Meadow View Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed at the service.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

At our last inspection we found that incidents were not always fully reported, and action was not taken to mitigate risks to people. At this inspection we found improvements. Incidents were documented on the provider’s electronic system, and these were automatically shared with the registered manager to ensure they investigated and implemented improvements. A staff member told us, “The registered manager investigates and then there's a clinical meeting with team leaders and this is relayed back to all staff. If it's a specific incident the registered manager emails or goes on the floor and lets staff know.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

At our last inspection, we found that staff did not always follow professional advice, for example when people were discharged from hospital. At this inspection, we found that discharge advice had been followed. Staff worked with professionals to ensure that people received joined up care. One person had a health condition which caused them to need to go to hospital for treatment. Staff were all aware of the person’s condition and monitored this. When the person went into hospital the registered manager advocated for the person to request that they received all the support they needed whilst in hospital. The registered manager also spoke with hospital staff to ensure that people were only discharged to the service once they were medically fit to.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

At our last inspection we found that people had not always been safeguarded from abuse. At this inspection we found improvements in this area. Staff ensured all incidents were fully documented, and that concerns were escalated to the registered manager. The registered manager had shared concerns with the local authority safeguarding team, and notified the CQC as required. People told us they felt safe, a person told us, “I do feel safe. I am talked to kindly.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the registered manager demonstrated a good understanding of DoLS and when applications should be made.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. At our last inspection we found that risks to people had not always been identified and mitigated. At this inspection we found some areas of improvements, however there remained areas where risks had not been mitigated.

One person was at risk of constipation. Their care plan stated that they should be offered medicine to help them open their bowels. However, we found that this medication was not offered to the person until the 8th day they had not opened their bowels. This left them at risk of being in severe pain and discomfort, or potentially life threatening complications due to failure to appropriately monitor the risks posed to people by constipation.

One person was at risk of skin breakdown. Whilst the person’s skin remained intact, records relating to how frequently they should be supported to re-position to support their skin to remain healthy were inconsistent. Staff we spoke with were not clear on how frequently the person should be supported to re-position.Although no skin damage was evident at the time of inspection, inconsistent care planning and staff understanding increased the risk that pressure area care would not be delivered consistently.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider could not assure us that there was sufficient staffing at night to support people to evacuate safely in the event of a fire or similar emergency situation. Fire drills were being carried out, however this did not include any mock evacuations to prepare staff in the event of a fire. Although the provider was aware of this and were planning to carry out mock evacuations, this had not occurred at the time of the inspection. The provider told us they planned to re-assess the staffing needed to evacuate people safely.

There were limited dementia friendly adjustments to support people safely navigate the building. There were some signs on doors to help people orientate to their rooms however these were small and would need to be viewed close up. The registered manager was considering creating specific communities, for example to support people living with dementia, and was considering any environment amendments as part of this. Other checks on the environment had been completed including checks to ensure the water temperatures were not too high to scald people. People’s rooms were personalised to their individual tastes. A relative told us, “He’s in a lovely room where he can go straight outside.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs. At our last inspection, we found there was not enough staff to meet people’s needs. At this inspection, we received some mixed feedback about staffing numbers.

The provider had assessed the number of staff through a dependency tool, and had met this assessed number of staff, however, relatives did not always feel there was enough staff. A relative told us, “There are times I think they could do with one or two more, you can’t find the person you need because they’re attending to other people, at mealtimes it’s difficult to find someone because they’re dealing with residents in the dining room.” A person told us, “Bit of a wait for breakfast.” A relative told us, “I think it’s more task orientated, they will spend time with him, but I think they could do with 1-2 more on the floor.”

Staff told us that staff numbers were due to be reduced and if this was the case, there would not be enough staff to meet people’s needs. One staff member said, “We have been hearing it will be 3 carers and 2 seniors. If seniors are on the floor it will help but if there off doing medications and other things like usual it will be really hard,” and “Today we are 4 and it’s still difficult,” and “It’s a bit of a struggle this morning.” On the first day of our inspection, there was not enough staff due to sickness. The registered manager took the place of the staff member to make up the numbers. On the second day the provider was aware of our inspection. There was more staff on duty. Staff told us they had been asked to work due to our inspection, and the provider had pulled two senior carers from another of their home to support the service that day. A relative told us they had never seen so many staff. Another told us that they had never seen so many cars in the car park.

Since our last inspection, staff had completed training and competency checks in key areas, including supporting people with epilepsy and catheter care. We found staff to be knowledgeable and competent in these areas. Relatives told us that staff had the skills to re-assure people when they became distressed. They told us, “They are always there to encourage her, if she gets stressed they will calm her down.”

Staff were recruited through safe recruitment practices. This included ensuring that staff work history was checked to ensure there were no gaps, and making sure that staff have disclosure and barring (DBS) checks in place before they started work. DBS checks help organisations make safe hiring choices, especially for roles working with adults with complex health needs.

The provider did not always assess or manage the risk of infection.

At our last inspection we were not assured that people were being protected from the risk of infection. At this inspection, there were some improvements. At our last inspection there were strong malodours including the smell of urine throughout the service, within people’s rooms and in communal areas. At this inspection, we found that this had improved. The provider had identified some people would benefit from a change of flooring. Plans were in place to replace this flooring, although not yet completed.

We received mixed feedback from relatives regarding the cleanliness of the service. Some relatives told us they were happy with the cleanliness, whilst others shared concerns. One person told us, “They keep my room nice and clean.” A relative told us, “There could be room for improvement, sometimes the room is not as clean as you want it to be, it’s a perfunctory job, sometimes there’s a strange smell, something that doesn’t smell very nice.”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

At our last inspection we found that staff were not always safely supported with their medicines. At this inspection, we found there had been some improvements, however we identified other concerns with medications.

Some people were prescribed medication which was time specific. We found this medication was not always administered within the required window. Delays to the administration of this medication could cause the person’s symptoms to worsen. We raised this with the registered manager, who investigated and put a plan in place to address this.

Some people were prescribed pain patches. These are patches applied to the skin that release a measured dose of pain relief through the skin. Staff were not documenting the site of the pain patch application to ensure it was being rotated to prevent the person from getting skin irritation or skin breakdown. We raised this with the registered manager, and they implemented this.

One person told inspectors they were in pain, due to sores they had. We raised this with staff, but the person was not offered any PRN (as and when) pain relief until the following day. Staff did not always ensure that people’s pain was managed.