Tendring Meadows

Tendring Meadows is a residential care home providing personal care and accommodation to up to 53 people. The service provides support to people with physical disabilities, sensory impairments, mental health needs and to people living with dementia. At the time of our inspection there were 16 people using the service. Tendring Meadows accommodates people in 1 adapted building over 2 floors. At the time of inspection, the top floor was closed for renovation works.

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

People’s medicines were given safely and as prescribed. Risk was well managed, including for people’s individual health conditions. We were assured infection prevention and control measures were effective. Staff were recruited safely, and there were sufficient numbers of staff suitably deployed to meet people’s needs. Safeguarding matters were investigated fully, and lessons learned.

New directors had taken over since the last inspection, and they had invested significantly in the environment, leading to extensive improvements to the building and grounds. Staff received an induction, training, supervisions, and practical competency assessments in line with national best practice guidance. People were supported to eat a balanced diet. The service worked well with other professionals, making referrals, and acting on guidance as required.

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.

Staff were kind and compassionate, treating people with dignity and respect. Systems and processes were in place to support a consistently caring service. There was a calm and positive atmosphere. Equality and diversity characteristics were considered as part of the care planning process. People’s views and preferences were considered and acted upon.

Care was planned and updated in response to people’s changing needs. There was an effective system for monitoring and responding to complaints. Information was communicated in an accessible way. People could spend time engaging in meaningful leisure activities. The service worked with other professionals to support people reaching the end of their life.

A new registered manager and new directors were in place since the last inspection, and rapid improvements had been made. There was a positive and open culture, which impacted on staff morale. Systems and processes were in place to facilitate good governance; this now needs to be developed, embedded, and sustained. Professionals and those important to people living at Tendring Meadows gave us good feedback on partnership working with 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 and update

The last rating for this service was inadequate (published 3 February 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 improvements had been made and the provider was no longer in breach of regulations.

Following serious concerns about the management of choking identified at an earlier inspection (published 30 March 2022), we imposed urgent conditions on the provider's registration. These conditions required the provider to report to the CQC every month on how they were keeping people safe from the risk of choking. Following this inspection, these conditions will be removed due to the improvements made.

At our last inspection we recommended staff receive regular competency assessments in alignment with national best practice guidance. At this inspection we found this had been implemented effectively.

This service has been in Special Measures since 29 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

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.

Enforcement

Since the last inspection we recognised that the provider (under the previous directors) had failed to ensure a registered manager was in post since 2021, without reasonable excuse. This was a breach of regulation, and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full. A registered manager was now in post to oversee the running of the service.

Follow up

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

Tendring Meadows is a residential care home providing accommodation and personal care to up to 53 people. The service provides support to people with physical disabilities, sensory impairments, mental health conditions and to people living with dementia. It is also registered to provide specialist support for people with a learning disability and autistic people. At the time of our inspection there were 20 people using the service.

The care home accommodates people in one adapted building, with 4 separate wings across 2 floors. At the time of inspection, part of the ground floor was closed for renovation works.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support: The model of care and setting did not always maximise people’s choice, control and independence. Although renovation work had taken place, the premises was still in poor repair, and institutional rather than person-centred. There was limited evidence to show how the environment had been designed to meet people’s sensory needs and preferences. The provider told us they would ensure people's choices were sought and acted on going forward, in collaboration with other stakeholders such as the local authority.

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.

Right Care: Despite the continued failings identified, staff were kind and caring, and treated people with respect and dignity. Staff received training in how to meet people’s specific health and care needs. We have made a recommendation about ensuring staff competency is regularly assessed. There had been some improvements in care plans and risk assessments to guide staff. Staffing levels and deployment had been considered and positive action taken. However, ineffective systems and processes established under the provider had prevented staff from consistently providing the right care.

Right Culture: The ethos, values, attitudes and behaviours of leaders did not ensure people could lead confident, inclusive and empowered lives. Whilst there had been some improvements since the last inspection, the provider had failed to remedy many areas of the service which could impact on people’s safety and quality of life and had a poor understanding of their legal and regulatory responsibilities. The management team based locally within the service had worked to improve morale and the culture of the service, and engage with people, staff and relatives. Systems and processes required embedding and refining to show they were effective and sustained.

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 30 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following serious concerns about the management of choking identified at the last inspection, we imposed urgent conditions on the provider’s registration. These conditions require the provider to report to the CQC every month on how they are keeping people safe from the risk of choking. Following this inspection, these conditions remain in place due to our continued concerns about safety.

At this inspection we found the provider remained in breach of some regulations but had made improvements in others.

Why we inspected

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

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.

The inspection was also prompted in part by an incident following which a person using the service died in 2021. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking and identifying and mitigating risks from accidents and incidents more widely. This inspection examined those risks.

