Meadowbrook House

We found the following examples of good practice.

There had been an outbreak of Covid-19 at the service. During this time the registered manager had communicated with people, staff and families regularly to ensure everyone understood the measures put in place to help keep people safe.

The registered manager had worked closely with external healthcare professionals to enable people to have access to the appropriate health care and equipment, for example oxygen if needed. There were regular calls with the local authority to report people’s daily observation results, such as oxygen levels. This meant, for people who were unwell with Covid, the right care could be provided in a timely manner.

The service had sufficient supplies of Personal Protection Equipment (PPE) and this was available throughout the service. Signage was in place throughout the service regarding the requirement for wearing PPE. Additional signage identified the PPE to be worn when a person was assessed as being at higher risk of infection. Staff put on and took off their uniforms in a designated room. This helped to reduce the risk of infection because staff did not enter areas of the home, where people lived, until appropriate infection control measures were in place.

The service was clean, hygienic and uncluttered in appearance. Effective cleaning routines had been put in place to ensure infection control risks were minimised and people were kept safe. There were supplies of anti-bacterial wipes for staff to use to clean surfaces and bathrooms, after each use, in addition to the increased cleaning routines. There were posters around the service to prompt and remind staff about the infection control procedures in place. All high contact areas were cleaned regularly throughout the day and night staff also had a cleaning rota.

The design of the service had enabled staff to work in two teams. One team to work with Covid positive people and another team to work with Covid negative people, to prevent the risk of the virus spreading to others.

Procedures were in place regarding self-isolation for people and staff if they showed symptoms of Covid, or who were admitted to the service from the community or other health care provision. The admission procedure had been reviewed and developed to reduce the risk of infection from Covid. Specific Covid policies had also been developed to provide guidance for staff about how to respond to the pandemic and the outbreak. These policies were kept under continuous review as changes to government guidance was published.

Due to the current national lock-down, visiting had been restricted. However, as of 8 March 2021 these restrictions had changed. The service had prepared for the new guidance which included one designated visitor per person. Friends and families were provided with information on the new restrictions. Where visiting was permitted inside the service for compassionate reasons, for example, for people receiving end of life care, suitable infection control procedures were in place. Visitors were screened for Covid prior to entering the service. Visitors were required to wear masks and PPE.

The service was in the process of setting up a separate lounge area to enable visitors to meet people safely. People were supported to speak with their friends and family using IT and the telephone as necessary.

Appropriate testing procedures for Covid had been implemented for all staff and people who used the service following national guidance regarding the frequency and type of testing. Arrangements had been made to enable people and staff to access the vaccine.

Infection control policies and procedures had been updated in line with the national guidance relating to Covid. Staff had completed online infection prevention and control and Covid-19 training. Additional PPE had been provided for staff, such as visors, to use during the outbreak. The service had maintained good stocks of PPE and the registered manager worked with care and domestic staff teams to ensure infection prevention and control measures were followed.

The registered manager had been well supported by staff within the service and support from the company’s management team. Cornwallis Care, the company that own Meadowbrook House, has their own agency staff to support their service and provide additional staff. They had been allocated to specifically work at this service, to reduce the risk of cross infection.

The registered manager had completed risk assessments regarding the environment and risks to staff and people who used the service. The registered manager was aware of staff members who were at increased risk from Covid and a plan had been agreed with staff should there be another outbreak in the service.

The provider had a detailed contingency plan to manage any further outbreak of Covid.

Meadowbrook provides accommodation with personal care for up 42 predominately older people. There were 33 people using the service at the time of our inspection.

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

The service worked closely with healthcare professionals to improve the care provided to people living at Meadowbrook. The service was involved in a best practice pilot to reduce the use of prescribed nutritional supplements.

Meadowbrook had joined a project to help facilitate timely discharge from hospital. The registered manager visited the hospitals to assess people who may benefit from a short stay in a care home to be re-enabled to return to independent living, or who were waiting for a package of care from an agency.

People were provided with effective care by staff who were well trained and supported. Staff were happy and felt valued.

Care plans were accurate, up to date and regularly reviewed. Risk assessments provided staff with sufficient guidance and direction to provide person-centred care and support.

Staff were safely recruited. There were enough staff to meet people’s needs. Staff had time to provide person-centred care in a calm and relaxed manner.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

The registered manager listened to people’s feedback. Staff ideas were implemented, and relatives were supported to share their ideas about the running of the service.

The service was clean and free from malodours. There were robust infection control processes in place. Staff had access to personal protective equipment, such as gloves and aprons. These were used effectively to help reduce the risk of cross infection.

Medicine systems and processes were in place. People received their medicines when prescribed.

People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These were correctly set for the person using them.

People were 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.

People told us, “You can't fault the place,” "They are always enough staff around to keep us all safe” and " They always keep popping into my room to ask if I'm ok."

Relatives told us, “My relative has improved 100% since she has been here" and "Everywhere is so clean and tidy, the home is spotless."

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records.

There were varied activities provided for people. The activity co-ordinator was supporting people to enjoy activities of their choice. People were supported to go out in to the local area as they wished.

