Meadowside

Meadowside is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Meadowside is registered to accommodate a maximum of 10 people at any time. It is a respite service, offering occasional overnight stays for people with learning disabilities, who usually live with family members or carers. Meadowside provides access to respite support for 84 people in total. At the time of the inspection there were six people staying at the service, one was on long stay placement, meaning they were living at the service until a more suitable place could be found.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People were encouraged to be a part of the local community; attending clubs, the library, pubs, visiting local shops, cafes, swimming pools and gyms. People were supported to move on to supported living services to become more independent.

Since the last inspection, where we found four breaches of regulations, we found that improvements had been made so the service was no longer in breach and now met the characteristic of good in all areas.

¿ People were provided with the support they required. People and their relatives/carers took an active role in developing their care and support plans and these were reviewed each time a person revisited the service to ensure information was up-to-date.

¿ We asked people if they felt safe and they nodded. Relatives told us that they felt their loved ones were safe and well cared for.

¿ There were safeguarding and complaints information in easy read and pictorial form for people and the information was communicated to people in resident's meetings.

¿ Risks to people were identified and mitigated. Since the last inspection, the fire system had been completely replaced and new fire doors had been fitted throughout.

¿ New positive behaviour training and support plans had been implemented so staff had a greater understanding of people's behaviour and how to manage and overcome it safely.

¿ There were enough staff who had appropriate training to support people and it was clear to see that people felt relaxed and comfortable in the company of staff. Staff knew people well and we saw agency staff and staff who had little contact with people previously reading people’s care plans and communication aids before they met them.

¿ People had access to medicines which were stored safely and checked by staff. People were encouraged to take their medicine independently.

¿ Incidents and accidents were investigated and learnt from so the risk of reoccurrence was reduced.

¿ People received the necessary support when they were physically or mentally unwell as staff worked closely with medical professionals and people's relatives/carers.

¿ People had a choice of what they had to eat and drink. Refreshments were available throughout the day and people were encouraged to make their own drinks and help prepare meals.

¿ The environment was adaptable and met people's needs. It was clean, and the premises had been redecorated throughout.

¿ People's privacy and dignity were respected.

¿ Personal independence was promoted, and people were challenged to try new things and learn new skills.

Rating at last inspection: At the last inspection we rated the service requires improvement. (Published 1 March 2018).

Why we inspected:

Scheduled inspection based on previous rating of requires improvement.

Follow up:

We will continue to monitor this service to ensure that it continues to be good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Meadowside is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Meadowside is registered to accommodate up to 20 people. It is a respite service, offering overnight stays for people with learning disabilities, who usually live with family members or carers. Meadowside provides respite support for 84 people. At the time of the inspection there were six people staying at the service, two were on long stay placement, meaning they were living at the service until a more suitable place could be found.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. At the last inspection there were five breaches of regulations.

The provider had not always assessed and managed risk to people, had failed to ensure any supervision and deprivation of liberty was lawful, people were not always enabled to make choices and receive care as they preferred. The provider had not ensured there were enough staff on duty, staff did not always have appropriate supervision, support and training. The provider had failed to assess, monitor and improve the quality of the service and maintain accurate records for each person using the service. At this inspection some improvement had been made but there continued to be breaches of regulations and the action plan had not been complied with.

The service had a new registered manager in post, who had started working at the service in October 2017. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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 the previous inspection we identified that the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service had been built to support up to 20 people. At this inspection, the registered manager told us that the service would now only be supporting a maximum of 12 people. The building was being redesigned to provide a more inclusive environment for people.

At our previous inspection the registered manager had told us that the provider’s maintenance department was slow to respond to requests for works to be completed. At this inspection we found that essential maintenance works to keep people safe in the event of a fire had not been completed in a timely manner. Regular checks and audits had been completed on the environment and equipment to make sure they were safe.

Previously risks to people’s health and safety had not always been assessed and there was not detailed guidance in place to mitigate risks. We found that there had been no improvement. There was no detailed guidance for staff to mitigate risks when supporting people to mobilise. Staff did not consistently record or monitor people’s behaviour. Staff did not complete incident forms when incidents had occurred, analysis had not been completed to reduce the risk of the incidents happening again. There was no detailed guidance for staff to follow to manage people’s behaviour.

