.

People were supported to remain as independent as possible. People told us that staff respected their privacy, we observed staff knocking on people’s doors and waiting to be asked in. Staff knew people well and were able to support them when they were anxious. Staff spoke to them with compassion and kindness.

The provider had values for their services, ambition, diversity, integrity, quality and sustainability. The registered manager and staff shared this vision. There was an open and transparent culture within the service. Relatives told us they were able to speak to the registered or deputy manager whenever they wanted. The registered and deputy manager knew people well and were recognised and greeted warmly by people during the inspection.

The registered manager worked with agencies such as the local commissioning groups and the local safeguarding authority. People were protected from abuse. Staff knew how to recognise signs of abuse and knew that they should challenge colleagues if people were being discriminated against. Staff knew how to report concerns and felt confident they would be dealt with appropriately.

The building had been adapted to meet people’s needs and it was clean. People were protected from the risk of infection, staff wore protective clothing when required and kept the building and equipment clean. Checks on the environment and equipment used by people were maintained to help keep people safe.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The registered manager was aware that they needed to inform CQC of important events in a timely manner.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the registered manager had conspicuously displayed their rating on a notice board in the entrance hall and on their website.

At this inspection breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

Meadow View is a residential care home without nursing for up to 60 people living with dementia and/or physical disability. Meadow View is a purpose built care home which is situated in a quiet residential area of the village of Hersden. Accommodation and facilities are on two floors. There are several lounges and separate dining rooms. There is a large landscaped garden with raised flower beds and a sun terrace on the top floor. People’s bedrooms have en-suites facilities with a wet room. At the time of the inspection here were 39 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in 2016 and a new manager had been appointed in November 2016. The new manager had applied to the Care Quality Commission to be the registered manager. 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.

Risks to people’s safety and behaviour were assessed but further detail of how to manage these risks safely and consistently were not always recorded. Details of accidents were not recorded accurately by staff, the information recorded was analysed to identify trends and to reduce the risk of a further occurrence.

People told us they felt safe living at the service. Staff had received training on how to keep people safe and knew the action they needed to take to report any concerns if they suspected abuse. The management responded appropriately when concerns were raised and liaised with the local authority to make sure people were safe.

People’s finances were protected as there were systems in place to ensure that people’s money was accurately recorded and checked.

Environmental and health and safety checks were carried out by staff to ensure that the premises were safe and equipment, such as hoists, were in good working order. The systems in place to record accidents were not always completed accurately to show how these were being monitored and what action had been taken.

Regular checks were carried out on the fire alarms and other fire equipment to make sure they were working properly. A fire risk assessment was in place and fire drills were carried out with all staff so they knew what to do in the event of a fire. The information in the personal evacuation plans for each person were not sufficient as they detailed instructions to staff to tell people what to do but people living with dementia may not be able to do this safely.

The service had an ongoing recruitment drive to ensure that there was enough staff to meet people’s needs. There had been a considerable amount of new staff, including the manager, deputy manager, and senior staff. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed. Systems were in place to ensure that people were recruited safely but not all staff had two references on file.

Staff received the training they needed to have the skills and competencies to perform their role. New staff received induction training which included shadowing more senior staff. Staff said they were supported by the new manager who worked with them to make sure people received the care they needed.

People received their medicines safely and when they needed them. The staff monitored people's health needs and sought professional advice when it was required. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

People were supported to have a healthy and balanced diet. Their nutritional needs were assessed and when required appropriate referrals to health care professionals, such as dieticians, were made.

Staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Applications had been made for DoLS authorisation when people who lacked capacity to consent were restricted.

People and relatives were satisfied with the care being provided. They said the staff were kind and caring. The atmosphere in the service was calm and relaxed. People were able to move around the service, going to their rooms if they wished or relaxing in the dining rooms or lounges. Staff supported people to make choices of where they wanted to be and ensured their privacy and dignity was respected. When people became anxious staff took time to sit and talk with them until they became settled.

Before people decided to move into the service their care needs were assessed to make sure the service would be able to offer them the care that they needed. Care plans contained the detail needed to show how all people’s care was being provided in the way they preferred. The plans were regularly reviewed to ensure that staff were aware of people’s current needs.

People had the opportunity to take part in activities of their choice. Activities were being provided by the staff as the service was in the process of recruiting a new activities co-ordinator.

Records were not complete and up to date, the manager had not consistently recorded complaints and the actions taken in response to these, staff files were not completed when staff completed their probation.

People, staff and relatives told us that the service was well led and that the management team were supportive and approachable and that there was a culture of openness within the service.

The manager had sought feedback from people, their relatives, staff and other stakeholders about the service.

Audits and checks were regularly carried out by the manager and staff. These were recorded and action was taken when shortfalls were identified, however the shortfalls identified in this inspection had not been identified. The regional manager visited the service regularly to check the quality of the service. They carried out audits and checks on different areas of the service. If shortfalls were identified detailed action plans were then put in place to improve the service.

The manager was aware that they had to inform CQC of significant events in a timely way. Notifiable events that had occurred at the service had been reported. Records were stored safely and securely.

We found two 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.