Meadow Court Residential Home

We found the following examples of good practice.

Staff wore personal protective equipment (PPE) correctly. There were hand sanitising points and PPE available throughout the service with further PPE available in people’s room.

Staff had completed training to develop their knowledge on safe COVID-19 practices.

People’s rooms and communal areas were visibly clean and hygienic.

The service had installed a visitor’s pod. This was a separate structure outside the premises which had two sealed parts separated by glass. This allowed people to safely see their relatives.

The provider had an admission policy to safely admit new people into the service. This incorporated a virtual pre-admission assessment, a COVID-19 test before arriving at the service and the persons personal belongings were sanitised.

Further information is in the detailed findings below.

People’s experience of using this service: People were supported to take their medicines in a safe way however we found a few instances where medicines were not always safely managed. We have made a recommendation about the management of some medicines.

Everyone we spoke with told us Meadow Court was a friendly and lovely place to reside and visit, that staff were kind and caring and people were treated with respect.

Recruitment processes were robust and thorough checks were completed before staff started working in the home. We saw there were sufficient numbers of staff on duty to make sure people’s care needs were met. Staff had received training and supervision to ensure people received appropriate care.

The provider and staff knew what to do to keep people safe. Individual risks had been assessed and identified as part of the support and care planning process. We saw nice interactions between staff and people who used the service. We saw staff respected people’s privacy and dignity.

People’s nutritional needs were met and the menus we saw offered variety and choice. Records showed people had regular access to healthcare professionals to make sure their health care needs were met.

A complaints procedure was in place. People and a relative told us they would have no hesitation in raising concerns. All feedback was used to make continuous improvements to the service.

The home had good management and leadership. The provider and registered manager was visible working with the team, monitoring and supporting staff to ensure people received the care and support they needed.

More information is in Detailed Findings below.

Rating at last inspection: Requires improvement (report published 1 December 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and the provider was no longer in breach of the regulation relating to recruitment. The service had improved and is now rated good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Meadow Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides residential care for up to 37 people; at the time of this inspection 30 people were using the service. The building has two floors. There are communal lounges, a TV room, a conservatory and a dining area on the ground floor, and shared bathrooms and toilets on both floors.

Meadow Court was last inspected in February 2017. At that time we rated the home as ‘Requires Improvement’ overall, as it was deemed to be ‘Inadequate’ in the key question of ‘Safe’, ‘Requires Improvement’ in the key questions of Effective, Responsive and Well-led, and ‘Good’ in the key question of Caring.

Because there had been a rating of ‘Inadequate’ in one key question on two consecutive CQC inspections, we placed the home into Special Measures after the last inspection. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The home had a 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. The registered manager had changed since the last inspection.

Records at the home could not evidence robust recruitment procedures were in place. As the only breach of regulation identified at this inspection, this showed that whilst much improvement had been made since the last inspection, some concerns relating to governance remained.

Risks to people had been assessed and managed. This included risks posed by the building, its utilities and equipment. Staff could describe how they kept people safe from abuse.

People told us, and our observations showed, sufficient staff were deployed to meet people’s needs.

Medicines were managed safely and administered in a person-centred way.

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 at the service supported this practice.

Staff had access to training, supervision and appraisal in order to help provide people with effective care and treatment.

Feedback from people and relatives about food and drinks at the home was positive. People were asked to feedback about the meals they received and this was used to change the menus.

People told us, and records showed, they had access to a range of healthcare professionals to help support their holistic health needs.

Meadow Court had been adapted to better meet the needs and preferences of people who lived there.

People and their relatives told us staff were kind and caring. All interactions between staff and people we saw were polite and respectful; we also observed plenty of banter and good humour was exchanged.

Staff respected people’s privacy and dignity. They could also describe people’s likes, dislikes and personal histories in detail.

The registered manager and registered provider promoted an open and inclusive culture at the home.

