Meadowcare Home

We found the following examples of good practice.

People we spoke with told us, "I am happy” and “No I am not worried about staff wearing masks”. One volunteer told us, “I enjoy visiting here. I am part of the homes testing. I feel very safe”. One relative told us, “The visits are really important to both of us. I am grateful we can visit”.

There was a clear process for visitors, which included a temperature check and the wearing of PPE. They were required to take a lateral flow COVID-19 test with a negative result before entering. We observed two relatives going through the process of entering the home safely.

Visitors were required to sign in and they had to show a negative lateral flow test. The vaccination status was checked for health and social care professionals and contractors. This was in line with legislation that had come into effect in November 2021.

People were supported to see friends and family in accordance with government guidance. Some relatives were the named essential carer givers for their loved one. This meant they will still able to visit during the outbreak at the home. In order to be an essential care giver, set procedures were followed. This included participating in regular testing for Covid. Where people were isolating or not able to receive visitors, phone calls and video calls were utilised to promote contact with family and friends.

The home was cleaned regularly and this was monitored through audits and checks. There were staff on duty during our inspection, carrying out cleaning duties.

Social distancing measures were in place to protect people. Lounge chairs were distanced from each other to help keep people safe.

Staff had received training on the signs, symptoms and management of COVID-19. Training to don and doff PPE had also been completed by all staff. PPE stations were located throughout the home.

The home took part in regular testing for COVID-19. The registered manager maintained an audit of the dates staff and people were last tested. The registered manager told us all staff had been double vaccinated. Some staff had received booster vaccinations and others planned to have this when they were able to. The Covid passports of staff had been checked by the management team.

The registered manager told us they had not experienced any workforce pressures during this outbreak. We were told the staff team picked up extra hours as overtime, but this was monitored to ensure staff were not over worked.

Meadowcare Home is a care home providing accommodation, nursing and personal care for up to 34 people. At the time of the inspection there were 29 people living at the home. The home is a converted and extended building with rooms over four floors.

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

There had been significant improvements following the inspection of March 2021. We saw positive changes had been made to the home’s infection control procedures. Staffing levels had been reviewed and increased. Quality assurance processes had improved.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. There were also systems in place to identify and manage risks. Medicines were managed and administered safely. Safe recruitment procedures were in place.

The provider monitored the quality and safety of the service. They asked for people's views and took account of their feedback to further improve the service. The provider understood and acted on their responsibilities under the duty of candour. The staff worked in partnership with other services to ensure people received appropriate care.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 22 April 2021). There were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an inspection of this service on 11 and 15 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good. This is based on the findings at this inspection.

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

Follow up

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

Meadowcare Home is a care home providing accommodation, nursing and personal care for up to 34 people. At the time of the inspection there were 29 people living at the home. The home is a converted and extended building with rooms over four floors.

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

People were not protected by the homes infection control policy and procedures. Infection control and prevention measures, the cleanliness and repair of the home, fixtures and fittings required improvement. We could not be satisfied staffing levels kept people safe from harm and promoted choice and person-centred care.

Systems to monitor and audit the service were not effective and had not identified the improvements that were required. The service had not been consistently well led which had contributed to the failure to improve the service. The provider had failed to identify or act to mitigate the risks to people of receiving care that was not consistently safe and of a high quality.

Medicines were managed safely, and records were up to date. Processes to safeguard people from abuse were in place and risks, other than infection control and staffing levels, were reviewed and maintained. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people.

The operations manager and deputy led by example and had expectations about the standards of care people should receive. They were proud of the staff team and how they worked together and supported one another.

Communication was effective to keep everyone who used the service up to date.

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 (April 2018).

Why we inspected

The inspection was prompted in part due to concerns received from a whistle-blower. These included, infection prevention control measures, staffing levels, recruitment and health and safety of the environment. A decision was made for us to inspect and examine those areas of risk.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to the services response to infection control measures, ensuring safe levels of staffing and good governance. This meant that improvements were required to ensure quality monitoring and management and provider oversight was more effective.

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.

Meadowcare Home provides accommodation for up to 34 people who require nursing or personal care. At the time of our visit there were 30 people living at the service.

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 of the Health and Social Care Act 2008.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

People were protected from the risk of infection. Staff understood the importance of infection control and prevention.

There were enough suitable staff to meet people's needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Appropriate checks were made before staff started to work to make sure they were suitable to work in a care setting.

Medicines were handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people's prescribed medicine had been given.

Staff received training to ensure they had the skills and knowledge required to effectively support people. Staff felt well supported by the registered manager and received regular supervision and appraisals.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and DoLS.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were monitored and encouraged with their eating and drinking where required and concerns about their health were quickly followed up with referrals to relevant professionals.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People's privacy was respected, and their dignity and independence promoted.

People's needs were reviewed and monitored on a regular basis. Care records were reflective of people's individual care needs and preferences and were reviewed on a regular basis. People knew about the service's complaints procedures and knew how to make a complaint.

People were supported and helped to maintain their health and to access health services when they needed them.

