We carried out a review of the data available to us about Meadows House Residential and Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Meadows House Residential and Nursing Home, you can give feedback on this service.
Meadows House Residential and Nursing Home 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.
Meadows Residential and Nursing Home provides care and accommodation for up to 59 people across four separate units; three residential units and one nursing unit each of which have separate adapted facilities. One of the residential units specialises in providing care to people living with dementia with behaviour that may require a response. At the time of the inspection there were 56 people using the service.
People’s experience of using this service and what we found
There were a range of activities provided. However, we found for some people living with advanced dementia some improvement was needed to ensure there was appropriate stimulation available. Staff received training and support to meet people’s needs but we observed staff were not always able to respond in the most creative way to people's advanced dementia needs. The provider was reviewing their dementia strategy at the time of the inspection and had recognised staff needed more support to respond in the most appropriate way throughout people’s dementia journey.
We will follow up on the progress with these issues during our monitoring and at the next inspection.
We have also made a recommendation for the provider to review how feedback from people is gathered on the experiences of their care.
People told us they felt safe. Staff understood their roles in safeguarding people from harm. Risks to people had been assessed and staff knew how to manage these risks safely. There was a process to identify learning from accidents, incidents and safeguarding concerns. Appropriate recruitment checks took place before staff started working at the home. Medicines were safely managed. Staff worked in ways to reduce the risk of infection. There were enough staff to meet people’s needs.
People’s needs were assessed before they started using the service. Staff asked for people’s consent before they provided care. 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. People’s nutritional needs were assessed and met.
Staff treated people with care and kindness. People were consulted about the support they received. Staff treated people with dignity, respected their privacy and encouraged their independence. People’s needs in respect of their protected characteristics were assessed and supported.
People had a personalised plan for their care. These were up to date and reflected their needs. People’s wishes relating to their end of life care needs had been discussed with them or their relatives, where appropriate.
Relatives knew how to complain and expressed confidence that any issues they raised would be addressed. The registered manager understood the responsibilities of their role. Staff spoke positively about the support they received from the registered manager and management team. The provider gathered feedback from staff and people about the service.There was an effective system to monitor the quality and safety of the service.
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 inspection rating for this service was Good (report published January 2019)
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because the information of concern related to these two key questions.
No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect these. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.
Meadows House Residential and Nursing Home 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.
Meadows Residential and Nursing Home provides care and accommodation for up to 59 people across four separate units; three residential units and one nursing unit each of which have separate adapted facilities. One of the residential units specialises in providing care to people living with dementia with behaviour that may require a response. At the time of the inspection there were 56 people using the service.
There was a registered manager in post, although they were not present at the time of the inspection. 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 this inspection we found that risks to people were identified and actions were taken to minimise harm or reoccurrence. Risks in relation to falls were identified, assessed and there was guidance for staff on how to reduce the likelihood of falls reoccurring. A falls checklist was completed following a fall to ensure all necessary action was taken and to consider any actions to minimise the likelihood of it occurring. Some staff needed some further support to fully understand how to complete new electronic risk assessment documents. The regional manager advised us of the plans with the training department to provide further training in relation to this. Refresher falls training for staff was in the process of being organised through the training of falls champions.
There were systems to manage risks in relation to emergencies. Risks in relation to the premises and equipment were managed appropriately between the landlord’s premises contractor and the home. Risks in relation to window restrictors were being reassessed following an incident in which someone had left the service through a ground floor window. Action had been taken to minimise the risk of reoccurrence.
Staff were trained to protect people from abuse or harm. They knew the procedure to report any concerns and how to escalate their concerns to external agencies if needed.
The service looked to learn from any accidents, incidents, safeguarding or safety issues and learning was shared across the home and amongst the provider’s other locations.
There were enough staff to meet people’s needs. Staff underwent recruitment checks to ensure they were suitable before they started to work with people.
People received their medicines as prescribed and medicines were safely managed. Staff were trained in infection control and followed good infection control procedures.
