The Meadows

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question requires improvement with a breach in legal regulation of good governance. Improvements were found at this assessment, and the provider was no longer in breach of regulation. At this assessment the rating changed to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had a clear vision for the service which was shared with staff at the beginning of their recruitment journey. The registered manager promoted the values of the home by acting as a role model, embedding actions and behaviours into staffs’ daily practice including dignity and respect for each person. Compassion and person-centred care was present in every interaction with people, relatives and staff. Relatives told us, “If I was not happy, I would talk to the registered manager I have been in other care homes this one is very caring and professional.”

Staff said they enjoyed their roles and felt listened to; there were long standing members of the team at all different staff levels. Staff told us, “I enjoy my job and I feel listened too.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The registered manager and other senior staff were considered knowledgeable, professional and responsive. Staff told us they appreciated the support they received. People, relatives and staff were complimentary about the management and staff team. Relatives’ comments included, “Staff have been absolutely supportive to me” and “The manager is good. They are approachable as are all the staff.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There was a whistleblowing policy. Staff said they would feel confident to raise any issues, and they would be listened to and concerns acted upon. Where lessons had been learnt following investigations or concerns, these had been shared with staff in a timely manner to make sure improvements were made and maintained. The registered manager ensured their office door remained open whenever possible, and staff felt comfortable in approaching them or the deputy manager. The registered manager invited conversations, questions and feedback from staff, people and relatives. One relatives’ comment included, “I give feedback as and when I see [Name of registered manager], they have an open-door policy.” Feedback was gathered through informal channels and recorded in care plans. The provider is exploring formal mechanisms for collecting feedback in the future, such as surveys.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Leaders provided flexible working agreements to staff to account for personal circumstances such as caring responsibilities and health issues. Leaders took steps to ensure staff were representative of the population of people being supported. Staff told us they were treated equally by leaders.

Staff had access to equality training to help them understand about protected characteristics, bullying and harassment and relevant policies were in place, in-line with current best practice guidance.

The provider did not always demonstrate effective governance, as they had not identified the issues we found during this assessment.

The registered manager demonstrated oversight of the service through established governance systems. Regular audits and checks were carried out across key areas, including care records, health and safety, the environment and staff practice, and actions were taken where improvements were identified. However, we found that safeguarding notifications had not been submitted to the Care Quality Commission as required. The management team acknowledged this oversight, noting that other required notifications, such as those relating to serious injuries and deaths, had been submitted.

Staff were clear about their roles and accountabilities and had regular opportunities to meet, discuss, and learn from the performance of the service. A clear organisational staff infrastructure was in place. People and relatives praised the registered manager and the staff team; 1 relative told us, “I couldn't speak highly enough of the manager, a very kind and approachable lady; she knows her job well.”

The nominated individual provided support and oversight and monitored the strategic direction of the home; they carried out regular visit’s, audits and checks of compliance. They reviewed key performance indicators such as staffing levels, incidents, complaints and quality outcomes. The nominated individual supported the registered manager with the service improvement plan and any strategic decisions.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider, registered manager and staff worked in partnership with local organisations and people were supported to engage with the local community, which had a positive impact on them. A local hairdresser visited people at the home on a regular basis. People’s daily lifestyle was identified in their care plans; this provided information on what each person’s interests and what they liked to take part in.

There was shared decision-making via multi-disciplinary meetings with GPs, nurses, mental health teams, and the supporting pharmacy. Any external advice was added to people’s care plans and updated information was cascaded to staff through daily handovers and digital systems. Professionals told us, “The management at the home is excellent. I receive updates on care, we discuss medical issues and the managers are great at communicating with the relatives as well. All our decisions are very patient centred. The home communicates effectively with our surgery and quickly highlight medical issues with us so we can deal with them effectively.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

Leaders could access additional training and participated in forums and groups to keep up to date with current guidance and best practice. There was learning from any professional feedback received, such as from district nurses, hospital teams and safeguarding teams, and this was used to improve outcomes for people and improve service quality. A relative told us, “He and they [the service] get support from the mental health team and last week the consultant from Southmead came out and discussed him with us.”