Meadow Bank House

Meadow Bank House is a purpose built care home and is registered to provide both personal and nursing care for up to 47 people. The service provides support to older adults, including people living with dementia. The home is divided into two units, Primrose, and Poppy. At the time of inspection 44 people were living at the home; 21 on Primrose and 23 on Poppy.

People’s experience of the service and what we found:

People told us they were well treated, and their equality and diversity respected. People felt staff respected their privacy and dignity and took into account their views when agreeing the support required. Staff identified people’s communication needs and addressed these with appropriate actions.

Systems in place helped safeguard people from the risk of abuse. Assessments of risk and safety and supporting measures in place helped minimise risks. Staff managed people’s medicines safely. Staff followed infection prevention and control guidance to minimise risks related to the spread of infection. Staffing levels were sufficient to meet people’s needs and managers recruited staff safely.

Care plans included information about support required in areas such as nutrition, mobility, and personal care to help inform care provision. Staff made appropriate referrals to other agencies and professionals when required.

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.

The provider and registered manager responded to complaints appropriately and used these to improve care provision. The provider and registered manager were open and honest, in dealing with concerns raised. The registered manager was available for people to contact and undertook regular quality checks, to help ensure good standards of care.

The provider and registered manager followed governance systems which provided oversight and monitoring of the service. These governance systems and processes ensured the service provided to people was safe.

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 2022).

Why we inspected

We received concerns in relation to the management of people’s pressure care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Meadow Bank House on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Meadow Bank House is a purpose built care home in the Great Lever area of Bolton and is registered to provide both personal and nursing care for up to 47 people. The home is divided into two units, Primrose and Poppy. At the time of inspection 43 people were living at the home.

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

Improvements were required with medicines management, engagement with people and relatives and the completion of supplementary charts. However, the provider had identified the majority of issues we noted and these had been added to the home's improvement plan.

People told us they felt safe living at the home and received good care from staff who knew them well. People, relatives and staff provided mixed comments about staffing levels. Although feedback indicated enough staff were deployed to meet needs, staff were reported to be very busy and had little time to provide a more personalised approach or engage in activities with people. Accidents, incidents and falls had been documented and reviewed to look for trends and help prevent a reoccurrence. We found the home to be clean, with effective cleaning and infection control processes in place

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. Staff told us they received enough training, support and supervision to carry out their roles effectively. People’s healthcare needs were being met, with referrals to professionals made in a timely manner when any issues had been noted. People were happy with the food provided, with choices available at each mealtime.

The provider used a range of systems and processes to monitor the quality and effectiveness of the service provided. Actions had been identified and added to the home’s improvement plan, which was regularly reviewed by the registered manager and at provider level. People and relatives spoke positively about the registered manager, who was reported to be open and approachable.

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

Rating at last inspection and update

The last rating for this service was good (published 22 December 2018).

Why we inspected

We received a concern in relation to the management of oxygen and medicines in general, staffing levels and staff being rushed, lack of choice at mealtimes, people having a poor diet and lack of fluids and the management of people’s continence needs.

As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow Bank House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Robust checks were carried out for any visitors to the home. Visitors were also asked to sign a disclaimer and appropriate hand hygiene was promoted on entry to the home.

The management team had worked closely with colleagues across health and social care, such as the local infection control team, to ensure they were following the most up to date guidance. Staff wore and disposed of PPE appropriately and used hand hygiene stations regularly.

The service had a robust cleaning schedule and the home was clean and tidy. Chairs in communal areas had been moved to ensure social distancing was observed.

Robust risk assessments were completed, making it clear how staff could reduce the risk of transmission of COVID-19. Staff had received training in infection control and how to use personal protective equipment (PPE) appropriately.

Staff had been supported regularly with team meetings and 1-2-1 telephone supervisions. Staff had been risk assessed to identify any risk factors such as being part of a BAME community or having underlying health conditions. Where risks had been identified, measures to support staff had been recorded.

PPE stock was of an appropriate standard and plentiful. We asked the provider to seek clarification on the use of visors and eye protection.

Further information is in the detailed findings below.

Meadow Bank House is a purpose built care home in the Great Lever area of Bolton. There is limited outside garden space. Car parking is available at the front of the home and on the main road. The home is close to local amenities and public transport.

Meadow Bank House is a ‘care home’. People in care home 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.

At our last inspection on 3 April 2018. We rated the service as requires improvement. We found five breaches of the regulations. These related to appropriate care and treatment, dignity, safe care and treatment, governance and staffing.

On 10 April 2018 the home sent us an action plan showing us how they planned to make improvements and a timescale for when these would be completed.

At the inspection on 22 November 2018 we found that the breaches had been met. The home was working closely with the local authority quality assurance monitoring team, safeguarding team and the Clinical Commissioning Group (CCG).

The home had a registered manager in post. 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.

People were safe from the risks of abuse and ill treatment. Staff had undertaken training in safeguarding vulnerable people and policies and procedures were in place for staff to refer to.

