Archived: Meadow Dean

Updated 13 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18, 19 and 26 June 2018 and was unannounced. The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the last day of the inspection an Inspection Manager visited the service to discuss the shortfalls found at this inspection.

The provider completed a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We looked at the previous inspection reports and any notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

We spoke with twelve people using the service, the provider, the deputy manager, team leader and four staff. We observed staff carrying out their duties, communicating and interacting with people.

We also contacted two health care professionals about this service and included their comments in this report.

We looked at six people’s care plans and the associated risk assessments and guidance. We looked at a range of other records including four staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance surveys and audits.

We last inspected Meadow Dean in October 2017 when four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. At this inspection some improvements had been made, but there remained continued breaches and two further breaches in of the regulations.

Updated 13 February 2019

The inspection took place on 19, 20 and 26 June 2018.

Meadow Dean is a ‘residential 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. The service is registered to provide accommodation and personal care to 26 older people who may be living with dementia, in one adapted building. At the time of this inspection there were 13 people living at the service.

We last inspected Meadow Dean in October 2017 when we found continued shortfalls and non-compliance of the regulations. The overall rating was requires improvement however well led remained inadequate, therefore the service also remained in special measures. The provider sent us an action plan to demonstrate what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. The provider had failed to implement the action plan and make the necessary improvements to the service.

The service did not have a registered manager in post. Although the provider had made some efforts to recruit a new manager this had been unsuccessful. The registered provider had decided to apply to CQC to be considered for the registered manager position. 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.

The provider had recognised that additional support for the management team was required and had sought advice from a consultant who had visited the service two weeks ago so it was too early to see what impact this had on the service to drive improvement.

The audits and systems in place to check the quality of the service being provided were not regularly carried out or fully effective as they had not identified the ongoing shortfalls identified in this report.

The management of the service remained unstable and the deputy manager left the service the day after the inspection leaving the provider with no other management support.

The provider, deputy manager and the team leader were not aware of the current methodology of how we inspect using the key lines of enquiries.

The provider had not sought advice from the local safeguarding team or raised a safeguarding alert in line with guidance when an incident occurred where special lotions was left on people’s hair for too long which resulted in sores to their scalp. The provider had not informed CQC of this safeguarding incident in line with current legislation.

Accident and incident forms had been completed but had not been analysed to look for patterns and trends to reduce the risk of them happening again.

At the last two inspections risks assessments to support people with their behaviour and mobility did not always contain sufficient information to guide staff on how to mitigate risks and keep people safe. At this inspection some risk assessments had been completed to support people with their behaviour however there remained no guidance for staff of how to support people with their mobility.

People did not always receive the support they needed with their healthcare. Although referrals were made to health care professionals, such as dieticians and dentist, these were not always followed through to ensure that people were receiving the care they needed.

People’s care plans were not always personalised to reflect the care being provided. Care plans had been regularly reviewed but not always updated to reflect people’s changing needs.

People’s dignity was not always maintained as staff did not respond promptly when people needed to go to the bathroom. People’s independence was promoted.

Staffing levels were sufficient at the time of the inspection, however there were times when people who needed help and support from two staff had to wait to go to the bathroom. A review of the deployment of staff was therefore needed to ensure that two members of staff were available to respond to this person in a timely manner.

Staff had not been recruited with all the necessary checks in place as the provider had failed to ensure potential staff full employment history was recorded.

Although staff were receiving training to give them the right knowledge and skills to support people, records were not up to date or accurate to confirm this. The provider had a programme of supervision and appraisal in place to support staff.

At times, during the inspection, the provider was unable to produce the records we needed to complete the inspection. At the last inspection records were not always accurate or up to date and these shortfalls remained the same.

People were supported to be involved in their care. Although at times some people felt they were not being listened to as staff did not come promptly when they called.

People were asked for their consent when staff were supporting them and staff had an understanding of people’s mental capacity.

The management of medicines had improved since the last inspection and people were now receiving their medicines as prescribed and at the correct times. However, risk assessments were not in place to reduce the risks when using paraffin based inflammable creams. Medicine records were also an area for further improvement.

The provider had made some improvement to the premises, peoples bedrooms had new flooring, the conservatory had been refurbished and people and relatives could now meet in private. The communal lounge and dining room had been re-arranged and this had improved the space for people to sit and relax. However, the provider told us that they did not have enough resources at the time of the inspection to complete the maintenance programme.

People told us they enjoyed the activities and were able to join in with quizzes, playing board games, and singing. There was also outside entertainment such as singers. At the last inspection the provider told us that they intended to employ an activities co-ordinator but at this inspection they said this was no longer the case.

People and relatives knew how to complain and were encouraged by the provider to discuss any concerns or issues.

People told us they enjoyed the food and said there were able to choose to have a cooked breakfast if they wished. Drinks and snacks were available during the day to make sure they had enough to eat and drink.

People’s needs had been assessed when they moved into the service and people told us that they had been asked about their health and social care needs.

Infection control systems were in place together with deep clearing schedules to ensure the home was clean. Checks to the premises had been made, such as fire safety checks, health and safety and environmental risk assessments.

The provider had introduced a programme of supervision and appraisal to support staff. T hey had attended workshops to improve their practice and had links with the skills network to keep up with current ways of working. Staff told us that the provider was supportive and worked with the staff to provide person centred care.

The provider was trying to forge links with the community and had held an ‘open’ day to encourage local people to visit the service.

We found four continued breaches and three additional new 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 the report.

Although some improvements had been made, the progress was slow and there were still many areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of regulations and additional breaches at this inspection and there remained no registered manager in post. The service will therefore remain in special measures. We will continue to monitor Meadow Dean to check that improvements continue and are sustained.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement and there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.