Meadows Edge Care Home

Meadows Edge Care home is a residential care home providing personal and nursing care to up to 45 people in 1 adapted building. The service provides support to old and younger adults and people living with dementia. At the time of our inspection there were 29 people using the service.

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

We have made a recommendation the provider considers installing privacy screening to some of the bedrooms.

Important information was not always available in people’s medicine records to ensure staff had the appropriate information to provide safe care and treatment.

We identified areas in the building that required maintenance to ensure they were not an infection, prevention control risk.

Individual risks identified in incident forms were not risk assessed. For example, when people had hit other people and staff when distressed.

The systems and processes to review incidents were not robust and did not evidence learning lessons.

Audits were not always accurate or reflective of what actions had been already taken. Medicine and maintenance audits did not show who was responsible to complete actions and if they had been completed.

Notifications were not always made to the Care Quality Commission when required.

Terminology and language used in care plans and other records was respectful and there were no indications of a closed culture. Care plans were well written with consideration for people’s personal preferences and encouragement for staff to promote choice.

Health monitoring forms and communication tools were effectively used to monitor people when risks to their health had been identified.

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.

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 24 May 2023). 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. This service has been in Special Measures since 23 May 2023.

Why we inspected

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

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, good governance and staffing 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

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

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.

Meadows Edge Care home is a residential care home providing personal and nursing care to up to 45 people in one adapted building. The service provides support to both older and younger adults. At the time of our inspection there were 30 people using the service.

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

People were not always supported in line with their personal preferences. People were often recorded as being distressed when receiving personal care against their wishes.

Care plans did not always contain information that was important and relevant. This meant staff did not have the appropriate information and guidance to ensure they were supporting people in line with their needs and preferences.

The provider continued to not identify and assess risks through quality assurance processes to keep people and staff safe.

People were given as required (PRN) medicines routinely and not in line with protocols. People were at risk of being over medicated when staff found their needs difficult to manage.

The environment continued to not always promote safety and good infection prevention and control practices. We identified areas in the environment that required repair and renovation to ensure they were safe and could be effectively cleaned.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had not identified or reviewed the day-to-day culture in the home to ensure people were treated with dignity and respect and given maximum control over how they wanted to be supported.

There were some management systems in place to assess, monitor and improve the quality-of-service people received. However, these were not always effective and did not identify the shortfalls we found during inspection.

Staff had not always completed training specific to people’s needs to ensure they had the competency and skills to support people safely.

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.

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

Why we inspected

We undertook this focused inspection to follow up on breaches identified at the last inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 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.

Enforcement

We have identified breaches in relation to dignity and respect, safe care and treatment, safeguarding people from abuse and improper treatment, good governance and staffing 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 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.

Meadows Edge Care home is a residential care home providing personal and nursing care to up to 45 people in one adapted building. The service provides support to both older and younger adults including two people with learning disabilities. At the time of our inspection there were 37 people using the service.

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

Medicines were not managed safely, this posed a risk to people’s health. People were not supported safely to receive medicines, this risked a negative impact on people’s health. Risks to people were not always assessed or mitigated. Risks in people’s environment were not always identified and managed. Some actions were taken by the registered manager to manage medicine and environmental risks once they were highlighted by inspectors.

Incident recording was inconsistent and did not include enough information to improve care and support in the future. Lessons were not learned from incidents.

Hygiene practices did not support the prevention of infection. We were assured about other processes at the service to protect people from infection.

The provider failed to identify and address risks to people through quality assurance processes. Following a discussion with inspectors, some actions were taken by the registered manager to improve systems at the service.

People’s needs were not always assessed effectively and care plans were not always detailed with people’s needs. Staff told us of people’s needs which were difficult to manage and information was not available to staff to support with this in care plans.

Staff did not always have training in relation to people’s specific mental and physical needs. The registered manager stated they would arrange for this training to take place.

Areas of the environment had been updated but some areas of the service needed further improvements.

Policies and systems in the service did not always support people to have maximum choice and control of their lives as staff had not been supported to complete training in the Mental Capacity Act (2005). However, we observed staff to support people in the least restrictive way possible and in their best interests.

People were supported by caring staff in most instances, but there were some examples of staff not using compassionate language. Staff upheld people’s rights to privacy and dignity and people were supported with decision making where needed. Relatives felt people received person-centred support and gave examples of where people had experienced positive outcomes.

Staff understood safeguarding and incidents of abuse were reported to the local safeguarding authority to help keep people safe. Staff were recruited safely and staffing levels were safe. People and relatives felt the service was safe.