People were supported by enough staff to meet their needs.

Individual care records were in place. Information reflected people’s involvement where possible and had been reviewed and updated.

People told us that activities were provided both in the home and outside in the community.

People told us, and we observed, staff treat them with dignity and respect when offering care and support. Staff were said to be helpful and caring and understood people’s individual needs and wishes.

All relevant recruitment checks were undertaken prior to new staff commencing employment.

Relevant authorisations were in place where people were being deprived of their liberty. Care records showed that capacity and consent had been considered when planning people’s care and support.

Safe systems were in place for the management and administration of people’s prescribed medicines. People had access to relevant healthcare support so that their health and well-being was maintained.

Effective systems were in place to ensure the premises and equipment were regularly serviced and safe to use. Internal maintenance checks were completed. Issues identified during the inspection were immediately acted upon so that the building was safe.

Suitable arrangements were in place to minimise the risk of cross infection.

Systems were in place for the reporting and responding to any complaints and concerns. People and their visitors said they were able to raise any issues and felt they would be listened to and acted upon. The home had received a number of thank you letters and cards.

Meadow Bank House 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 home had 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.

At our last inspection in September 2015, we rated the service as good. At this inspection we found that the service had deteriorated and was in breach of five regulations. This was because people living at the home did not receive appropriate care and treatment; were not provided with sufficient activities; their dignity was not always maintained; and were not safe in relation to health, safety and welfare. We also found that records were not accurate and the staffing levels were not always sufficient.

We asked people if they knew who the registered manager was in case they wished to speak with her. One person said, “I don’t think I have seen her, she’s very busy”. Another said, “Yes she does a good job”. A third person told us, “I’ve seen her but she doesn’t come round everyday”. A relative said, “The manager comes to see her [person who used the service]”.

Some staff told us they felt they could be better supported by the management team and that they did not always feel they were listened to and any concerns they raised were not taken seriously.

We asked people if they thought the home was well run. Comments included: “They [staff] are trying their best”. Another said, “It’s alright, it would be good if they had a few more carers”.

We looked at the Key Clinical Indicators Summary for February 2018. We were told this was an audit that was undertaken monthly. The document identified such things as; incidence of pressure ulcers, weight loss, falls, use of bedrails and infections. We were told the audit helped the registered manager and senior management to assess the safety and quality of their service.

We saw that the service was meant to ensure regular checks and audits were carried out. However, the audits were ineffective or inadequate as they had failed to pick up the concerns found during the inspection.

Three care records showed there were gaps of several months between reviews of the risk assessments. For one person the mattress checklist should be have been completed daily by the day and night staff. This was to ensure that the bed setting was correct for the individual. We only saw three dates of checking, namely, 30 and 31 of March and 1 April 2018 were recorded. This meant that the checks had not been carried out as required and the provider could not be assured that the mattress setting was correct, posing a risk to the person using i.e. found gaps in some of the weekly /monthly checks. For example, on one record of daily tasks to be completed we saw this had not been completed since 27 March 2018. The weekly checking of fire extinguishers and fire blankets had not been completed since 2 January 2018.

We saw that certificates were in place for the maintenance of the gas and electrical testing, testing of small electrical appliances (PAT), water testing, lifts and hoists. There was a contingency plan in place in the event of utility failure.

Processes were in place to listen to residents, relatives and staff, and respond appropriately. An annual resident / relative survey was completed. Resident / relative meetings every month and the day and time of the meeting was alternated to accommodate all those wishing to attend. There was have a voice survey tablet situated at in the reception area of the home, which is accessible to all residents, relatives and visiting professionals.

The register manager attended the care home and provider meetings. The home had recently applied for and had successfully secured funding from the council transformation fund. We were told this money was to be used for sensory material on both floors and a new diner with a 1950s theme was planned.

People spoken with confirmed they were treated with dignity and respect and were overall happy with the standard of care provided.

Comments received from people using the service included: 'I'm being looked after'; 'I'm perfectly happy living here'; 'I'm alright. I have no concerns. The staff are always helpful and friendly'; 'In an ideal world it would be nice to have more staff as they work very hard but my needs have always been met'; 'The carers are great. The care is fantastic and staff are always available when needed' and 'There is no place like home but I cant complain about this place. It's the next best thing. The manager and all the staff have our best interests at heart.'

Likewise, feedback received from visitors included: 'I have no worries. In my opinion there are sufficient staff and they are always smiling and helpful'; 'I have always been kept up-to-date on any changes and this is reassuring' and 'So far the service provided has been fabulous.'

We found the dining areas were bright and inviting and people were given the choice of where they wished to sit.

We found there was a choice of menu and the chef visited people the day before to discuss their requirements and preference of meals. We saw that wine was offered to people in the evening alongside other beverages.

People told us: "The food here is good". "I have been here four years and have never had a bad meal, sometimes I don't fancy what's available and they will find me something else". "I have porridge for my breakfast and my supper it's like being at home".