Effective audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service.

We observed many very kind and caring interactions between staff and people. Staff spent time chatting with people as they moved around the service.

Many compliments had been received from grateful families. Any complaints were recorded, and responses were seen. There were no on-going complaints at the time of this inspection.

The registered manager had regular communication with people, their families and friends to seek their views and experiences of the service provided.

Rating at last inspection and update:

At the last inspection the service was rated as requires improvement (report published 28 August 2018) and we issued requirement notices and imposed a condition on the providers registration of the service which required the service to report to CQC each month on areas of concern identified at that inspection.The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Positive conditions applied after the previous inspection in August 2018 were met.

Why we inspected: This inspection was carried out to ensure improvements required at the last inspection had been made.

Follow up: We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Full information about CQC’s regulatory response to enforcement action being taken following this inspection is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced comprehensive inspection took place on 3 July 2018. The last inspection took place on 6 June 2017 when the service was not meeting the legal requirements. We were concerned about the processes used to monitor staff training requirements, gain appropriate signed consent from people or their representatives, and how staff were provided with accurate guidance and direction on how to care and support people well. The service was rated as Requires improvement that time and we issued a requirement notice. Concerns continued to be identified at this inspection and breaches of the regulations were again identified. The service has been rated as Requires improvement for a second time.

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 service is required to have a registered manager and at the time of the inspection there was no registered manager in post. However, the acting manager was in the process of registering with the CQC. 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 and associated Regulations about how the service is run.

People were not always protected the from risk of harm because risks were not consistently identified and managed. Risks in relation to people’s daily lives were mostly identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible. Where people had been identified as losing weight timely action was not always taken to address the risk to the person.

Records of care provided were not always completed by staff in a timely manner. Where people needed to have some aspects of their care monitored there were gaps in these monitoring records.

There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular medicines audits were being carried out and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR). However, we identified some people, who did not have capacity to decide for themselves, were receiving their medicines with food. There were no records to show that guidance had been sought, from an appropriate healthcare professional, to confirm if each person’s medicines were safe to take with food.

The service was comfortable with no malodours in the corridors or communal lounges. However, an equipment storage area was very malodourous and equipment seen used by staff was not always clean. Staff did not always follow robust infection control processes.

Staff were not supported by a robust system of induction training, supervision and appraisals. This was a concern at our last inspection. The manager had a record of staff training and support, however, there were many gaps in this record where staff had not received mandatory training or regular supervision.

We spent time in the communal areas of the service. Staff appeared to know people well and had an understanding of their needs and preferences. Staff provided care and support in an unhurried manner. People told us, “Brilliant staff,” “They [staff] know me, we get on well, they pop in for a chat, they like to chat with me” and “They [staff] are good and helpful.”

The service had recently increased staffing levels and there were sufficient numbers of staff to meet people’s needs. People’s views were mixed about staffing, they told us, “They [staff] come quickly, I do use it [call bell],” “Never waited very long I use it [call bell] every night” and “I have used it and waited for a while for them to come.”

People had access to activities. An activity co-ordinator was in post. There were photographs of people taking part in activities displayed. There was a programme of activity displayed. However, people and relatives commented that they did not think there were sufficient activities that they enjoyed.

Care plans were held on an electronic system which had only been in use for a few weeks prior to this inspection. These contained information which helped guide staff to provide person centred care. Care planning was reviewed regularly and people’s changing needs were recorded.

Several areas of the service had been redecorated and refurnished. People’s bedrooms were personalised to reflect their individual tastes. The premises were maintained by a maintenance person. Equipment used at the service was regularly checked and serviced appropriately to ensure it was safe to use. The service was registered for dementia care and there was pictorial signage at the service to support some people who may require additional support with recognising their surroundings.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. People told us, “Yes I am its good food, like home cooked food. I particularly like the apple crumble and custard,” “It’s very good, I like the way it’s done.”

Technology was used to help improve the delivery of effective care. Pressure mats were in use in people’s bedrooms, who were at risk of falls, to alert staff to when they were moving around so they could support them.

The manager had some understanding of the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. However, signed consent was not always sought appropriately from relatives with the necessary legal powers.

The manager was supported by the provider and a team of motivated staff. The staff team felt valued and morale was good. Staff told us, “Things are much better now we have some more staff,” “The manager is very good and easy to talk to” and “I am very happy here.”

There were quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the manager and a member of the senior management team. However, some actions from these audits had not been addressed in a timely manner. This meant opportunities had been missed to improve how the service was run.

Concerns found at the last inspection remained at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run. There was a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.

Meadowbrook House is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 28 people living at the service. Some of these people were living with dementia. The service uses a detached house with two floors. There were only people living on the ground floor of the service at the time of this inspection.

The service had been operating under new ownership for five months and had recently undergone a great deal of renovation and re-decoration of the premises. New equipment and bed linen had been purchased and additional staff had been recruited.