Since the last inspection the provider has made improvements to choking risk management, such as improved care plans and risk assessments as well as training and guidance for staff. However, we identified continued concerns about identifying and escalating themes and trends in incidents and accidents more widely. The provider had also not always met the conditions on their registration with the CQC. This meant people remained at the potential risk of harm.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive 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.

Enforcement and recommendations

We have identified continued breaches in relation to person-centred care, safe care and treatment, safeguarding people from abuse and improper treatment, maintenance of the premises and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 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.

Tendring Meadows is a residential care home providing personal care and accommodation to up to 53 people. The service provides support to people who may be living with dementia or have physical disabilities. At the time of our inspection there were 38 people using the service.

The accommodation at Tendring Meadows is situated across two floors, with four distinct units. During this inspection, one unit was being used for people who were isolating due to COVID-19.

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

Potential risks to people were not being safely managed. We identified serious concerns about the risk of choking. Risk assessments and care plans were not always detailed, consistent or in place. Records were not being accurately kept in areas such as medication and catheter care. There were insufficient numbers of trained staff available to meet people’s care and support needs in a safe and person-centred way. Staff were not always aware of their safeguarding responsibilities. Infection prevention and control (IPC) measures were poor. Improvements in a number of areas had not been made and sustained since our last inspection.

Staff did not always have access to information on how to support people following best practice guidance or their assessed needs. Training and supervision were provided to staff but were not always effective or embedded. Agency staff were not robustly inducted into the service. There was a poor dining experience for people and menus were not accessible. The environment was in poor repair and extensive renovation work was required. A previous recommendation for maintenance plans had not been met. The manager was working with other health and social care professionals.

Systems were not in place for staff to provide support in a consistently caring way. We observed multiple examples of people’s privacy and dignity not being upheld. People and their relatives told us their clothing, electronic goods and aids such as glasses had gone missing. People’s belongings were not respected and kept safe, and people were wearing other people’s clothes. This was a continued concern from the last inspection. The poor environment did not show people they were respected and valued.

It was not demonstrated people’s care and changing needs had been planned for in a personalised way. There were no meaningful activities for all people living at Tendring Meadows on a day-to-day basis, although the service had supported some people with specific interests. People’s relatives told us they were satisfied with the visiting arrangements. Complaints handling was poor, and the opportunity to improve the service from feedback was not taken. The manager was introducing new documentation to meet the Accessible Information Standard (AIS). There was no one being supported with end of life care.

The service was not well-led, and governance and oversight systems were poor. The provider had not met the objectives and requirements following the last CQC inspection and were not compliant with the Warning Notice issued. The manager told us they were committed to improving the service and had taken steps to do so. The provider had not supplied sufficient resources and support for them to carry out their role effectively. The manager was working to try to improve the culture of the service, support staff and encourage openness.

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.

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 25 May 2021).

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 or inadequate for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection in the key questions of safe, caring and well-led. It was also prompted in part due to concerns received about the risk of choking. A decision was made for us to inspect and examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there were concerns in multiple further areas of the service, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

We raised urgent concerns about the safe management of people at risk of choking and infection prevention and control. The provider acted to provide assurances these risks would be mitigated and engaged with the support of external health and social care professionals.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, nutrition and hydration, premises and equipment, complaints handling, good governance and staffing.

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

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.

Tendring Meadows is a residential care home providing personal care and accommodation for a maximum of 53 people. This includes support for older people who may be living with dementia or have physical disabilities. At the time of the inspection there were 29 people living at Tendring Meadows.

The accommodation at Tendring Meadows is situated across two floors, with four distinct units. During this inspection, one unit was being used for people who were isolating due to COVID-19.

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

It was not demonstrated that sufficient staff were deployed to safely meet people’s needs at night. Care plans and risk assessments had been completed but did not always contain sufficiently detailed information. Staff received training and competency assessments on medication, but medication audits were not consistently completed to identify any errors or poor practice. Whilst personal protective equipment (PPE) was being worn by staff and the service was clean and hygienic, some other areas of infection prevention and control (IPC) required improvement.

Whilst staff were seen to treat people kindly during the inspection site visit, feedback received from people’s relatives did not describe a caring service. Relatives told us they felt excluded and unable to support people to be involved in planning their own care. Concerns were also raised about people being treated with dignity and respect, including a lack of access to their own clothing and glasses. People were not always supported to be independent with effective rehabilitation when discharged into the service from hospital.

Systems and processes for quality assurance, oversight and risk management were ineffective. The service had not demonstrated learning or made sufficient progress in this area, despite it forming part of the service’s action plan following the last inspection. Some policies and procedures, including for the management of infection control and COVID-19, were out-of-date or not tailored to the service.

Opportunities to improve in other areas had not been actioned since the last inspection. For example, recommendations made for improving personal emergency evacuation plans, a maintenance plan for improving the environment and increased awareness of the Accessible Information Standard had not been developed.