People were supported to maintain their nutrition and hydration effectively. People were supported to access external healthcare services. Staff and relatives felt engaged by the service.

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.

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 04 March 2020). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 inspected and found there was a concern around the Mental Capacity Act within the service, so we widened the scope of the inspection to include the key question of effective.

You can see what action we have asked the provider to take at the end of this full report. The provider took some actions to mitigate the risks identified at this inspection and some of this was effective.

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 remained 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 Meadows Edge Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 people’s health and safety, governance and staffing 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

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.

Meadows Edge Care Home is registered to provide accommodation and support for up to 45 older people and people living with dementia. There were 36 people living in the home on the first day of our inspection.

People’s experience of using this service:

Although service quality had improved since our last inspection, the provider still did not always ensure people received consistently safe, effective, caring or well-led care.

Infection prevention and control practice and the management of people’s medicines were not consistently safe.

Some staff used undignified, impersonal language to refer to people living in the home and did not support people in a consistently compassionate way. The provider had failed to respect people’s right to privacy.

Staff did not always reflect their training in their hands-on-practice. Some staff did not receive formal supervision on a regular basis.

There were shortfalls in the systems used to monitor the quality of the service and the provider had failed to notify the Care Quality Commission (CQC) of a significant issue involving a person living in the home.

More positively, in other areas of service provision, the provider was meeting people’s needs.

The provider employed sufficient staffing resources to meet people’s individual needs and preferences. Staff recruitment practice was safe.

Staff understood people’s individual care needs and preferences and used this knowledge to provide them with flexible, responsive support. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Training plans and competency assessment frameworks were in place to ensure staff had the knowledge and skills to meet people’s needs effectively.

Staff worked collaboratively with local health and social care services to ensure people had support when required. People received food and drink of their choice and their nutritional needs were met.

Staff worked in a non-discriminatory way and promoted people’s independence. People felt safe living in the home and staff knew how to recognise and report any concerns to keep people safe from harm.

The provider upheld people’s rights under the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives, in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The registered manager had an open, reflective leadership style and promoted learning from significant incidents. Concerns and complaints were well-managed. The provider was committed to the ongoing improvement of the home.

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

Our last inspection of this service was scheduled in response to information of concern and focused solely on two key questions, Safe and Well-Led. The service was rated as Inadequate in both key questions and Inadequate overall (published 20 August 2019). There were several breaches of regulations and the service was placed in Special Measures.

We took enforcement action against the provider and imposed additional conditions on their registration. The provider has applied for these conditions to be removed and we are considering this application.

At this inspection, we found some improvements had been made and the rating is now Requires Improvement. The service is no longer in Special Measures.

Prior to this responsive inspection, the last rating for the service was Good (published 1 December 2018).

You can read the reports from these inspections, by selecting the ‘all reports’ link for Meadows Edge Care Home on our website at www.cqc.org.uk.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Meadow Edge Care home is registered to accommodate up to 45 people with residential, nursing needs, including people living with dementia. On the day of the inspection, 27 people living at the service had nursing needs, 14 people had residential care needs and three people were in hospital.

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

People were at risk of harm. Risks associated with people’s care and treatment needs, including how clinical needs were assessed, monitored and managed were of significant concern. Guidance for staff about how to meet people's individual care and treatment needs either lacked detail or was not available for staff.

There was no clinical leadership or oversight at the service, including clinical supervision of nursing staff. The lack of clinical training completed by nursing staff impacted on people receiving safe care and treatment.

The governance framework in place was not sufficiently robust to ensure risks were assessed, continually monitored and mitigated. This included how prescribed medicines were managed and monitored. How equipment such as mattresses were monitored to ensure they were effectively working. Care plans and risk assessments, including supplementary records were not sufficiently monitored and completed correctly. There was a lack of action and priority, when risks had been reported to the registered manager and provider.

Incident and accidents were recorded and analysed for lessons learnt, but needed to be more detailed and robust to ensure actions were taken to reduce further risks.

People, visitors and staff had access to safeguarding information. Staff had received training in safeguarding. There were sufficient staff available to meet people's needs and safe staff recruitment procedures had been followed. The service was found to be clean.

Rating at last inspection

Goods (published 1 December 2018)

Why we inspected

We received concerns in relation to how people’s clinical needs and risks were assessed, monitored and managed. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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 changed from Good to Inadequate. This is based on the findings at this inspection.

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

Enforcement

We have identified three breaches in regulation; how people had their care and treatment needs assessed, monitored and managed. How medicines were administered and managed, the training and support staff received and the systems and processes that monitored safety.

