The Meadows Residential Care Home

The Meadows Residential Care Home is a residential care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 25 people over three floors. It is owned by a family run limited company.

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

The provider had systems and processes in place to help keep people safe including risk assessments and risk management plans. Medicines were generally managed safely. Where we found a discrepancy in medicines management, this was addressed immediately. People were well cared for and relatives told us they thought people were safe and supported by capable staff. Safe recruitment procedures were in place.

The provider had effective systems to manage infection prevention and control. These reflected risks associated with the COVID-19 pandemic. Staff wore personal protective equipment (PPE) appropriately and visiting was managed safely in line with government guidance. COVID-19 testing and information around vaccinations was in place.

The provider had systems for managing incidents, accidents, safeguarding concerns and complaints to help make improvements to the service. This included investigating the issue, identifying outcomes and liaising appropriately with other relevant agencies such as the local authority. There were also effective systems, such as audits and spot checks, for monitoring and improving the quality of the service.

The provider worked closely with external professionals to help ensure people’s health and wellbeing needs were met. Relatives, staff and other professionals said the registered manager was approachable, listened and responded appropriately to them.

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 22 October 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 and 11 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

The Meadows Residential Care Home is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 25 people over three floors. It is owned by a family run limited company.

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

During the inspection we found there were systems in place to identify and manage risks but these were not always effective as risk assessments and risk management plans were not in place for people going into the community, people who had specific conditions such as Parkinson’s disease or a behaviour that challenged the service. We also found some areas of the environment that were not that safe. For example, a locked cupboard had the key in it meaning anyone could access medicated creams in the cupboard.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people but these were not always effective and did not always identify areas where improvements were needed or identify risks to people's safety and wellbeing.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were in place and there were enough staff on duty to meet people’s needs. Staff followed appropriate infection control practices to help prevent cross infection.

Supervisions, appraisals and competency testing provided staff with the support they required to undertake their job effectively and safely. People's needs were assessed to ensure these could be met. People were supported to maintain health and access healthcare services appropriately. People were also 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.

Staff were kind and provided support in a respectful manner. People were involved in making decisions about their day to day care. Staff respected people’s dignity and promoted their independence.

Families were welcomed to the service. People had the opportunity to engage in activities in the home. There was a complaints procedure in place and people felt able to raise complaints with the registered manager.

People, relatives and staff reported the registered manager was approachable and promoted an open work environment.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 1 October 2018) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of two regulations identified at the June 2018 inspection. This is the second time that the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. We spoke about the above concerns with the registered manager who agreed to take action to resolve these issues.

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

Follow up

We will request an action plan for 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.

The last comprehensive inspection took place 13 and 14 September 2016. The service was rated requires improvement in the key question is the service well led? We found one breach of regulation relating to the notifications of incidents because the registered person had failed to notify the Care Quality Commission of a safeguarding concern. We asked the provider to make the necessary improvements by November 2016.

On 15 February 2017, we carried out a follow up inspection to check that improvements to meet legal requirements planned by the provider after our September 2016 inspection had been made. We inspected the service against one of the five questions we ask about services: is the service well led? No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. On 15 February 2017, we found the provider was not fully meeting the regulation relating to notifications as they had notified us of seven out of eight incidents.

At this inspection we found the provider had met the regulation regarding notifications but was not fully meeting the regulations for the need for consent, safe care and treatment, good governance and fit and proper persons employed.

The Meadows Residential 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. The Meadows accommodates a maximum of 25 people. At the time of the inspection, 24 people were using the service.

The service is family run. The business owners were part of the management team and were active in overseeing the service. Another family member was the operations manager and there was also a registered manager. 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.

During the inspection we found individual risk assessments were not always completed for areas such as risks related to falls, skin damage and pressure ulcers, malnutrition and moving and handling. Furthermore, window restrictors were not secure, some windows did not have restrictors and there were no risk assessments regarding this. This meant the risks associated with people’s care and well-being were not always identified so these could be appropriately mitigated.

Safe recruitment procedures were not always followed to ensure staff were suitable to work with people as gaps in employment that had not been explored, references were not always from the last employers and details of their criminal records checks at the time they started working at the service were not on file.

The principles of the Mental Capacity Act (2005) were not always followed as mental capacity assessments were not decision specific and we saw examples of relatives signing consent forms for people when they did not have the legal right to do so. Where people were able to make choices and give consent we saw that the provider and staff supported this.

Care plans mostly had appropriate information about people’s needs and preferences. However, we found information about their sleeping pattern and the times people liked to get up and go to bed, were not accurately recorded or not recorded at all.

The service had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective as not all risks had been assessed and mitigated and health and safety checks had not identified the issues with the window restrictors. Additionally, checks carried out on care records had not identified the issues regarding the completeness of these or the way in which some of the consent forms had been completed.

Incident forms recorded the details of the incident and the resulting actions. There were procedures for reporting and investigating allegations of abuse and whistle blowing. Staff we spoke with knew how to respond to safeguarding concerns.

Medicines were managed safely and staff had appropriate training.

The premises were well maintained and there were systems in place to identify any repairs needed. Staff we spoke with understood how to manage infections and wore appropriate protective equipment to reduce the risk of the spread of infection.

People’s needs had been assessed prior to moving to the service and care plans included people’s likes and dislikes. There were also records of end of life wishes and Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) forms to provide guidance to staff in such events.