We reviewed the systems for the management and administration of medicines. It was possible to establish that people had received their medicines as prescribed. There were no gaps in the medicine administration records. However, there was a quantity of medicines that required stricter controls which had been drawn up but not used. This was found in a locked medicine cupboard with a date on it of 8 May 2017. The registered nurse and the registered manager were not aware of the presence of this syringe. The service raised an incident investigation immediately and the service took action to amend their medicines policy to include the actions to take in such a circumstance. Internal medicine audits were being carried out to monitor the management and processes in place for the safe administration of medicines however, the presence of the syringe had not been identified.

Care staff were directed in care plans to record in specific files in people’s rooms, when they provided care and support for people. While there was no evidence that people‘s needs were not being met, some records were not always completed accurately by staff. Some skin checks, weights and food records contained gaps where staff had not recorded care that was directed in people’s care plans. Some guidance in care plans was not consistent with information provided in the shift handover records or in people’s room records. Staff told us they knew people well and often did not refer to records to check what care and support to provide. However, this meant that new staff and agency staff were not always provided with accurate information to refer to about people’s needs.

The manager held a record of staff training. This record had not been kept up to date. We requested a revised training record which showed there were many staff who required updates in mandatory training subjects such as health and safety and fire training. Some training, such as safeguarding adults and Mental Capacity Act 2005 had been planned for with training sessions advertised in the service for the coming weeks.

Some information requested by inspectors took time to be located by the manager. This was being held by the deputy manager who was not working at the service at the time of this inspection. Inspectors were also provided with inaccurate information by the manager at inspection, such as the number of people living at the service and the current status of staff training.

The manager had recently created new roles for staff with more responsibility. A head housekeeper and two senior carer posts had been recently created and taken by existing staff. These roles were to support the manager in the day to day running of the service. We have judged that these roles needed time to develop and bring about consistent change. There was a service development plan in place with set dates for specific actions to have taken place. Some actions were delayed, some had just been started. This had led to changes that were in process at the time of this inspection. Such as the provision of moving and handling training for staff and the commencement of audits of health and safety, infection control and the kitchen. It was not yet possible to judge the potential impact of these changes on people living at the service at the time of this inspection. We will review the progress of these changes at the next inspection.

There were many audits being carried out to monitor equipment, personnel files, room files, people’s weight records and medicines management. Some of these audits were not yet entirely effective at the time of this inspection but the manager told us, “It is work in progress, we are not quite there yet, but we are getting there.” However, some changes had already had a positive impact. For example, people told us the staffing levels had improved and visitors confirmed this.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. However, the manager had not recognised that family members can only sign consent forms on behalf of another person if they hold a lasting power of attorney for care and welfare. Consent forms were signed by family members with no such powers. We were assured this would be addressed immediately.

The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. One authorisation was in place at the time of this inspection. The conditions to this authorisation were being complied with, although the records to support this were not always completed by staff.

Meadowbrook House was clean and tidy with no malodours throughout the service. There were people living at the service who were independently mobile and living with a degree of cognitive impairment. The service had some pictorial signage to meet the needs of people living with dementia. Some rooms had dark blue painted doors to distinguish them from bedrooms, but did not yet have a pictorial sign to clearly indicate what the room was used for.

Staff were supported by a system of induction training when they began working at the service. Most staff had been provided with supervision. Some appraisals had been carried out by the deputy manager. There was a programme in place to ensure all staff received regular supervision and appraisals in the near future. Staff meetings were held regularly. These provided staff with an opportunity to be informed of any changes and raise any suggestions or concerns they had regarding the running of the service.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned to minimise the risk of harm.

The manager had not held any meetings for people who lived at the service or their families. During the inspection the manager handed out a survey for people and their families to complete. We were told the information from the survey responses would inform a planned meeting to be held in July 2017. The service development plan stated that the service should plan to hold such meetings every two months and be in place by the end of June 2017. Families that we spoke with following the inspection had not received such a survey.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. Many new staff had joined Meadowbrook in recent months, with new nurses planned to join the service in the weeks following this inspection. The service had one nurse post and one part time carer post vacant.

People were treated with kindness, compassion and respect. 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. Staff were heard to ask people for their choices and wishes throughout the inspection. One person had made a choice to live in a very cluttered bedroom, which had led to an environment which was difficult for staff to keep clean. This person regularly went out to the local shops alone and enjoyed their independence.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff checked what people ate to help ensure they stayed healthy. However, people’s food and drink intake was not always recorded as directed in their care plan. There was no evidence of such records being monitored, totalled and reviewed to help ensure people always had an adequate intake.

Care plans were in the process of being moved to the new providers format. Some care plans we reviewed had been started in the new format. There was guidance and direction for staff which was organised and accessible, although this was sometimes conflicting with other information provided such as on handover sheets and in room files. The handover sheets used at shift changes did not contain specific relevant information on people’s care needs, such as when staff should provide re-positioning and record food and drink intake or if a person had any skin damage. This meant that any new or agency staff were not provided with key information. Care planning was reviewed regularly and people’s changing needs recorded. However, there was no record that people, or their relatives if appropriate, were included in these reviews.

People and their relatives commented that there was little to occupy them. People had access to some activities. A 1000 piece jigsaw was laid out partially co