Meadow Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The provider had recently introduced a new digital care planning system. This would ensure people’s care plans and risk assessments could be developed with the inclusion of people, their relatives, and staff. This was still being completed for some people with further information being added once collated. One relative told us they were, "aware that there is a care plan in place, but feels sometimes they have to initiate conversations about it, so feels the involvement is not consistent.". People received their care in line with current standards to achieve effective outcomes. Clinical reviews were being held on a regular basis. We were told how staffing levels were reviewed when changes were identified in the levels of support people required. People’s rights for seeking consent and respecting their choices were upheld.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt staff anticipated and knew their needs well. Several people said they had been very involved in their care planning. However, other people had advised not, with one person saying, “I don’t remember anyone asking me what I need; but then I get what I need anyway, so that’s ok”. Some relatives told us they too had been involved in developing a plan of care. However, others said they had not been involved at all, or said they felt satisfied that some staff were more aware of their relative’s needs, than others.

We reviewed four people's care plans and could see that people's needs were assessed using a variety of assessment tools. We saw there was evidence of the involvement of the person and/or their relatives in the plans we viewed. We found overall, a well organised system of care plans and care records. The electronic system had recently been introduced and still required some elements to be more personalised. However, the information in the care plans was sufficient and comprehensive enough to guide care staff in how to support the person to meet their care needs. The registered manager also explained how they still used paper-based incident forms but intended to move to electronic incident reports in the near future. They advised they were wanting to be cautious and not overwhelm the care staff with too many changes all at once.

Staff told us they were happy with the new electronic system as this meant they were informed of the up-to-date plan of care and any specific advice or guidance from relevant professionals. The registered manager was confident that staff knew people well and the electronic system meant any changes in people's needs were quickly identified. The registered manager also told us they had commenced a rollout of care plan reviews on the new system, which included inviting relatives to be involved further. We saw evidence that this was already underway and that more detailed information was being added to the electronic system.

People told us that they received appropriate care. People told us they were encouraged to continue with activities they had enjoyed previously and were important to them. We saw there was a varied activity and entertainment program available. We also saw where people had prescribed thickening powder added to their drinks, because of swallowing difficulties; these were administered this safely, and the records relating to this were completed accurately and were significantly detailed enough for staff to follow.

The provider was adhering to the latest guidance and subscribed to a compliance system to help them stay abreast of any changes with regard to the latest legislation and guidance. We saw records and specific instructions during our site visit, which supported staff to continue to provide care in line with best practice. For example, best practice guidance and the use of thickeners to allow people to safely consume liquids. We could see where the new system had supported any changes in care or treatment to be more readily accessible.

Staff told us they had regular training to ensure they were up to date with best practice. One staff member had explained how they enjoyed supporting more junior staff members with their skills and knowledge, in order they could support people more effectively. The registered manager had shared the recent training matrix with us, demonstrating how they had oversight of staff keeping up to date and how they had regular meetings to keep them abreast of any changes for care provision. They also advised of the introduction of staff as ‘champions’ for staff who demonstrated an interest in specific areas. This meant that current ‘best practice’ in specific areas such as ‘Dementia Care or Nutrition’ could be identified and shared with the wider teams.

We reviewed some of the written feedback from staff just prior to the registered manager taking up the post and when compared with what staff were telling us now; things appeared much more positive. Staff told us, they felt they were now all working well together as a team and that they could escalate any concerns to management. Some staff said, they were still needing more staff to join the team in order to provide fully joined up care but felt that the support from agency staff had been valuable, especially when they had been regular staff who got to know people.

Relevant training was provided and required competencies checked, to ensure that learning was embedded, for staff at all levels to be able to provide safe care for people. Clear lines of delegation were seen with staff escalating concerns through to more senior staff, who were then able to share information to partner agencies such as health or social care professionals. Systems were in place to ensure any changes in guidance was distributed down through the staff team.

During the site visit we spoke with visiting healthcare professionals, who were impressed with standard of care given and the knowledge of the residents by staff. We also had positive feedback from the local authority, who had also been kept updated with changes happening at the service.

People told us their needs were met and any issues raised had been shared with the appropriate services. One relative told us, generally staff understood all healthcare needs, but felt that the newer/younger members of staff coped less well than the more experienced staff. However, they suggested it was probably down to life experience, as overall staff knew what they were doing and would always escalate when needed. Another relative advised, either they or the other family members, were kept informed of any updates, including conversations with the GP. We did speak with some relatives, who said they did not know of the new manager. We saw there had been recent meetings to introduce the manager, and there was information in the reception area to advise of who and how to contact.

Staff told us how they supported people to live healthier lives. One staff explained about the recent improvements in the kitchen and the different choices made available for people. They also shared how the activities had improved and were encouraging people to be more active where they were able. They explained that as the weather improves a schedule of outdoor activities would be identified with people being able to choose their activities. Where people were unable to join in group activities, they explained how individual support could always made available.

The provider had a process in place to regularly review the individual health and wellbeing support needs for people. We saw this was a 'working document' which they referred to regularly and updated. We saw there was a scheduled weekly provision for a GP round where people could raise any concerns or have their health needs monitored. This demonstrated the registered manager and the service as a whole, had good oversight of people's ongoing healthcare needs.

People told us they were encouraged to manage their health and wellbeing where able. Staff assessed people so they were able to continue to manage their own medication safely. People also shared the activities they attended which helped with exercise and movement. One relative advised they have been closely involved in building relationships and would trust the staff to encourage their relative to do the right thing, whilst continuing to support both their and the relatives wishes. We saw where referrals had been made to external healthcare agencies, and where advice or guidance was given, relatives confirmed that they have been informed of the outcomes.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us they were able to make decisions and choices about what they wanted to do on a daily basis. People who lacked capacity, had mental capacity assessments undertaken. People were encouraged to make their own decisions and were helped to do so, where this was needed. People were supported by their family in some cases to advocate for them. Relatives told us they felt their family members’ rights and choices were respected.

Mental capacity assessments were in place when required and the provider was working in line with the MCA. Where people lacked capacity to make specific decisions about their care and support, we saw records demonstrating how staff followed the principles of the MCA. For example, in specific circumstances, best interest decisions had been held with the relevant people, (including relatives) to make sure the decision was the least restrictive option. Details were also noted in people's care plans, if there was a lasting power of attorney arrangement in place.

Staff told us they were aware of the Mental Capacity Act 2005 (MCA) and ensured people's consent to care was sought. For example, staff told us how people were given the time and space to acknowledge, or reply to staff, before any intervention or support began.