The registered manager had the necessary experience and skills to manage the service and the arrangements for support for their role worked satisfactorily and ensured that the Commission was notified of any significant issues as required. The inspection rating was displayed as required.
People, relatives and staff spoke positively about the management of the service. There was a system of meetings to ensure communication worked across the service. Staff were clear about their roles and responsibilities and understood the provider’s aim to deliver good quality care.
Audits were completed to monitor the quality of the service and safety of the care provided to people.
The service worked in partnership with other organisations to meet people’s needs effectively. The regional manager had recently established systems to improve the exchange of communication between them and the landlord’s premises contractor to ensure any issues were identified and acted on promptly.
At this inspection on 25 and 26 January 2017 we checked that the action plan had been completed and the breaches identified at the last inspection had been addressed. We found that improvements had been made in relation to management of medicines and records, Medicines were appropriately stored, administered and recorded properly. Risks to people were assessed and provided clear guidance and information for staff. Care plans and care delivered to people were person centred. The provider had an effective system in place to monitor the quality and safety of the service provided.
Meadows House Residential and Nursing Home provides nursing and residential care for up to 59 older people with dementia care needs. At the time of this inspection the home was providing care and support to 49 people.
There was a registered manager who had been in post since March 2016. 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.
Safeguarding adult's procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.
There were enough staff to meet people's needs. The provider had carried out appropriate pre-employment checks to ensure staff were suitable and fit to support people using the service.
Staff training was up to date. Staff received supervision, appraisals and training appropriate to their needs and the needs of people who they supported to enable them to carry out their roles effectively. There were processes in place to ensure new staff were inducted into the service appropriately.
The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and Deprivation of Liberty safeguards (DoLS). Staff asked people for their consent before they provided care.
People were protected from the risk of poor nutrition and had access to a range of healthcare professionals in order to maintain good health.
People were treated with kindness and compassion and people's privacy and dignity and confidentiality was respected. People were supported to be independent where possible such as attending to some aspects of their own personal care.
Staff were knowledgeable about people's individual needs. People's cultural needs and religious beliefs were recorded to ensure that staff took account of people's needs and wishes.
People were involved in their care planning and the care and support they received was personalised and staff respected their wishes and met their needs. Care plans and risk assessments provided clear information for staff on how to support people using the service with their needs and were reviewed on a regular basis.
People knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.
Regular staff meetings took place and people’s views had been sought about the service.
People and staff told us they thought the service was well run and that the registered manager was supportive.
This inspection took place on 01 and 03 December 2015 and was unannounced. At our last inspection 17 September 2014 we found the provider met all the regulations we inspected.
Meadows House Residential and Nursing Home provides nursing and residential care for up to 59 older people with dementia care needs.
There was no registered manager in post at the time of our inspection. 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.
We found breaches in legal requirements in management of medicines, assessments of risks, person centred care and assessing and monitoring the quality and safety of the service provided. People’s allergies were not consistently recorded; therefore, people were put at risk of receiving medicines that may have an adverse impact on their health and safety. Appropriate information was not always in place for the application of topical creams. Medicines to be given when required did not always have the appropriate protocols to ensure information was available to staff to provide care and treatment that was safe and met individual needs.
Some risks to people’s health and safety had not always been recognised or assessed adequately and acted upon. People’s care plans included relevant risk assessments which were reviewed monthly; however, where significant changes had occurred the frequencies of these assessments were not reviewed to meet people’s changing needs and monthly care plan reviews did not always reflect changes in people’s health conditions. People’s health charts were not always updated to evidence the care being provided was meeting their needs. Each person who used the service had a care and treatment plan in place. However, there was little in the way of individual needs being recorded.
People’s records including their health charts were not always completed to confirm their needs were being met.
The provider had monitoring checks in place but this was not always effective as they did not identify the concerns we found at our inspection.
