Meade Close

Meade Close is a care home and provides the regulated activity of personal care to people who require support with physical and sensory impairments, communication difficulties, moderate to severe learning impairments, complex physical and mental health needs and/or Autism. At the time of our inspection there were 9 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The service gave people care and support in a safe and clean environment that had been adapted to meet their physical needs. People had a choice about their living environment and were able to personalise their rooms. Staff supported people to take part in activities and pursue their interests. The registered manager was working with families and staff to further improve this area to ensure people lived fulfilling lives.

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.

Right Care:

The service had enough staff to meet people's needs. We have made a recommendation about positive behaviour support and person-centred care in the effective domain of the report. People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

There was an open and transparent culture within the management team with a clear focus on improving the home. It was acknowledged short term and long-term sickness had impacted on the quality of care and plans were progressing to recruit new staff and to embed a new senior team. People and those important to them, including advocates, were involved in planning their care. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 Good (Report published 22 May 2023).

Recommendations

At our last inspection we recommended implementing RESTORE2 as a tool to assist in recognising health conditions likely to deteriorate. A programme of training had been implemented promptly after the last inspection.

Why we inspected

We received concerns in relation to poor leadership, safeguarding concerns, medication issues, shortage of staff and maintenance of equipment and premises. 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 found no evidence during this inspection that people were at risk of harm from these concerns. We have found evidence the provider needed to make improvements and the provider had a clear plan in place to achieve this.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meade Close 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.

Meade Close is residential care home providing the regulated activity of personal care up to maximum of 9 people. At the time of our inspection there were 8 people using the service.

Meade Close provides specialist care and support, particularly for people with physical and sensory impairments, communication difficulties, moderate to severe learning impairments, complex physical and mental health needs, and/or Autistic Spectrum Disorder experiences.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

The service gave people care and support in a clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. The service supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. People had a choice about their living environment and were able to personalise their rooms. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right Care

The service had enough staff to meet people’s needs. Staff had received training in basic life support and first aid at work, however in the event of a person experiencing acute ill health, a systematic, evidence-based approach to recognise and respond to such events was not in place. We have made a recommendation about this in the safe section of the full report. Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 Good (Report published 08 March 2019).

Why we inspected

The inspection was prompted due to concerns received about staffing levels, leadership and management and a notification of an incident following which a person using the service died. This incident is subject to an ongoing review by CQC. As such, this inspection did not examine the specific circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of conditions likely to deteriorate. This inspection examined those concerns.

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.

Follow up

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

Meade Close is a residential service which provides accommodation and personal care for a maximum of ten people with complex health and care needs. Those people lived in three bungalows with self-contained apartments, all with back door patio door access. At the time of the inspection there were four people living in one of the bungalows and three in the other. A third purpose-built bungalow was about to become occupied and this was an exciting new venture for the service.

We found the following examples of good practice:

Staff and people using the service all undertook a regular programme of testing to keep everyone safe and free from infection. Staff and visitors were subject to a range of screening procedures such as providing a negative test before entering the premises. Staff used appropriate PPE and were encouraged to wear surgical masks when leaving and re-entering the building.

There were no shortages of PPE and all staff we observed were wearing appropriate PPE when supporting people. We saw ample available PPE for staff and anyone visiting the premises.

People were able to move around the building freely and easily (with assistance) whilst maintaining social distance from others. Communal areas were well spaced and hygienically clean. The home was well ventilated and there were plenty of areas where visiting could take place in private without the need for visitors to come in contact with other people living at the home or staff.

There were management plans for those people required to self-isolate and additional support available for people who may struggle with isolation.

This was the first inspection since Meade Close was bought by Ambito Care (which is part of the Salutem Group) in April 2018. The staff team at Meade Close, including the registered manager and team leaders, remained the same. The area managers also transferred to the new company. The home, under its previous ownership (Scope), was inspected in June 2016 and was rated as Good in all domains.

Staff members and the registered manager said there had been no change in the support provided for the people living at Meade Close following the change in ownership.

Meade Close 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.

Meade Close comprises two separate fully adapted bungalows. Each bungalow could accommodate up to four people with a severe learning disability, some of whom also had physical needs. The staff team work across both bungalows.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Meade Close had a registered manager in post. They were supported by two team leaders. 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.

Clear person-centred risk assessments and care plans were in place providing guidance for staff so they could meet people’s assessed needs.

People had little (one word) or no verbal communication. Information was available for staff to interpret what people’s facial expressions or body language was trying to communicate. From our observations it was clear staff knew the people and their needs well. People seemed relaxed and comfortable with the members of staff. We observed people being treated with dignity and respect during our inspection.

Staff enjoyed working at the service and had the training and support to meet people’s needs. Staff had completed specific training, such as Percutaneous endoscopic gastrostomy (PEG) feeding, the use of suction machines, moving and handling and epilepsy where required.

People received their medication as prescribed. The registered manager said they would introduce records of when thickeners were added to drinks to reduce the risk of choking and have clear protocols for when medicines should be administered that were not routinely given.

There were sufficient staff on duty to meet people’s needs. A recruitment system was in place to ensure staff were suitable for working with vulnerable people.

The service was working within the principles of the Mental Capacity Act. Capacity assessments, best interest decisions and deprivation of liberty safeguard applications were all completed as required.

Staff gave people choices where possible and involved them in the day to day tasks of the home. This ensured people were engaged by staff throughout the day. Each person had an activity planner in place with what they were doing each day. These were personalised for each person. Two relatives said that they thought more activities should be arranged for people living at the service. The registered manager was working with the staff team to plan and record activities, both within the house and when they went out.

People’s health, nutritional and dietary needs were being met by the service. Other professionals, for example physiotherapists and speech and the language team (SALT), were involved in supporting people and the service where needed.

The service had been pro-active in arranging a change in one person’s PEG feed regime which had meant they had not had any further hospital admissions since this change.

A quality assurance system was in place, with weekly and monthly checks being made for the care plans, people’s finances, medicines, mattresses and the environment.

We saw evidence that best interest decisions had been made with one person’s family and other professionals to agree on the support they needed at the end of their life.

A complaints policy was in place, although no formal complaints had been made. Relatives and professionals told us that the communication with the service was good and the service was transparent and effective.

People’s cultural and religious needs were being met by the service.

The home was visibly clean with no malodours. Equipment was maintained in line with national guidelines. People’s rooms were personalised with photographs and pictures of their choice. The registered manager planned for the communal areas to be re-decorated, following some leaks of water through the sky-lights.