Meadow House

Meadow House is a residential care home providing personal care for up to nine younger adults and older people whose primary needs relate to their mental ill health. At the time of our inspection seven people lived at the home.

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

People felt safe living at Meadow House and staff understood their responsibilities to keep people safe. Improvements had been made to the management of individual and environmental risk, including fire safety. However, further improvement was needed to ensure all care was provided safely in a safe environment. Staff had been recruited safely and people received their medicine as prescribed from trained staff. Staff had been trained in the prevention and control of infection and worked to current COVID-19 government guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Records to relating to the assessments of people’s capacity and best interest decision making, required improvement. The manager and staff worked in partnership with other professionals to support people to maintain their physical and mental health and wellbeing. Staff had been recruited safely and received the training and support they needed to be effective in their roles. People had confidence in the skills and knowledge of the staff who provided their care and support.

People and staff spoke highly of the manager and management oversight of the service had improved. The manager had created an open culture based on trust, respect and teamwork. The open culture encouraged learning when things had gone wrong. People were encouraged to share their views of the service. Further work was needed to ensure feedback was understood and used to drive improvement. The manager had introduced a range of quality monitoring systems and processes. However, further time was needed for these to be fully effective and embedded. The manager and staff team demonstrated their commitment to ensuring people received a quality service that reflected and met each person’s individual needs.

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 07 January 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 24 November 2020. 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 and governance of the service.

We undertook this focused inspection to check they 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, Effective and Well-led which contain those requirements. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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 requires improvement. This is based on the findings at this 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.

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

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.

Meadow House is a residential care home and was providing personal care to eight people with mental health needs at the time of the inspection.

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

Risks associated with people’s care and support had either not been assessed or had not been reviewed to help ensure people were sufficiently supported to keep themselves and others safe. This included risks associated with fire, infection control, and the environment. People did not experience care in the least restrictive way possible. Records did not show people had been involved in best interest decisions to enable them to have maximum choice and control of their lives.

Ineffective provider and management level oversight of the service had impacted on the quality of care people received. The provider's systems to monitor the quality and safety of the service were not effective and their policies and procedures were not always followed. The management team had not identified the concerns that could arise through poor infection control and the lack of clear records.

People told us they felt safe and were positive about the staff. We saw people were comfortable around staff demonstrating they felt safe. Arrangements were in place for the safe recruitment of staff but not all pre-employment checks had been fully completed. Staff knew people well and knew how to support their needs. They shared mixed views about management of the home due to experiencing frequent changes in management.

We identified there were ongoing actions needed to fully comply with the conditions placed on the provider’s registration. There continued to be two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment and good governance.

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 (11 May 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made, and the provider was still in breach of regulations.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 carried out an unannounced comprehensive inspection of this service on 18 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. This was in regard to actions to comply with Safe Care and Treatment, Good Governance and the requirement to display performance assessments (their rating).

We undertook this focused inspection to follow up on the conditions we imposed on the provider’s registration, as well as, to check they had followed their action plan 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 remained the same. 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 Meadow House 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 monitor the service.

We have identified breaches in regard to the management of risks associated with people’s care and management oversight of the service. The provider had not ensured effective systems and processes were in place to monitor the quality and safety of the service and drive improvement.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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:

¿ The service checks and maintenance had failed to ensure the service and equipment was safe for people living at Meadow House.

¿ People’s safety had not been promoted and risks in relation to fire safety had not been sufficiently mitigated.

¿ Systems of governance and oversight were not sufficiently robust to have identified the issues we found.

¿ Staff were safely recruited and received the training and support they needed to undertake their role.

¿ People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

¿ There was a wide range of opportunities for people to engage in activities and follow hobbies and interests.

¿ People were very positive about the staff and told us that their privacy and dignity was promoted.

¿ The service had good community links such as local churches and schools.

¿ Preferences and choices were considered and reflected within records and work was ongoing to improve the new electronic system.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, good governance and failure to display rating. Details of action we have asked the provider to take can be found at the end of this report.

We found the service met the characteristics of a “Requires Improvement” overall rating

More information is available in the full report.

Rating at last inspection:

Good (Published June 2017)

Why we inspected:

We received information from the fire service regarding an escalation of concerns about the service. We completed this inspection based on these concerns.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with other agencies.

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

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.

People received support from staff who knew how to keep them safe. Staff knew how to protect a person from the risk of harm and how to report any concerns they saw. People were assisted by staff who ensured they were available for people when needed. Staff had time to support people in every aspect of their daily lives. Staff gave people their medicines when needed and recorded when they had received them.

People’s care was provided by staff that had been trained to understand their needs and were supported in their role. People’s decisions about their care and treatment had been recorded and staff showed they listened and responded to people’s choice in how they received care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People made choices regarding their meals and planning the menu options and alternative diets had been considered. People were supported to access health and social care professionals with regular appointments when needed and were supported by staff to attend these appointments.

People were comfortable around the staff that supported them. People were happy to chat and relax with staff. Staff knew people’s individual care needs and respected people’s dignity and independence.

People chose how they spent their days in their home, the garden or out and about. People had the opportunity to raise comments or concerns and these were addressed. There were processes in place for handling and resolving complaints and guidance for people living in the home was available in alternative formats. Staff were also encouraged to raise concerns on behalf of people and they had done so where necessary.

The registered manager was available, approachable and known by people. The provider ensured regular checks were completed to monitor the quality of the care delivered. The management team had kept their knowledge current and they led by example.

We spoke with four of the six people who lived at Meadow House. They were all happy with the support they received. One person, who had been critical of the service when we last visited, told us that there had been big improvements. People said:

"I feel safe here."

"It's not a bad place to be in, they're pretty good to you here."

We talked to the contracts officers at Coventry Primary Care Trust and Coventry City Council. They told us they had seen improvements at the service and were now satisfied with support being provided to people living at Meadow House.

We looked at the staffing arrangements at the service. We saw there were sufficient staff on duty to meet the needs of people who lived at Meadow House.

We spoke with staff and looked at care records. We were satisfied people living at Meadow House received appropriate care and support to help them with their mental health needs.

We looked at the premises. The premises were safe and the furniture, fixtures and fittings were sufficient to meet the needs of people living at Meadow House. The d'cor and carpets in some areas of the home looked a bit tired and worn.

We checked the cleanliness of the home. We were satisfied that the home was clean and staff knew their roles. Record keeping for infection control needed to be improved.

We had been made aware of concerns about the availability and choice of food for people living at Meadow House. We were satisfied that action required by Coventry City Council to improve this had been acted upon. We were told by staff and people who use the service that there had been big improvements. The four people we spoke with all said they had plenty to eat and liked the food. We had concerns that external agencies had to require systems be put in place to ensure the availability and choice of food for people.

We looked at management systems to see whether they supported people living at Meadow House in having safe and effective care. We had concerns about management arrangements. A member of staff had been promoted to the role of deputy manager. The deputy manager was undertaking both care and management duties. Details of the agreed delegation of management duties and the identification of time to complete them was not available at the time of our visit. The registered manager was not working in the home at the time of our visit.

We had concerns about the management of staff rotas and planning for staff sickness and annual leave. We also had concerns about the complaints policy and whistleblowing policy. They did not give clear information about the processes or time frame of responses people should expect.