People’s care plans had much improved since the last inspection in February 2017. They now contained detailed person-centred information which care workers knew how to access, and people were consulted regularly about them.

A range of activities were available for people to take part in at the home. People were consulted monthly about activities they had taken part in and asked for their ideas for new activities.

No complaints had been received since the last inspection. The complaints policy was displayed at the home and had been discussed in a residents’ and relative’s meeting in 2017.

Feedback about the registered manager and management team at the home was positive. They used a collaborative approach to include people, relatives and staff in decision-making.

A range of audits were in place to assess safety and quality at the service. Records showed findings were discussed at management and staff meetings.

The management team used good practice and partnership working with other organisations to drive improvement at the home.

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Meadow Court is a residential care home for up to 37 people. It consists of one building with two floors. All bedrooms are single; 29 have ensuite facilities and eight have a sink but are located near a shared bathroom and toilet. On the ground floor there are two communal lounges, a TV room, a large conservatory and dining room. Both floors have shared bathrooms, toilets and shower rooms. The home has an enclosed courtyard area with seating.

At the time of this inspection there were 32 people living at the home; two of these people were using the service for respite care.

Meadow Court was last inspected in February 2016. At that time it was rated as ‘Requires Improvement’ overall. It was judged to be ‘Inadequate’ in the Safe domain, ‘Requires Improvement’ in the domains of Effective, Responsive and Well-led, and ‘Good’ in the domain of Caring.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

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 so 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.

The home had a registered manager, although they had recently become the activities coordinator and were in the process of deregistering as manager with the Care Quality Commission (CQC). The plan was for one of the directors of the registered provider company to apply to become the registered manager. The director was managing the home at the time of this inspection. 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.

People’s care plans did not always contain measures to manage risks that had been identified. Some care plans we saw had not been updated after incidents had occurred.

Relatives had made decisions for people without the correct legal authorisation to do so. Staff knowledge, including that of the home manager, around the Mental Capacity Act 2005 (MCA) and how it was applied in a care home setting needed to be improved. These were concerns identified at the last inspection in February 2016.

People’s care plans did not always contain the person-centred detail staff needed to support them effectively. Some people lacked care plans for a specific health condition and two people receiving respite care at the time of this inspection had no risk assessments or care plans in place.

Concerns with medicines identified at the last inspection had been resolved. Most aspects of medicines administration and management were well managed, although we did find some problems with topical cream charts and the recording of the medicines room temperature.

Most aspects of the building’s utilities and facilities had been checked for safety, although we did identify some gaps. This included not checking water temperatures in the hand basins of people’s rooms. We found water temperatures recorded for communal bathrooms exceeded guidelines from the Health and Safety Executive. Fire drills had not been undertaken.

Improvements had been made to the quality monitoring systems at the home, but more work was required to ensure care plans were up to date and all accidents and incidents that occurred were analysed together.

People told us they felt safe at Meadow Court and their relatives agreed. Care staff could describe how to identify the different forms of abuse and said they would report any concerns to managers.

Concerns with the recruitment process at the home identified at the last inspection had been resolved. People and their relatives told us there were enough staff deployed to meet people’s needs, although they said they had to wait for support at times.

Information about falls had been analysed for trends and used to increase staffing at times of the day when people were identified as being at higher risk.

We found the home to be clean, tidy and odour-free. People and their relatives agreed.

Staff told us, and records showed they now had access to regular supervision. With the exception of MCA training, staff had received the training they needed to support people effectively. Care staff new to health and social care were enrolled on the Care Certificate.

Feedback from people and their relatives about the food served at Meadow Court was good.

People had access to a range of healthcare professionals to help meet their wider healthcare needs. Feedback we received from healthcare professionals who visited the home was positive.

Members of the management team had sought training on dementia-friendly environments and had made some changes to the home in accordance with what they had learned.

People and their relatives described staff as kind and caring. Care staff could describe people well as individuals.