At the last inspection, staff had not received the training and support they required to complete their role effectively. Improvements had been made, however, further improvements were needed. Staff had not received training to meet people’s specific needs and to provide support following current guidance. The registered manager had organised a training week to address the shortfalls in staff training. Staff now received supervision to discuss their personal development and issues they may have. There were sufficient staff on duty, who had been recruited safely.

At our previous inspection people were living at the service and their liberty was restricted but the registered manager had not applied for DoLS to ensure this restriction was lawful. At this inspection the two people living at the service had the capacity to consent to do so. Other people stayed at the service for short periods of time. The provider did not have a policy in place regarding applying for DoLS for these people, if they were unable to consent to staying. The registered manager had not applied for DoLS for these people.

Previously, staff did not always know the best way to communicate with people, which resulted in people becoming frustrated and distressed. At this inspection, some improvements had been made but further improvement was required. Some people were unable to communicate verbally and not all staff could consistently communicate with people. We have made a recommendation about staff communicating with people.

At the last inspection people’s care plans had not always been updated between respite stays and the level of information contained in the plans was inconsistent. At this inspection, some improvements had been made but further improvement was required. People’s care plans now contained information about the person since their last respite stay and care plans had been updated as required. However, the information in the care plans was not consistently detailed about people’s choices and preferences. People were supported to take part in activities.

The registered manager had introduced a new system of managing and monitoring complaints and were aware that historically these had not always been adequately documented. Staff referred people to specialist healthcare professionals when required. People who were living at the service long term were supported to access the dentist, optician when needed. The service did not provide end of life care.

Checks had been completed on medicines and infection control by senior members of staff. The registered manager had not yet implemented a system of formal checks and audits to ensure they were complying with the expected fundamental standards. The representative of the provider told us they ‘sampled’ care plans and had worked shifts at the service to observe staff practice, however, these checks had also not been formalised.

People were supported to eat and drink enough to maintain a balanced diet. Staff ensured that people received specialist dietary needs, for people to eat and drink safely. People had a choice of meals. People received their medicines safely and when they needed them. People were treated with dignity and respect, Staff were discreet when providing support to people. Staff supported and encouraged people to maintain relationships with loved ones. People were encouraged to be as active as possible.

Staff knew how to recognise abuse and discrimination, they understood their responsibilities to report any concerns. Staff were confident that the registered manager would deal with any concerns. The registered manager worked closely with other agencies to ensure that people’s needs were met.

The registered manager acknowledged that they were in the process of making changes to the culture of the service and were encouraging staff to be more person-centred. They told us, “I want to be encouraging people to be more independent. We should be working with people to set goals and help them achieve them.”

Staff attended regular staff meetings. The registered manager had introduced new working practices for team leaders so that they were more involved with the care given to people. Some staff told us that they felt that the changes were happening very fast but agreed that the meetings had allowed them to discuss the changes. Minutes showed that a range of topics were discussed including any changes to people’s needs and any potential safeguarding concerns. Staff understood their role in preventing infection.

People and their relatives had been asked for their feedback on the service via annual questionnaires. Questionnaires for people had been written in an easy to understand format, and included pictures to make it more meaningful for those using the service.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The registered manager was aware that they needed to inform CQC of important events in a timely manner.

At this inspection four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

Meadowside is registered to provide accommodation and personal care for up to 20 people. It is a respite service, offering overnight stays for people with learning disabilities, who usually live with family members or carers.

People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

Downstairs there was a kitchen, dining room, activities area, lounge and several bedrooms and bathrooms. Upstairs there were more bedrooms and bathrooms, and a small lounge.

At the time of the inspection there were nine people staying at the service. Two people were there on a long stay placement, meaning they were living at the service until a more suitable place could be found.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

Some people needed support to communicate. Although they had communication books to assist them to make their needs known staff did not use them. We saw one person sign to staff that they would like a drink and staff did not act or understand what they wanted. There was a lack of accessible communication within the service so it was not always clear to people who would be supporting them. People with more complex needs were not given choices in a way they could understand, about what they wanted to eat.

Staff did not always treat people with respect. Staff discussed a personal, private matter in front of people.

Medicines were not always stored safely and at the correct temperature. Some medicines had specific storage requirements and these were not always adhered to. Thickener powder, used to thicken people’s drinks if they had difficulty swallowing, was not stored safely. There was a risk that people could pick it up and accidentally swallow it.

