The Meadows

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement with a breach in the legal regulation of safe care and treatment. At this assessment the rating has changed to good. Improvements were found at this assessment, and the provider was no longer in breach of regulation. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents and incidents were recorded, reviewed and used for learning, which was shared with staff. Staff told us, “We record incidents on the iPad, and this is followed up by management. The learning is then discussed in meetings.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People were well-supported by staff, as they transitioned into the service at a pace that suited them. Detailed information was collected before people started to use the service and this was provided to staff. Pre-admission documents contained important information about people’s care and communication needs, including personal details, the type of medicines people were taking, and any pre-existing health conditions.

The provider had clear responsibilities, roles and systems of accountability that supported the delivery of safe care. People were protected from the risk of harm and abuse; however, safeguarding concerns were not always submitted to the appropriate agencies in line with statutory requirements.

Staff had completed safeguarding training and understood how to report concerns. There was relevant information easily accessible to staff. Staff understood their roles and responsibilities in ensuring people were safe and reporting any incidents or concerns immediately. The registered manager maintained a safeguarding file to monitor referrals and ensured recommendations from investigations were implemented. Safeguarding referrals were submitted to the local authority; however, they were not reported to the Care Quality Commission in line with the Health and Social Care Act 2028 (Regulated Activities) Regulations 2014. The registered manager and nominated individual acknowledged this oversight and took prompt action to address it.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The registered manager submitted applications to the local authority when a person was at risk of being deprived of their liberty, and Mental Capacity assessments were completed in line with national guidance. People told us they felt safe, with 1 person commenting, “It’s okay here, I feel all right” and “I am happy; I feel safe.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems were in place to identify and assess people’s risks, and records contained person‑centred information. Catheter risk assessments provided clear guidance for staff on recognising infection risks, changing catheter bags, and monitoring hydration. Hydration was recorded in daily care notes, however, a formal fluid chart was not in place in line with best practice guidance. The registered manager advised they would liaise with health professionals to address this.

Risk assessments were detailed, person‑centred, current, and regularly reviewed they included guidance on supporting people to safely access the community. A relative commented, “She can’t walk, talk or feed herself, she used to walk all the time, the staff were brilliant in the summer, they would take her out in the wheelchair.” Care plans contained explanations of the measures staff would follow to keep people safe, including where people may become distressed or anxious. A relative told us, “I think the best thing is that [Name]’s anxiety has improved since they have lived there.”

People were involved in decisions about positive risk-taking, and staff understood individual preferences and communication needs.

Staff demonstrated an understanding of people’s risks. One staff member told us, “We review people’s risk assessments in their care plans, these have all the information we need.” The management team conducted monthly reviews of risk assessments and care plans as part of their established audit process.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Regular health and safety checks of equipment and the environment were completed including gas, electrical and water safety. The environment was clean, well maintained, and adapted to people’s needs. The service had a staff member onsite who was responsible for completing routine maintenance. A maintenance log was kept and was reviewed regularly by management. People told us the service was, “Well maintained and clean,” another person told us, “It’s always clean, no smells.”

The provider ensured there were sufficient numbers of qualified, skilled and experienced staff. Recruitment followed safe procedures, including for staff appointed through the government’s overseas sponsorship scheme. Training compliance was high, and staff reported having access to appropriate learning and development opportunities, feeling valued and well supported. However, we identified some inconsistencies in the completion of supervisions in line with the provider’s policy. This had already been highlighted in the registered manager’s audits, and an action plan was in place to address the issue.

Staffing levels and rotas were aligned to people’s individual support needs, with flexibility in staffing to accommodate people’s preferences and activities. People told us, “There seems to be a good ratio of staff to people.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training. There was a good standard of hygiene around the building. A relative commented, “The home is clean and tidy. [Name]’s bedroom is decorated to suit their taste.”

The nominated individual advised that an infection prevention and control committee operates across all provider homes, meeting biannually to review processes and practices. Best practice guidance is subsequently disseminated through team meetings to support consistent staff practice.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Sufficient systems were in place for safe and effective medicines management. The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were stored securely, and records of medicines held by the service matched the stock levels we checked. People with ‘as and when required’ (PRN) medication had protocols in place and these were reviewed regularly.

Staff involved people in planning, including when changes happened. People received their medicines safely. Covert medication was authorised and documented in line with MCA and best-interest principles. A relative told us, “They are just on it with the GP, they do meds and liaise with GP, they let us know if they call the GP, we are fully informed, she has had falls all dealt with, they keep skin issues at bay with creams, there is a chart in her room.”

Staff that administered medicines had completed safe management of medicines training and had undergone an assessment to check their competency to administer medicines safely