Meavy View Retirement Home

Meavy View Retirement Home is a residential care home providing accommodation and personal care for up to 32 people. At the time of our inspection there were 23 people using the service.

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

Improvements continued to be required in relation to risk assessment and management, management of medicines, infection control, person centred care, premises and equipment, staff training and supervision, record keeping and the audit and governance process.

Risks were not always assessed or timely action taken to address identified risks. We identified gaps or a lack of detail in people’s risk assessments. Medicines were not always managed safely, as we identified a number of issues with record keeping including accurate and contemporaneous completion of the medicines administration records. Appropriate infection control measures were not always followed or implemented. Further work was required to improve the standard of the décor, fixtures and fittings. Work continued to be required to ensure the safety of the premises and equipment, helping to reduce potential risks to people’s health and well-being. We received mixed feedback about staffing levels. Staff absence was not always covered. Rotas confirmed the required number of staff had not always been deployed. Relevant recruitment checks had been carried out, though verification of staff’s references was not currently being completed.

We have made a recommendation about the recruitment process.

Staff supervision was not being provided in line with the provider’s policy. We could not be assured the training matrix was an accurate reflection of training provided at the home, as the registered manager admitted to including training a staff member said they had completed in previous employment. Where people required a modified diet, we found care plans and risk assessments were either inaccurate and/or lacked detail. Guidance from professionals, such as speech and language therapists was not available when requested. Thickening powder used to manage people’s risk of choking had been incorrectly added to one’s persons drinks for the last 4 months, as a result of inaccurate record keeping. 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 were largely complimentary about the care and support they received and the staff who provided this. Some positive observations of care were noted on both days of inspection. It was apparent staff knew people well and vice versa, with people being comfortable in staff’s presence.

Although we noted some improvement with activity provision, further work was needed to ensure people had access to meaningful activities of interest to them throughout the week. The provider did not provide information in alternative formats, to ensure it was accessible to all people living at the home. Overall, care plans contained a range of personalised information and explained how people wanted to be supported. However, information would benefit from being more specific. For example, some people’s care plans included guidance such as ‘check person regularly’, with no indication of how often this should be. Complaints had been managed in line with the providers policy.

The providers audit and governance processes were not robust, nor completed in line with specific timescales. Internal checks had not identified the majority of concerns we noted on inspection. Where issues had been noted through audits and monitoring, actions taken were either not clear, detailed or completed timely. The provider did not use an overarching action / improvement plan, to ensure effective oversight and demonstrate improvements were being made and monitored. Annual surveys were circulated; however, no actions were taken with the feedback received. Resident and relative meetings were not held, nor had people’s views been sought about whether they would find these meetings useful. Staff told us they enjoyed working at the home and felt supported by the registered manager.

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 inadequate (published 28 June 2023). At this inspection we found the provider remained in breach of regulations and remains rated inadequate. The provider has been rated either requires improvement or inadequate at the last 5 inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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, effective, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meavy View Retirement Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, risk assessment and risk management, medication management, infection control, oversight of the premises and equipment, governance and record keeping, staff support and training.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Meavy View Retirement Home is a residential care home providing accommodation and personal care to up to 32 people. At the time of our inspection there were 27 people using the service.

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

All required checks and maintenance to the building were not yet fully completed. Concerns identified in the fire risk assessment had not been fully addressed. Ongoing concerns were found with equipment and the environment. For example, there was a lack of appropriate lap belts for baths and a shower chair, some radiator covers and wardrobes were not fixed to the walls and a part of the kitchen flooring was torn.

Care records relating to the management of risk were not always accurate or complete. All required recruitment checks had not been made prior to staff starting to work at the home. Medicines were not always managed safely. Staff did not have the training required to ensure they could carry out their roles effectively. Care and support was not always designed to meet people’s needs or to reflect people’s preferences. Information was not always held securely.

Further improvement was needed to systems for auditing, assessing, monitoring and improving the quality and safety of the service. They were not sufficiently detailed or robust and had not identified or addressed issues found during this inspection or ensured the warning notice issued at the last inspection had been met.

