Meadows Edge Care Home

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• 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

The provider did not have any formal systems in place to ensure they had effective oversight of the service. At the time of the inspection there was no registered manager at the service. There was a manager who was planning on applying to become the registered manager. There was a clinical lead in post at the time of the inspection. However, they were not supported to effectively carry out their role. Plans were in place to improve person-centred care at the service. However, these were not fully embedded at the service.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders at the service including the provider, manager and finance manager told us they were working to improve the service. However, any additional work on the premises was currently on hold. The manager told us they had been working with staff around supporting people in a more person-centred way. However, this was not yet embedded at the service. For example, we observed a person requesting to be supported to do something they had chosen to do, however were told by staff the person would be supported along with others after everyone had received their breakfast.

We reviewed minutes from team meetings where managers discussed with staff improvements that could be made to the way in which they deliver care to make peoples care more person-centred. However, did not see any evidence of how this was followed up with staff. We were not assured from our observations that any changes were embedded in the service.

There had not been a registered manager at the service since June 2023. The current manager had been in post since October 2023. At the time of the inspection, they had not applied to the CQC to become the registered manager of the service. There was no appropriate nominated individual at the service. There was a director who at the time of the inspection had not registered with CQC. The service has a condition in place to ensure there is a clinical lead in post. This is due to the service delivering nursing care and the manager of the service had not always had a clinical background. We asked the provider what support was available for the clinical lead. We were not assured that there was any formal support for the person employed in the role.

Managers told us staff received 2 supervisions a year. As well as a group supervission session. Records showed the group supervision to be in the format of a team meeting. Conversations recorded in supervisions did not show the supervisor being supportive or asking about the staff members well-being. There was not always an appropriate supervisor to undertake suppervision for the clinical lead. We reviewed a range of policies at the service including the services policy around Disclosure and Barring Services (DBS) checks. This policy stated that there was no legal requirement to renew staffs DBS checks. However, the policy did not cover that this is considered best practice within the care sector. Staff would be asked during their supervision if there had been any changes that would affect their DBS.

Most staff told us that there was a good culture at the service and they were supported by the manager. However, not all staff felt listened to or able to speak up about areas of concern. For most staff working at the service English was not their first language and some staff did not understand what the term ‘whistleblowing’ was and what it meant. The provider had not provided sufficient support to aid staff’s understanding of what this was and why it was important.

Although there was a board displaying information for people and staff on how to raise a concern with either CQC or safeguarding there were no internal processes shared.

We received mixed feedback about how fairly staff felt they were treated. A staff member told us they felt constrained by their sponsorship visa and told us, “I feel I can't make a mistake because I'm out.” Additionally, another member of staff told us, “[I] feel there is an impression that the non-British workers have to do as they are told.” Other staff told us things had improved and they felt the manager was approachable and fair.

The service employed international workers. As part of this, there were processes in place for checking visas and staff’s right to work in the UK.

The provider told us they had been remotely monitoring the service by reviewing the audits that had been inputted online. Additionally, they explained a plan to base themselves at the service for a period of time so they could achieve better oversight. They told us they had not had the time to do this in the past. The provider did state they had frequent contact with the manager.

The service had a schedule of audits in place. Audits were allocated to staff, managers and the clinical lead. Audits did not always identify shortcomings. For example, the medicine audits and care plan audits had been allocated to be completed by the manager and carried out in January 2024, February 2024 and March 2024 but they had not identified the issues found on inspection. The provider recognised that staff did not always complete people’s daily records effectively. We were told they were looking into an electronic care records system where staff would be given prompts around what to include in peoples care records so they could achieve more detail.

We spoke with 9 relatives about their involvement in reviews for their loved one's care. Most relatives told us they had been approached about being involved in their loved one's care review, but either the review was yet to happen, or the relative had not been able to make the date of the review. Some relatives said that communication with the service was not good and they were not always informed of hospital appointments.

Staff and managers told us, and we saw records of referrals for people to be reviewed by the GP and mental health services. However, we were not assured that these referrals were always made in a timely manner. For example, during the inspection we asked why a person was receiving their medicines in a certain way. Following a conversation with the clinical lead a referral was made to the GP and changes to their medicines were made. There had been email exchanges to the GP asking for a review of this persons medicines as they had been refusing to take them. However, there was a lack of professional curiosity as to why they had continued to be prescribed their medicines in a particular way when there was no longer a clinical reason. This will not affect your rating.

We spoke with professionals who supported people living at the service. They told us staff were supportive of their roles and sought advice from professionals. However, they expressed concerns that physical health referrals were not always made in a timely manner.

We found referrals for people were not always made in a timely manner or chased when it had taken a professional longer than normal to respond. It was not always clear who was leading and taking responsibility for making referrals. For example, a person had been referred to the Local authority for a Deprivation of Liberty Safeguarding (DoLS) authorisation. The referral took place in June 2023 the DoLs team had not been in touch with the service and the service had not chased this. We spoke with the finance manager about this, who thought that the previous manager had emailed the DoLs team. This had not happened. There was a section on the services audit schedule for the finance manager to monitor DoLS notifications monthly and this was marked as having been completed. However, when people at the service had a need for a GP referral the nurse for the day or the senior carer on shift would ensure that a referral was made.

The manager told us that they had improved their systems around analysing accidents and incidents, by analysing all accidents, incidents and concerns monthly. There was then a monthly team meeting to discuss what actions needed to be taken. However we found not all incidents were logged and were therefore not analysed under this process. When actions had been identified they were not always carried out as the same incident accrued the following month as no action had been taken. Staff we spoke with described what they would do during an incident but did not explain what learning processes would happen afterwards.

Although there were processes in place for analysing accidents and incidents, actions were not always taken. When action was taken it was not always in a timely manner. The service had improved and were analysing accidents and incidents. However, there were times when immediate action could have been taken to keep people safe. We did not see any evidence that discussions happened promptly when needed. Not all incidents were discussed at the monthly meeting. For example, complaints by either staff or residents were not discussed. This was a missed opportunity for learning and improving people’s experiences.