There was system in place for responding to and acting on complaints, comments, feedback and suggestions.

There were effective processes in place to monitor the quality and safety of the service. People's feedback was sought through annual satisfaction surveys.

Meadowcare Home provides accommodation for nursing and personal care for up to 34 people. The service mainly provides support for older people who are living with dementia. At the time of this inspection in December 2016, there were 32 people living at the service.

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.

The service had not complied with the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. The service had not consistently ensured any conditions attached to people’s DoLS had been completed. In addition, staff were not fully aware of how the DoLS impacted on their work despite receiving training in the subject. Best interest decisions had not been consistently undertaken in accordance with the Mental Capacity Act 2005. The provider had failed to send DoLS notifications to the Commission as required by law.

People at the service told us they felt safe. People received their medicines on time and medicines were now stored correctly in a safe temperature range. People’s risks were assessed and identified risks were managed. There were sufficient staff on duty and we saw that people’s care needs were attended to promptly. Recruitment procedures were safe and people were cared for in a clean, hygienic environment. Environmental risks were monitored and an analysis of falls and incidents was completed.

People told us they received effective care and relatives we spoke with were complimentary. People had access to healthcare professionals when needed to ensure their needs were met. People’s weights were monitored, and where required they received the required support from staff. The service used a nationally recognised tool to monitor malnutrition and obesity risks and referrals were made when required. Staff received an induction when commencing their employment. Training for staff was provided and staff were supported through a supervision and annual appraisal process.

People and their relatives said they received support from caring staff. We made observations to support this, with staff delivering care in a compassionate and friendly manner demonstrating they knew people well. People could be visited by friends and relatives to avoid social isolation. Staff were responsive to people’s care needs and care records demonstrated a person centred approach to care provision. People had activities to partake in and there were links with the community. The provider had a system to record and respond to complaints.

People and staff told us the service was well-led. People spoke well of the communication they received from the service and staff were happy in their employment. Staff spoke of a good team ethos. There were systems to communicate with people, their relatives and staff. There were systems that monitored the quality of service provided and people’s clinical needs were monitored and reviewed.

Meadowcare mainly supported people with dementia care. Not all people were able to verbally tell us about the care and support they received. We observed how staff interacted and supported people. This enabled us to make a judgement on how people's needs were being met.

Since our previous inspection we found that the care planning system and documentation had been amended. The plans were person-centred and specific to the individual's needs. We found that the home had implemented a thorough pre-assessment and planning programme. This ensured that people's welfare was protected and their needs were understood from the outset.

We spoke with four relatives. They all confirmed that they were involved in discussions relating to the care planning of their relative. One relative told us 'I have been impressed with the care plan as x has only been here for a week. I feel they have been thorough'. Representatives of people who used the service could express their views and were involved appropriately in making decisions about their relative's care, treatment and support.

We revisited Meadowcare Home on 10 January 2014. We found that the appropriate corrective action had been taken. This meant that the people who used the service were now adequately protected against the risks of inappropriate or unsafe care.

Meadowcare supports people with dementia care. Not all people were able to verbally tell us about the care and support they received. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We viewed four care plans. The planning documentation was not person centred and specific to the individual regarding their care needs. We spoke with four relatives of the people who used the service. The family members we spoke with told us that they were not involved in regular formal discussions regarding their relatives care.

We viewed the staff training matrix and found that staff had attended or are booked onto training appropriate to their roles.

We found that the provider had introduced a support structure for staff supervisions and annual appraisals. The majority of the staff told us that they felt that staffing levels were now adequate.

We found that the provider did not have robust systems in place to regularly assess and monitor the quality of the services provided.

We viewed four care plans. The planning documentation used generic wording and was not person centred and specific to the individual regarding their needs and preferences. Staff we spoke with were knowledgeable about the people they supported. Two out of the four family members we spoke with told us that they were not involved in formal discussions regarding their relatives care plan.

We viewed the staff training matrix and found some areas of staff training required updating. A training plan had been implemented to address this issue.

We found that there was not an adequate support structure in place for staff supervisions and annual appraisals. The majority of the staff told us that they felt that staffing levels were inadequate in unforeseen circumstances, such as covering for sick absences. The acting manager advised that the service did not use agency staff and where possible absences were covered by existing staff.

We found that the provider did not have robust systems in place to regularly assess and monitor the quality of the services provided.

This inspection was to review the compliance action we placed following our inspection of 3rd May 2012. At that inspection we found there was a lack of person centred information to promote a greater level of person centred care. There was a lack of consistency in the recording of individual care needs and actions taken to meet those needs to ensure the welfare and safety of the person. We have not visited the service as part of this inspection but asked the provider to give us information as to how they have addressed the compliance action.

We found that the provider had taken the necessary action and had improved their arrangements in relation to needs assessment. The assessments are now person centred and they have put in place a system to record where people's care needs had changed. We found that the proper steps had been taken to ensure the each person is protected against the risks of receiving care or treatment that is inappropriate or unsafe.