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 were aware of their safeguarding responsibilities and knew how to identify and report concerns. Systems in place helped to minimise the risk associated with COVID-19 and other infections. There were no restrictions on people having visitors to the home.

There were sufficient staff deployed to provide people with unrushed, timely care. People were supported to eat a balanced diet. However, records did not always indicate people had received appropriate levels of fluid. People were supported to access health care services and support.

Throughout the inspection respectful, caring and patient interactions were observed. People were involved in decisions about their care. There was a system in place for recording and responding to complaints. We received mixed feedback on how involved visitors felt with their family member’s care. Staff were positive about the new registered manager and felt supported.

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 requires improvement (published 24 November 2022.) This service has been rated requires improvement for the last 3 consecutive inspections.

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 the provider remained in breach of regulations.

Why we inspected.

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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meavy View Retirement Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to premises and equipment, management of risk, recruitment, medicines management, staff training, person centred care and governance 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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

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

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 did not always support this practice. We could not be assured the provider was meeting the requirements of the MCA. The manager, the nominated individual and staff were not able to tell us initially which people who lived at the home had DoLS in place or which people had conditions placed on DoLS authorisations.

Improvements had been made to the building, furnishings and decorations. Some areas of the home were still in need of improvement or updating. The provider had developed an improvement plan, but this was not sufficiently detailed and needed to be shared with people who lived at the home and staff. Most of the required health and safety checks were being undertaken, but checks had not identified shortfalls in relation to some fire safety checks. Staff did not have the training required to ensure they could carry out their roles effectively. Care records identified people’s interests and hobbies, but people were generally not supported to follow interests or take part in individual or group activities. Further improvement was needed to systems for auditing, assessing, monitoring and improving the quality and safety of the service

New improved care records were in place. They were sufficiently detailed to guide staff on how to support people and manage risk. They were detailed, person centred and included information about people’s likes, dislikes and important routines. Safe systems of staff recruitment were now in place. During the inspection we observed sufficient staff to meet people’s needs in a timely manner, but we received mixed feedback from staff and service users. Medicines were managed safely. There were systems in place to protect people from abuse. People told us they felt safe living at the home. The home was clean. The risks associated with COVID-19 were well managed.

Staff told us they felt supported and had started to receive supervisions recently. People had their needs assessed before they started to live at the home. Detailed person-centred care records had been developed. These included information about people’s health conditions. People’s nutritional needs were met. People were generally positive about the food.

Staff knew people well. Kind and caring interactions were observed throughout the inspection. People spoke positively about the staff and the care and support they provided. People’s individuality was respected, and cultural and religious needs were referenced in care records. Staff spoke respectfully to people and gained consent before providing support.

Since our last inspection the manager had introduced a range of new systems for auditing, quality monitoring and oversight and evidence was seen of improvement in some areas. Everyone told us the manager was approachable. People who lived at the home told us they could raise any concerns and were listened to. CQC had requested a PIR, this had not been submitted before the deadline in May 2022. We found the nominated individual and manager responded immediately to any issues found and were open and transparent throughout the inspection.

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 requires improvement (published 14 September 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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 some improvements but found the provider remained in breach of regulations.

At our last inspection we recommended that the provider established an effective reconciliation system for controlled drugs and, set out a programme of cosmetic improvements and share with people and staff the progression by way of an action plan. At this inspection we found improvements had been made to medicines management, but not enough improvement had been made in relation to the premise’s improvement plan.

Why we inspected

The inspection was prompted in part due to concerns received about use of CCTV, bathing, food, cleanliness of the home, staffing and accessibility of information relating to costings for living at the home. A decision was made for us to inspect and examine those risks. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

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 .

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to premises maintenance, consent, staff training, activities and governance. The nominated individual and manager acted immediately during and after the inspection to rectify issues found or put plans in place to improve.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action and improvement plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Meavy View is a residential care home registered to accommodate up to 32 people in need of personal care. Accommodation is provided over three floors with rooms including en-suite facilities. On the days of the inspection there were 29 people living at the home.

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

Care planning and risk assessing was inconsistent. Some records had not been updated and some were incomplete. They did not always provide a reliable and accurate record to guide staff. We have imposed a breach of the regulations around these concerns that can be seen in the 'Safe' section of this report.