Care workers had relevant training, supervision and annual appraisals to develop the necessary skills to support people using the service.

People's dietary and health needs had been assessed and recorded and were met.

People were treated with dignity and respect and we observed care workers communicated with people with care and encouragement.

The provider had a complaints procedure and addressed any complaints appropriately.

People using the service and staff told us the registered manager was available, listened to them and took action where necessary to act on their suggestions or concerns.

The provider received feedback and shared information through team meetings and completed satisfaction surveys.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the need for consent, safe care and treatment, good governance and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.

We undertook this focused inspection on15 February 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Meadows Residential Care Home on our website at www.cqc.org.uk.

The Meadows Residential Care Home provides care and accommodation for up to 24 older people who may also have dementia care needs. At the time of our inspection there were 24 people living at the service.

The owner was also the provider. The provider, his wife and daughter were part of the management team and were active in overseeing the service. The registered manager had been in post since January 2014. 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.

At our focused inspection on 15 February 2017, we found that the provider had not followed all of their plan of action, dated 20 November 2016, and that the legal requirement had not been fully met.

The provider failed to raise a safeguarding alert and notify CQC on one occasion, however they had sent through seven notifications appropriately and as required.

Incidents and accidents were recorded appropriately.

The service had updated its’ notification policy and staff had read it.

The last inspection visit took place on 21 December 2013 at which time all the assessed standards were being met.

The Meadows Residential Care Home provides care and accommodation for up to 24 older people who may also have dementia care needs. At the time of our inspection there were 23 people living at the service.

The owner was also the provider. The provider, his wife and daughter were part of the management team and were active in overseeing the service. The registered manager had been on long-term leave and had returned to the service the week prior to the inspection. During their absence, the deputy manager had managed the service. 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.

We found one breach of the Regulations because the provider had not always followed procedures for raising safeguarding alerts to the local authority and notifications to the Care Quality Commission.

Care workers had attended safeguarding training and knew how to report safeguarding concerns.

Risks to people’s safety and wellbeing had been assessed to keep people safe and staff knew how to record incidents and accidents. The provider followed safe recruitment procedures and there were enough staff deployed to meet people’s needs.

There were a number of regular maintenance and service checks carried out to ensure the environment was safe. Medicines were administered and stored safely.

The deputy manager had made appropriate DoLS applications, however consent to care and treatment was not always sought in line with Mental Capacity Act (MCA) 2005 legislation. We recommended that consent is sought for care and treatment and where a person lacks mental capacity, the provider acts in accordance with the requirements of the Mental Capacity Act 2005.

People’s nutritional needs were met and they were able to have food and drinks when they wanted to. People had access to health care services and the service worked with other community based agencies.

People who used the service told us staff were kind and their dignity and privacy was respected.

Comprehensive care plans recorded people’s needs and goals and were reviewed monthly.

Activities were not meaningful for everyone who used the service. We recommended that the provider consult appropriate guidance and review activity provision.

All stakeholders indicated they could speak to one of the management team and felt they would be listened to.

The service had systems to monitor the quality of service delivered and ensure the needs of the people who used the service were being met.

We found a breach 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 the report.

A care plan had been developed detailing each person's individual needs and the action staff should take to meet these. Since our last inspection a new care plan format had been developed that provided more detailed information about people's needs. The home had also employed an activity co-ordinator since our last inspection and people told us that there was now more for them to do. People told us they liked living at the service and commented, "I am very happy here" and "I'm very well looked after."

Staff had received safeguarding training and were able to demonstrate that they would respond appropriately to any safeguarding concerns that they had. The relatives we spoke with said they felt their family member was safe at the service and one person we spoke with said, "I feel very safe here."

People were protected from unsafe or unsuitable equipment because the provider had taken steps to ensure that equipment was well maintained and checked at regular intervals to ensure it was in good working order.

Staff received sufficient support which included an induction to the service, regular supervision, an annual appraisal and training to ensure they were able to meet people's needs effectively.

There were effective quality monitoring systems in place.

At the last inspection on the 3 November 2012 we found that people were not being involved in making decisions about their care or about changes being made to their bedrooms. As a result the provider told us that he was going to introduce a 'consultation strategy' to ensure that people and/or their representatives were involved in individual care planning and consulted about any changes that were to take place.

At this inspection we found that some consultation had taken place with the people who used the service and their representatives. The provider had introduced new ways of recording information to ensure that people's wishes and preferences were considered but these had not yet been implemented, this will be verified at the next inspection.

At the last inspection we also found that there were issues with the maintenance of the home. All of the concerns identified had been addressed and the provider showed us a new system of checks that he was introducing to ensure that maintenance issues were addressed promptly.

We also saw up to date certificates relating to health and safety within the home that had not been available at the last inspection.

When we asked people about their experiences of being cared for by staff one person told us "it is very homely here" and another said "everyone is friendly". These contained details of people's needs and the action staff should take to meet them and had been reviewed regularly.

We found a number of maintenance issues at the home. There had been some redecoration but this was unfinished in places and there were risks to people's safety identified. For example, some communal areas were not adequately lit for people moving around the home independently. Equipment such as hoists used to lift people had been checked at regular intervals to ensure they were safe.

The staffing levels were adequate to meet people's needs. However, we saw that people were not engaged in activities as staff were busy supporting people with their meals and personal care. There was an appropriate system in place for people to complain if they were unhappy about the service.