Staff did not consistently record or monitor people’s behaviours. We saw three different staff members react in a different way to one person’s behaviour, as there was a lack of guidance for staff to follow. Sometimes staff did not complete incident forms when incidents occurred meaning further analysis was not done to look to reduce the chances of them happening again in the future. Staff did not update people’s care plans and risk assessments when their needs changed.

Some people needed help with eating and drinking or moving safely. People’s care plans explained how to manage these risks and ensure that people received the care they needed to minimise the risks from occurring. Other risks, such as those relating to unstable health conditions such as epilepsy were not assessed fully.

There was a number of staff off sick. People told us that they sometimes did not ask staff for assistance as they were aware of the high sickness levels. Some people needed one to one support but staff were engaged in other tasks so were unable to provide this level of care at all times. We saw some people becoming distressed and staff not responding immediately as a result.

People and their relatives told us they were not always able to go out as much as they would like. One person liked to go out but needed extra assistance from staff so did not go out as often as they would like. People were engaged in a variety of activities on the day of the inspection, including a music workshop and craft activities.

Due to the high levels of staff sickness, staff had not had regular one to one meetings with their manager or team meetings to discuss any issues and reflect on their practice. Staff received training on key topics such as safeguarding; however, some staff were due refresher training for topics such as behaviour support and medicine administration.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. One person had been staying at the service for several months and required continual support and supervision to stay safe. They were unable to consent to their care and treatment. The registered manager had not applied for a DoLS authorisation for this person. They contacted the local authority and applied for a DoLS on the second day of the inspection.

The registered manager told us that there had been several historical issues, relating to the premises and physical environment. Paint had been flaking from an entrance hall containing asbestos and the provider’s maintenance department had been slow to respond. The registered manager told us they had been focused on ensuring the physical environment was safe and the quality of care had ‘slipped as a result’. They moved their office to the front of the service so they were able to view what was happening on the second day of the inspection.

The registered manager and team leaders carried out regular audits on the environment and paperwork, but their checks had not identified the errors we found during the inspection. Annual questionnaires were sent out to people, relatives, staff and other stakeholders so they could give their views about the service. Easy read surveys were also available so that everyone had the opportunity to take part. The responses were collated and action was taken to address any ideas and suggestions made.

People’s needs were assessed before they started using the service. People’s healthcare needs were managed well. If people became unwell when using the service staff supported them to see a doctor.

Some people had eating and drinking guidelines in place from speech and language therapists (SALT). Staff followed these guidelines and food and drinks were served at the correct consistency. Staff ensured people had enough to drink during hot weather.

Staff were kind to people and there was affection between people and staff. When people needed to go to the bathroom they were asked in a discreet manner.

The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them. The registered manager was experienced in working with people with learning disabilities and providing person centred care. The CQC had been informed of any important events that occurred at the service, in line with current legislation. Staff were checked to make sure they were of good character and suitable to work with people.

People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. There was a complaints policy in place and people and their relatives said they knew how to complain if they needed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of the report.

Is the service safe?

People told us that they felt safe. Safeguarding and whistleblowing procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the provider to maintain safe care. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At the time of inspection, no-one was subject to Deprivation of Liberty Safeguards authorisation.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that care plans reflected their current needs.

Is the service caring?

We spoke with people who live at the service. We asked them for their experience about the staff that supported them. Feedback from people was positive, for example one person said, "I don't have anything negative to say. I enjoy living here". Another person told us, "I love it here. I can do what I want".

People who live at the service and their families were asked to complete a satisfaction survey by the provider. These were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The home worked well with other agencies and services to make sure people received care in a coherent way.

People knew how to make a complaint if they were unhappy.

People engaged in a range of activities both in the home and in the wider community.

Is the service well-led?

The service operated a quality assurance system which identified and addressed shortcomings. As a result, a good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. There was also strong evidence on people's records that staff advocated for people and involved outside agencies as required.

Care records showed that peoples' views had been considered when planning their care. People told us that staff always asked their permission before helping them with care tasks and this was supported by written records.

People told us that they had choice within the unit. We could see from the records that care was planned and information from family and outside agencies helped plan this care.

We saw that medication was stored correctly and there was a procedure in place. Storage areas were meticulously clean and medication records were up to date.

From speaking with staff and inspecting records relating to training and supervision we concluded that staff were supported. As the needs of the people staying in the unit were increasing, there was a need to provide specialist training.

Record keeping relating to people using the service needed attention; there were inconsistencies on care records and out of date information.