People and their relatives were involved in designing and reviewing their care plans on a regular basis. We saw people had access to independent support with decision-making if they needed it.

We observed, and people told us, care staff respected their privacy and dignity. Staff also promoted people’s independence.

Care staff could describe what good end of life care involved. Feedback from relatives of people who had received end of life care at Meadow Court was positive.

People told us they had access to a range of activities which they enjoyed. Our observations during the inspection supported this.

One formal complaint received since the last inspection had been addressed appropriately. People and their relatives told us they felt able to raise concerns with staff if they needed to.

People, their relatives and staff were given opportunities to feedback about the service at regular meetings. Feedback about the management team from people, their relatives and staff was positive.

Notifications had been made to CQC regarding any relevant accidents, incidents or events, as is required by the regulations. The ratings from the last inspection were not prominently displayed at the home when we arrived. This was because the entrance area had been decorated shortly before the inspection; we saw this was put back in place during the inspection.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was inspected in May 2013 and was not meeting one of the standards of the Health and Social Care Act regulations. It was inspected again in October 2013 and was found to be meeting all standards against which it was inspected.

There was a registered manager in place. 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.

Staff were aware of their roles and responsibilities in relation to safeguarding. Staff training in safeguarding was up to date.

Medicines were not administered safely. We could not see the provider had carried out any competency checks on staff who had been trained to administer medicines or completed effective medication audits.

People who used the service and staff we spoke with felt there were enough staff on duty and we observed call bells were answered in a timely manner. However, during the night when staff were busy offering personal care, there was no other staff available within the building to support people.

The accident records showed a high number of un-witnessed falls occurred during the night when there were only two members of staff on duty. Accidents and incidents had been recorded but not analysed. This meant the provider could not to establish any patterns or trends and put in plans to minimise the risk of harm.

There were no personal emergency evacuation plans (PEEPs) in place and fire drills had not been carried out on a regular basis.

We looked at the training matrix for the service and saw gaps in staff training for the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).The registered provider was meeting the requirements of the MCA 2005 and associated DoLS.

The food looked appetising and people we spoke with told us they enjoyed the food. People had been weighed monthly and the provider had referred people with weight loss to the General Practitioner (GP).

There was a variety of activities on offer for people to take part in. In the care records we looked at we saw the people’s social preferences had been recorded.

Staff were aware and knew how to respect people’s privacy and dignity.

Management of the service was divided between the registered manager and the providers. However, we found it difficult to establish what the role of the registered manager was when the provider was involved in the day to day management of the home.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take in the full version of this report.

The findings of this visit were that a programme of supervision and appraisal had been put in place.

Due to the focussed nature of this visit we did not speak with any of the people who lived at the home.

We observed positive interaction between care staff, people using the service and visitors. On the day of our inspection it was a hot sunny day and we observed care staff encouraging people not to sit directly in the sun. The windows were open which ensured the home remained ventilated and cool. When people asked for assistance we saw that staff responded to their needs in a timely manner.

We looked at the care records belonging to three people and spoke with staff. The care records we looked at contained sufficient information which demonstrated the person's health and social care needs were being met. The care staff we spoke with demonstrated they knew these people well and the care they described corresponded with what was written in the care records.

'Staff are very helpful you only have to say and they will do their best.'

'The food is excellent I really like the full English breakfasts.'

'The home is kept clean and tidy, and the laundry is looked after very well.'

'There are activities everyday during the week we do exercises, singing and crafts.'

'If you have to be in a home you couldn't be in one better.'

A visiting healthcare professional told us they had a positive relationship with the staff telling us staff did not hesitate in contacting them if they had concerns about someone's health . They also told us they thought the care was excellent and they did not have any concers about the way in which people were cared for.

One relative told us they were informed when their relative had an accident and told us they felt staff were approachable.

We looked at four sets of care records and found they did not contain an accurate account of the care and support the person required. The care records were not person centred and it was unclear from the care plans what support people actually required and how they liked the support to be provided.