Archived: The Meadows Care Home

The Meadows is a ‘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. The Meadows provides care for up to 69 people some of whom are living with dementia. At the time of our inspection 39 people were living at the service.

The home did not have a registered manager in place. 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 and associated Regulations about how the service is run. The manager had recently submitted their application to CQC for consideration and approval to become the registered manager. On the day of the inspection the manager was on annual leave.

The service is currently in the process of transitioning to a new provider. At present the new provider has daily oversight and management responsibility for the running of the service. However, the current provider remains legally responsible for the service until the sale of the service is completed.

Following the last inspection, we found that the provider was in breach of regulation 17 (Good Governance). We asked the provider to complete an action plan to show what they would do and by when to address those issues identified.

At this inspection we saw that the provider had not taken appropriate action and the breach identified at our last inspection had not been addressed. This has resulted in a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we also found breaches of regulations 9 (Person-centred care), 10 (Dignity and respect) and 18 (Staffing).

Care planning did not always examine the needs of people who used the service. Risk assessments and outcomes of these assessments were not person-centred in order to achieve positive outcomes for people.

We reviewed training records and found that 28% of training was out of date and that staff were not always supported with an appropriate induction once they commenced employment. Supervisions and appraisals were not always carried out, this was supported by records and also in discussions with staff.

The provider did not have a robust quality assurance process in place to check the quality of care provided and to drive necessary improvements.

Care provided did not always maintain people’s dignity.

You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives confirmed they felt safe living at The Meadows. They spoke highly of staff and care delivered and staff knew the people they care for very well.

Staff followed the provider’s procedures for safeguarding and were able to explain how they would keep people safe from harm or abuse. The provider had a recruitment process in place to ensure that only people who were suitable to work with vulnerable people were employed.

During both days of the inspection staffing levels were observed to be sufficient to meet the needs of people using the service. This was supported by a review of previous staffing rotas.

The service was undergoing a refurbishment. The provider was currently refurbishing two communal areas of the service, one into a ‘bar’ and the other into a ‘tea shop’. On the first day of the inspection we identified an issue with regards to refurbishment of the service and the use of unsafe equipment. This included a lack of a risk assessment regarding contractors being on site. We also saw electrical equipment in use which had been classed as unsafe for use following a portable electrical test (PAT) carried out on 8 June 2018.

Staff understood the principles of the Mental Capacity Act, 2005 (MCA) and ensured they gained people's consent before providing personal care and support. People were encouraged to be involved in decisions about their care.

Activities played a big part of daily life at the service and the provider employed a dedicated activities co-ordinator to support this. Internal and external activities were provided which people living at the service spoke very highly of. The activities co-ordinator had been very creative in their design of various activities which had a beneficial impact on people living at the service.

A complaints procedure was available and people were able to provide feedback of their views of the service. This included the opportunity for attendance at resident’s and relative’s meetings.

Staff that we spoke to confirmed that the manager was both supportive and approachable and very much hands on.

Lunchtime was a very pleasant and relaxed experience. The menu was varied and the food being served looked very appetising, was nicely presented and portions were of a good size. Staff asked people their preference prior to serving lunch. Staff supported people as necessary and encouraged people who were more independent.

Overall the premises were sufficiently clean, and the provider had a system in place to manage clean and dirty laundry. We saw that staff had access to personal protective equipment (PPE), and used this for the various tasks they carried out.

Certain areas of the service were very dementia friendly. For example, a reminiscence lounge on the first floor which contained lots of old artefacts which supported and encouraged conversation amongst people living with dementia. There was signage to help people find their way around and identify their own rooms.

This is the first inspection of this service under the management of Ultima Care Centres (No 1) Limited. This service had been taken over by a new provider since our last inspection in August 2016.

In September 2016, the new provider Ultima Care Centres (No 1) Limited took over the running of this home and implemented a comprehensive action plan to support the registered manager to improve the service. However, due to the history of non-compliance at the service, a multi-agency decision was made to place the service under South Tyneside Council’s ‘Provider Concerns’ process. This meant that this provider had to produce an action plan which would be closely monitored by the local authority contracts monitoring and safeguarding teams. This provider also agreed not to admit any new residents for a period of time.

In August 2017, following several unannounced visits by the local authority contracts team, a multi-disciplinary meeting was held and a decision was made to remove the service from the ‘Provider Concerns’ process due to the considerable improvements made and the positive feedback received from all external agencies involved. It was agreed by the multi-disciplinary team that the home’s on-going improvements should be closely monitored in line with the local authority’s quality assurance programme.

This unannounced comprehensive inspection took place on 19 September 2017.

There was a registered manager in post who has been employed to manage the service since April 2015. They re-registered with the Care Quality Commission (CQC) to carry on regulated activities in September 2016 when the new provider took over. A registered manager is a person who has registered with the 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 action plan drafted to address the areas which previously required improvement had worked well and positive outcomes had been achieved. Audits and checks were carried out to monitor aspects of the service. The registered manager and provider had oversight of the service but not all aspects of the service had been comprehensively audited or analysed which meant the issues we highlighted had not been identified through their quality assurance systems. Throughout the service record keeping was not always accurate, complete and contemporaneous which showed that the governance systems in place were not operated effectively.

We found that the registered manager and provider were not meeting all of the conditions of their registration. They had failed to submit a large amount of notifications. Notifications are changes, events or incidents that they are legally obliged to tell us about. We have dealt with this breach of the registration regulations outside of the inspection process and will report on the outcome in the near future.

People told us they felt safe. There were safeguarding procedures in place and staff were knowledgeable about what action they should take if they suspected people were at risk of harm or abuse. Risk assessments were in place to minimise the risks people faced in their daily lives.

Accidents and incidents were managed well by staff and they were recorded and reviewed. The registered manager reported them onto external professionals if necessary. However we found that some accidents had not been included in the registered manager’s analysis and subsequently four serious injuries had not been reported to the CQC as legally required.

The premises were clean and tidy. Checks and tests of the premises had been carried out to ensure they were safe and well maintained.

Robust recruitment procedures were conducted to ensure that staff were suitable to work with vulnerable people. There were sufficient numbers of staff deployed to meet people’s current needs.

Medicines were managed safely and consistently throughout the home. People's nutritional needs were met and they were supported by staff to access external health and social care services.

Records confirmed that training courses were delivered to ensure existing care staff were refreshed with key topics, however other topics which staff may find beneficial had not been completed by all staff. There had been a delay in implementing a robust induction process which meant a small number of staff had not completed one as we would have expected. We have made a recommendation about this.

All staff were supported though a supervision and appraisal system. Staff told us they enjoyed working at the home and that they felt valued by the registered manager. They told us morale had notably improved.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The registered manager told us they had made applications on behalf of most people to restrict their freedom in line with the MCA. However the CQC had not been notified of these as legally required. All staff demonstrated an understanding of the MCA and worked within its principals.

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 in the service supported this practice.

We observed staff interacted positively with people. Staff promoted and protected people's privacy and dignity. There was a system in place to ensure people and/or their supporters were involved in the development of their care plans.

Care plans were person-centred and contained the specific health and social care needs of each person. The arrangements in place for social activities and community engagement met people’s social, emotional, cultural and religious needs.

Complaints received by the service were managed in line with company policy and resolved in a timely manner. The complaints procedure was on display and had been shared with people and their families.