Meadow View Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance at the service.

This service scored 62 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

At our last inspection, we identified a poor culture within the service, which did not promote positive outcomes for people. At this inspection, we found improvements. People, relatives and staff told us that things had improved since the last inspection. A staff member told us, “Things have changed for the better.” A relative told us, “It’s improved now with certain updates and a new team, staff and more consistency.”

The registered manager had been open and honest, for example, liaising with the relevant stakeholders including the local authority safeguarding team.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

At our last inspection we found there was a lack of effective leadership at the service. Since the last inspection, a new registered manager was in position and had only been in post 5 months and registered with the CQC just over two weeks.Whilst some improvements had been made, other improvements needed more time to be implemented, embedded and evidenced. The registered manager had a clear vision on how they wanted the service to improve. Feedback from people and their relatives regarding the registered manager was positive. People told us, “[Registered manager} and I had a laugh and I quite took to them,” and “I always have a laugh and a joke with them.”

However, there were concerns from people, relatives and staff regarding the stability of the management team within the service, due to previous frequent management changes. A relative told us, “The managers come and go like buses.” One staff member told us, “It only works when we have a good manager and deputy, history shows when we don’t things go wrong.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

At our last inspection staff did not feel that they could speak up and their voice would be heard. At this inspection we found feedback from staff had improved, with most staff feeling that they could raise concerns with the new management team. Most staff members told us they felt their voice would be heard. Staff told us that the culture within the home had improved, and previous cliques were no longer in place which reduced the risk of closed cultures.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

At our last inspection we found that staff were not always treated fairly, with staff stating that managers had ‘favourites’. At this inspection we found improvements. Staff members told us that the culture of the service had improved since our last inspection, telling us they were happy working at Meadow View Residential Home. Some staff members needed adjustments to their working due to physical health conditions. Staff told us these were considered and adjustments made to ensure the person could continue their work.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. At our last inspection, we found that governance systems were poor. They failed to identify high risks to people and make the necessary improvements. At this inspection, we found that although some improvements had been made, other areas continued to need improvement.

There were a number of staff brought in though the provider to focus on implementing improvements at the service. For example, on the second day of our inspection, a quality improvement staff member was at the service to implement, review and improve PRN protocols. There was further oversight from the provider in relation to supporting the service, however there were still areas where improvements were needed.

Despite us raising concerns about constipation at our last inspection, there was still no overarching system to check if people had opened their bowels. The providers representative told us that they were aware of this and had plans to add bowel opening records to their dashboard to provide a clearer picture of any risks.

Other areas including pain patch documentation, always acting on health concerns, staffing, and oversight of care plans continued to need further improvement. The service has been rated requires improvement in three of the last five inspections. The provider has not demonstrated that they can consistently achieve and retain a good rating.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

At our last inspection we found that the provider had not always worked closely with professionals. At this inspection, we found that there had been improvements. The registered manager and staff worked closely with visiting professionals to ensure that people received joined up care. The provider also supported volunteers to come into the home, to support with activities and provide some social interactions for people.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

At our last inspection, we found that leaders had missed opportunities to improve the service and listen to concerns raised by staff. At this inspection, we found that feedback was used to improve the quality of the service. The provider had increased the support of staff to the service to make improvements with quality improvement staff visiting frequently. Staff told us this provided management stability and consistency until the new registered manager was appointed.

We did identify that there are areas which improvements are still needed. For example, the provider did not have a system to have oversight of bowel management for people.

Older adults face a high risk of constipation due to a combination of common side effects from multiple medications, lower physical activity, reduced fluid and fibre intake, and age-related changes or underlying health conditions. The provider told us they were looking to implement a system to share throughout all their services to ensure oversight of this risk.