You can see what action we told the provider to take at the back of the full version of the report.
We found some areas required improvement. The provider had an activities coordinator in post; however more could be done to aid people’s physical and mental stimulation. The provider had systems in place to assess the number of staff required to support people; however, this may not be sufficient in some cases and the provider informed us they would review their staffing level in line with best practices.
People and their relatives were complimentary about the home. There were safe recruitment protocols in place. There were procedures in place to protect people from abuse. Staff had received safeguarding training and demonstrated they knew what to do if they suspected abuse had occurred. There were arrangements in place to deal with foreseeable emergencies.
All staff had undergone an induction when they started working at the home and had received appropriate training to ensure they had the skills and training required for their role. Staff were also supported through regular supervision in line with the provider’s policy.
People had enough to eat and drink for their wellbeing. Where required, people had access to a range of healthcare professionals to ensure they received care and treatment that was safe and met their needs. Staff were aware of the need to ensure people consented to their care and treatment and both staff and management teams demonstrated a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
People and their relatives told us that staff were kind and caring towards them and we observed this during our inspection. People’s privacy and dignity were respected and independence promoted where appropriate. People and their relatives were involved in making decisions regarding their care and treatment plans. People’s religious needs were promoted and people were encouraged to maintain relationships. Where appropriate end of life care plans were in place for people to ensure their wishes were respected.
The provider had a complaints procedure in place and people told us they knew how to complain if they were not happy about the service. People could express their views about the service and their views were taken into consideration and acted upon.
People felt the service was well-led. Staff we spoke with told us they were happy working at the home.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
Staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Recent applications had been submitted and we found proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. We found that staff had a good understanding about adult safeguarding and they told us they would always escalate any concerns. A safeguarding policy was in place and staff had received training.
Risk assessments had been carried out for each person using the service and there were procedures in place for staff to follow to minimise such risks.
Is the service effective?
People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people’s care and support needs. One person told us. "The staff are all good. I am happy here.” Staff had received training to meet the needs of the people living at the home.
Is the service caring?
People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when supporting people. We observed this at lunch time when we saw staff supporting people to eat their meal at their own pace and were not rushed. One person told us “It’s all good here.” A relative said” they look after him well.” Another relative said ,”The care is excellent. Staff do a good job.”
Is the service responsive?
People’s needs had been assessed before they moved into the home. People told us they were happy with the care they received. Records confirmed people’s preferences, history and diverse needs had been recorded and care and support had been provided that met their wishes. People’s permissions was sought before providing care and they were encouraged to make decisions and choices about how they wish to spend their time. People had access to activities and people told us they enjoyed the singing sessions and watching old films. We spoke to relatives who told us the staff were responsive and kept them informed of any changes. One relative said, ”staff are good at communicating with me they tell us what is happening.”
Is the service well-led?
Staff had a good understanding of the ethos of the home and quality assurance processes were in place. One relative said “The home is well run.” Another relative said” you can ask them anything they will give you time.” Staff told us that they could raise any issues with the manager. Staff said they had regular team meetings, supervision and an annual appraisal.
We found the provider was aware of its regulatory responsibilities concerning incident notifications to Care Quality Commission.
We found people and their relatives were involved in decisions about their care. People's care and support needs were assessed and regularly reviewed. Staff understood people's care needs and knew how to protect them from risk and harm. People experienced care that met their needs. The provider had completed all appropriate checks for staff before they began work. In some cases the provider had not notified the Care Quality Commission (CQC) about reportable incidents. We found that quality monitoring audits have taken place and appropriate changes had been implemented to ensure people received consistent care.
In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.
Two out of seven people we spoke with felt that people did not experience care and treatment in a way that ensured their safety and welfare. One person said that they wanted to do gardening, but that staff would not allow them to, and a family member raised their concerns with staff relating to pressure sore management and a person's timely access to specialist skin care appointments.
People told us that they felt safe and comfortable to express their views and concern with the staff.