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.

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 26 April 2019) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do any by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

We identified serious concerns about COVID-19 policies and procedures at the service. We wrote to the provider to set out these concerns before the end of the inspection. The provider’s representative told us an action plan would be put in place to address our concerns about policies and procedures relating to COVID-19, including additional support for the registered manager.

Why we inspected

This inspection was prompted by a recent outbreak of COVID-19 at the 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 carried out an unannounced comprehensive inspection of this service on 18 March 2019 and 22 March 2019. 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 notifications of incidents, safe care and treatment and good governance. This inspection was also prompted by our decision to check whether the provider had followed their action plan and to confirm they now met legal requirements.

We inspected and found there was a concern with safe care and treatment, treating people with dignity and respect, staffing numbers and governance and oversight, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Caring and Well-led.

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 remained as requires improvement. 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 Tendring Meadows on our website at www.cqc.org.uk.

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 safe care and treatment, dignity and respect, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 for the provider to understand what they will do to improve the standards of quality and safety. We have raised our concerns with the local authority safeguarding team for investigation. 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.

People’s experience of using this service:

People's medicines were not always managed safely.

Personal emergency evacuation plans were not always detailed for staff to follow.

We have made a recommendation about personal emergency evacuation plans

Systems were in place to monitor the quality of the service; however, these were not effective and did not highlight concerns raised during the inspection

The registered manager was not aware of the legal requirement to notify the Commission of any authorised DoLs, safeguards or significant injuries to people using the service.

The environment was not always clean and required improvement. We have made a recommendation about the environment of the service.

Information was not available in other formats to aid people’s understanding where required. We have made a recommendation for the service to improve knowledge of the Accessible Information Standards.

People received effective care from staff who understood how to recognise potential abuse. However not all concerns were appropriately through safeguarding procedures.

People and their relatives were complimentary about the care provided at Tendring Meadows.

People were supported by sufficient and competent staff who knew people well and cared for them

according to their needs and preferences.

The registered manager and staff were encouraged to maintain and develop their knowledge and skills.

Staff respected people's privacy and dignity and interacted with people in a caring and compassionate way.

People's health was well managed and staff had positive relationships with professionals which promoted people's wellbeing.

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

People were encouraged to maintain their independence and to make their own choices about where they spent their time and how. People were offered activities which they had the opportunity to join in.

The owners of the service had a visible presence and provided good support to the registered manager.

Rating at last inspection: Good (10 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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 we receive any information of concern, we may inspect sooner.

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

The service had an application in progress to register a new manager at the time of our inspection. A registered manager is a person who has 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.

Staff had received training in regard to how to protect people using the service from abuse or harm. Staff we spoke with were knowledgeable about the types of potential abuse people may be exposed to and understood how to report any concerns. Records showed, and staff and the manager which confirmed, that all staff, including newly appointed staff had received the expected level of training required to ensure competence in their role.

Recruitment had taken place and there were sufficient staff available on the day of inspection, however thought should be given to staff availability at busier times of the day. This is because the service was not yet at full capacity and we saw that sometimes two staff were needed to work together. An extra member of staff to float between units would ensure staff were readily available to support people and maintain their safety in the different areas of the service, when another member of staff required support.

Medicines were stored, handled and administered safely. Guidance was available for staff to ensure that medicines were provided for people in line with instructions from the prescribing GP.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. Some people at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional needs were monitored regularly and reassessed when changes in their needs arose. Staff supported people in line with their care plan and risk assessments in order to maintain adequate nutrition and hydration.

Staff were responsive to people when they needed assistance. Staff interacted with people in a positive manner and used encouraging language whilst maintaining their privacy and dignity. People told us they were encouraged to remain as independent as possible. Activities that were on offer to people considered people’s interests and hobbies; through consultation with the individual and their relatives.

People and their relatives told us they were provided with information about the service and their care and treatment. People were supported to continue to maintain their cultural and religious preferences. Information was readily available for people or their relatives about local advocacy services.

People and their relatives were consulted about their care needs and involved in planning how their care was delivered. People’s care was delivered in line with their

care plans with reviews and updates regularly undertaken.

People and their relatives were asked to provide feedback about the service through meetings or through use of a suggestions box. The complaints process was displayed for people and their relatives to refer too. This contained the contact details of external agencies and where any concerns or complaints about the service could also be reported.

People, their relatives and staff spoke confidently about the leadership skills of the new manager. Daily walkabouts of the service were undertaken by the manager in order to check that the care being delivered was safe and of high quality.

The manager undertook regular reviews and analysis of systems in place to ensure that quality and safety was being maintained. Systems for monitoring staff training and assessing people’s mental capacity were robust. This also included analysis of incidents and accidents that had occurred and identifying trends or patterns through monthly auditing.