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

We will request an action 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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 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.

We inspected the home on 25 October 2018. The inspection was unannounced.

There was a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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 we found shortfalls in the auditing of service quality. As a result, the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Reflecting this and other concerns, the overall rating of the home was Requires Improvement.

At this inspection we were pleased to find the breach of regulations had been addressed. Some shortfalls in the management of people’s medicines aside, service quality in all other areas had also improved and the overall rating is now Good.

Staff worked alongside local health and social care services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control although action was required to ensure the management of people’s medicines was consistently safe.

Staff worked together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were sufficient staff to meet people’s care and support needs without rushing. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach. People told us they enjoyed the food and drink provided. There was a programme of regular activities and events to provide people with physical and mental stimulation.

In her short time in post the registered manager had won the trust and respect of her team. Throughout our inspection she demonstrated an admirably open and responsive approach which set the cultural tone in the home. A range of audits was in place to monitor the quality and safety of service provision. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. Systems were in place to promote organisational learning from significant incidents and events. The number of formal complaints was reducing and any informal concerns were handled effectively. There was an ongoing programme of improvement to the physical environment and facilities in the home.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted a DoLS authorisation for 11 people living in the home and was waiting for a further 5 applications to be assessed by the local authority. Staff understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Senior staff documented decisions that had been made as being in people’s best interests.

Meadows Edge Care Home can provide accommodation, nursing and personal care for 45 older people and people who live with dementia. There were 39 people living in the service at the time of our inspection of whom 23 needed nursing care.

The service employed both nurses and care workers. In our report when we speak about both of these groups we refer to them as being, ‘care staff’.

The service was run by a company who was the registered provider. There was an acting manager who had taken up their post four weeks before our inspection visit and who had applied to us to become the registered manager. In our report we refer to this person as being, ‘the manager’.

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. In this report when we speak about the company we refer to them as being, ‘the registered person’.

At our inspection on 14 July 2016 we found that improvements needed to be made to ensure that people who lived in the service fully benefited from it being safe, effective and well led. The improvements needed to make the service safe included putting right defects in the accommodation and addressing a security issue. In relation to developing the service’s effectiveness we found that people who lived with dementia needed more support to find their way around their home. We also concluded that parts of the catering arrangements were strengthened so that meals were appetising and hot. In addition, we found that the service was not always well led as robust action had not been taken to address the concerns we had noted.

At this inspection we found that only some of these shortfalls had been addressed and we also identified some additional concerns. We found one breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because records did not show that suitable arrangements had not been made to fully involve people in the development of the service. In addition, the records we were shown did not assure us that robust quality checks had not always been completed. You can see what action we have told the registered person to take at the end of the full version of this report.

Our other findings at this inspection are as follows. People had not been fully helped to avoid preventable accidents and parts of the accommodation were not clean. Medicines were not consistently being managed in the right way. However, there were enough care staff on duty and background checks had been completed before new care staff were employed. Care staff knew how to respond to any concerns that might arise so that people were kept safe from abuse.

Although some care staff had not received all of the training the registered person considered to be necessary they knew how to care for people in the right way. Most people enjoyed their meals but some people did not promptly receive the help they needed to eat their meals. Suitable steps had not always been taken to fully promote positive outcomes for people who lived with dementia. However, nurses ensured that people received all of the healthcare they needed.

People were helped to make decisions for themselves whenever possible. When people lacked mental capacity the registered person and the manager had ensured that decisions were taken in people’s best interests. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered person and manager had ensured that people only received lawful care.

Although care staff were kind, people did not always receive care that they considered to be compassionate. However, people’s right to privacy was promoted and there were arrangements to help them to access independent lay advocacy services if necessary. Confidential information was kept private.

People were given the nursing and most of the personal care they had agreed to receive. However, care staff had not always followed the correct procedures to ensure that a person was safely assisted to be comfortable when in bed. In addition, there were no records in the service to show if complaints had been properly investigated and quickly resolved. However, suitable provision was in place to promote equality and diversity. In addition, people had been supported to pursue their hobbies and interests.

The registered person had told us about significant events that had occurred in the service. In addition, they had correctly displayed the ratings we had given to the service in order to inform members of the public. Good team working was promoted and care staff said that the service was run in an open way so that they could speak out if they had any concerns.

Meadows Edge Care Home can provide accommodation, nursing and personal care for 40 older people and people who live with dementia. There were 39 people living in the service at the time of our inspection.