Recruitment processes needed to be reviewed as they did not meet current legislation and guidelines. They were not effective at ensuring staff members were always suitable with working with vulnerable people. Some essential safety checks had not been made. We have imposed a further breach of the regulation that can be seen in the 'Safe' section of this report.

We found improvements were required with medicines handling. The service needed to make sure some drugs that could be abused were held consistent with guidelines. We have made a recommendation around this in the 'Safe' section of the report. People did however receive medicines as prescribed by their health care professionals.

In some areas, management oversight and responsibility was not robust. The provider’s systems and processes for the oversight, quality monitoring and safety of the service had been ineffective in anticipating and addressing concerns we found during the inspection. This placed people at risk of harm. We have imposed a further breach of the regulation that can be seen in the 'Well-led' section of this report.

It was recognised that since the last inspection, the provider had made some 'structural' improvement in the home and to the outside space. Parts of the home required cosmetic refurbishment and we have made a recommendation about this.

Infection, Prevention and Control (IPC) processes were appropriate and we were assured about the service's ability to mitigate the transmission of infections.

Staff were competent with safeguarding processes and knew how to protect people from abuse. A relative said their loved one felt safe in the home and were trusting of staff and management. We observed good practices and interactions between staff, management and people during the inspection. The service's safeguarding processes were robust.

Staff supported people to have access to health professionals and specialist support and the service worked well with external professionals.

The provider and manager acted during and immediately after the inspection to address the risks we found. This included improved monitoring, checks and reviews.

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 requires improvement (published 26 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 the provider remained in breach of regulations.

Why we inspected

We received concerns regarding a specific incidents involving a people who lived in the home and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection, we have identified breaches of regulations in relation to the oversight of the service and systems used to oversee the quality and safe running of the home. In addition, breaches have been implemented around safe care planning and risk assessing and safe recruitment. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the 'Safe' and 'Well-Led' sections of this full report.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Meavy View Retirement Home is a residential care home providing personal care to 18 people at the time of the inspection. The service can support up to 32 people in one adapted building.

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

People told us they felt safe and were happy with the care provided. The environment was clean in all areas seen. Staff were caring and we observed some positive interactions between staff and residents. Most relatives had no concerns about the service and they told us they had received updates about their family members during the covid pandemic.

There were sufficient numbers of staff on duty and they responded to people’s needs in a timely manner. However, there were concerns about security at the service as several people had managed to leave the premises. There were concerns that the service was not raising safeguarding concerns appropriately and there was little evidence of learning lessons from incidents that had occurred, to minimise the risk of them happening again.

We found maintenance issues within the home and although there were sufficient supplies of personal protective equipment, we found some issues around infection control that had not been addressed effectively.

People told us the registered manager was very supportive and well liked. Although audits were taking place, they were not robust enough to pick up the issues we found on inspection. The provider had little oversight of the management of the service and there was no evidence of any provider audits taking place.

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 11 May 2018) At this inspection we found the service had deteriorated to requires improvement.

Why we inspected

This inspection was prompted in part due to concerns received. A decision was made for us to inspect and to examine any risks to people’s health and safety. This report only covers our findings in relation to the key questions Safe and Well-Led.

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 the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meavy View Retirement Home on our website at www.cqc.org.uk

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to requires improvement.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified two breaches in relation to Regulation 12 Safe Care and Treatment and Regulation 17 good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is requires improvement. We will meet with the provider following this report being published. In addition, we will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This is the first rated inspection for this service since the home changed providers. Prior to the inspection we received a concern from a whistle blower which we investigated during the inspection.

A manager was in post and was given the news that they had been successful with their registration with the Care Quality Commission during the 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. The manager had been in post since September 2017.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. However, we have made a recommendation that the provider looks at best practice information around more personalised care plans and recording people’s end of life wishes.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow.

The home was clean, tidy and homely in character. The environment was maintained at a good level and homely in character.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of therr responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to remain independent where possible.

We saw that people were able to attend activities of their choice and families and friends were able to visit when they wanted.

Audits, surveys and key worker sessions helped the service maintain and improve their standards of support.

People thought the registered manager was approachable and supportive.