There was 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.

At our inspection on 2 July 2015 there were two breaches of legal requirements. We found that medicines were not always safely managed and quality checks had not been robustly completed. After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 29 February 2016. This delayed timescale was due to an administrative error by CQC.

At the present inspection we found that the improvements necessary to meet the two legal requirements had been made. However, we also concluded that further improvements were needed to the way some quality checks were completed. This was necessary to ensure that people received the facilities and services they needed

Parts of the accommodation were not clean and hygienic and people had not always been helped to avoid the risk of accidents. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse and medicines were managed safely. There were enough staff on duty to care for people and background checks had been completed before new staff were appointed.

Some areas of the accommodation were not designed and adapted to meet people's individual needs. Although people had been assisted to eat and drink enough parts of the catering arrangements did not support people to enjoy their meals. Staff had received training and guidance and they knew how to care for people in the right way including helping them to receive any healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (MCA) and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. The registered manager had taken the necessary steps to ensure that people’s legal rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and there was provision for confidential information to be kept private.

People had been consulted about the care they wanted to receive and they had been given all of the practical assistance they needed. People who lived with dementia and who could become distressed received the individual support and reassurance they needed. People were given opportunities to pursue their hobbies and interests and there was a system for resolving complaints.

Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

We saw the home had achieved the Gold Standard Framework for end of life care. This is a framework that guides staff on how to give a person at the end of their life a pain free and peaceful death.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI). SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their visitors and the staff supporting them. We also looked at three care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We asked care staff if the home was a safe place for people to live. They told us it was a safe place to live. One member of care staff said, 'The home is safe, we have alarms on the stairs, on the fire doors and buzzers and sensor mats.'

We found some people may be put at an infection control risk as hoist slings and wheelchairs were shared and not cleaned between use.

We found some discrepancies with the safe management of medications, such as the safe administration, storage and disposal of controlled drugs and topical applications such as skin creams.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift.

We found staff attended training courses to meet the individual needs of people such as people living with dementia or people who are at the end of their life.

Is the service caring?

We observed staff speak with people in a kind and caring way and give them time to answer questions. We saw no one was rushed and staff helped people to do things in their own time.

We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent.

We asked people if they felt well cared for. One person told us, I'm well looked after, I get help to do things. They all know what condition you are in and what to do.' Another person told us, 'I am well enough looked after. Staff look after me.'

One visitor told us, 'The care is very good, he is looked after really well, staff are really good to XX.'

Staff told us there was not enough staff to meet people's needs. One member of staff told us, 'The demands of the job are high'I am not satisfied I can give full care.'

Is the service responsive?

We saw recorded in the care files that when a person's condition changed or deteriorated care staff called in the appropriate health professionals such as the person's GP or district nurse. We spoke with a relative whose comments supported this. They told us, 'Staff ring me straight away and tell me when XX is unwell. They tell me what they have done; rang the doctor and called an ambulance.'

We saw when care workers raised concerns about people's health and social care needs the provider contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

During our inspection the manager was on leave and the deputy manager was working permanent night duty. This meant there were no senior staff members on duty during the day. We spoke with newly appointed member of staff who told us they had not received an induction and did not work under supervision. We observed this staff member working on their own.

We spoke with staff who told us the manager was approachable. One staff member said, 'Her door is always open.'

We spoke with a relative who told us, 'I can go to XX at any time, if I need to talk to her I can just pop in.'

We looked at records and observed how staff supported the people living in the home.

Staff spoke about making sure people gave them their consent to help them get up in the mornings or have their personal hygiene needs met. However, one member of staff told us some people were got up without their consent being obtained.

People told us they were happy living in the home. One person said, 'I'm well satisfied with the care and the girls are very good.'

We found the home's medicine policy was not being adhered to in relation to the administration of controlled drugs.

There were enough skilled and qualified staff to meet the needs of people in the home. Nursing staff were overseeing the care needs of people requiring personal care as well as those needing nursing care. This could impact on the amount of time nurses had to meet the needs of people who required nursing care.

On this visit the manager and deputy manager observed lunchtime with the inspector. Lunch was served in the open plan lounge/dining room. All care staff on duty were available to assist people at lunchtime.

People were offered a choice of fruit squashes with their meal. One person asked for a cup of tea and this was made for them.

We saw staff sat to assist people who required support to eat their meals. People were not rushed and lunchtime was a positive experience.

We spoke with three members of staff; two support workers and a registered nurse. They told us mealtimes and nutrition had improved since our last visit.