Meadow Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe systems were in place to escalate any concerns to external health professionals, we observed positive partnership working whilst on site. Staff and leaders took appropriate actions to ensure people were safe, to mitigate any risk, ensuring people were not left at risk of harm. Leaders ensured people were supported in line with their individual care plans. We observed that all areas of the service were clean and well maintained, and where work was underway for areas being refurbished, these were separated off to limit any impact or noise. There were enough staff deployed during our visit and staff had received suitable training in order to support people safely. Staff managed medicine administration in line with safe systems for appropriate handling and storage of medicines.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We saw that notifications were being made to the Local Authority and to the Care Quality Commission appropriately. This meant that any changes required for people’s care could be actioned appropriately and swiftly. The service itself does not provide any nursing care, the local District Nurse team attend to provide nursing support when needed by individuals.

Staff told us they were able to manage and monitor care safely, although the electronic recording system was quite new and still being developed across all areas. Some events were still recorded on paper forms, which were reviewed by the registered manager to check for immediate action which may be needed. This demonstrated that the service was able to retain full oversight whilst new systems were embedded.

People we spoke with said they felt their overall care was managed and monitored safely. Nobody expressed any concerns to us, and all felt the regular staff provided a good standard of care, raising and sharing concerns as required. One person said, "I’ve been very satisfied here, they seem to take great care of us".

The service had effective systems in place for managing and monitoring safe systems of care. They recorded incidents and accidents as required and also produced a monthly summary chart, which was reviewed for any themes or trends and to ensure lessons were learned if appropriate. The service has effective links with external health care professionals which demonstrates how the service is working collaboratively with other agencies. They could also generate handover sheets from the electronic system should people need to move between services, ensuring that if people moved on, they had the continuity of care.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were supported to be involved in managing any areas of risk identified. People told us staff knew them well. Several people said they had been involved in their assessments and confirmed staff met their needs in a way they wished. Five relatives expressed they felt involved in how risks were managed for their relative and one told us, "I’m confident that the staff would act quickly should there be any problem". However, three other relatives, said they had not been involved in assessment processes.

Staff we spoke with told us they used a person centered approach when assessing risks. Staff were able to access people’s records and told us they understood the individual guidance in relation to people's specific needs. Two staff told us they were still getting used to the new electronic recording system but said they had received the time and training required to support them. The registered manager told us they had taken a methodical approach to introducing the new electronic care records and that staff were now using the handsets routinely.

Care plans were detailed and identified people's care and support needs, including any areas of risk. We reviewed 4 people’s care plans and relevant risk assessments. We saw evidence and people told us; they were involved in their care reviews (where they had the capacity to be involved). The digital system meant that the information was collated and highlighted where any change was occurring, or staff could schedule a date to reassess or review specific areas. We saw people had specific individual risk assessments in place. For example, to reduce the risk of choking. These detailed what measures and actions were in place and where assessments identified further support was needed, i.e. from relevant healthcare professionals, we saw advice had been sought.

During our visit, we saw people were supported in line with their documented support needs. We saw there was evidence of the involvement of the person and/or their relatives in the documents. We noted how the reintroduction of named workers, was helping to develop a closer relationship between people and staff, so they felt more able to discuss things that were important to them. We saw staff followed the recommended guidance within people's individual plans to keep people safe.

We saw the environment was clean, hygienic, and well maintained. This supports their assurance that processes were in place to detect any safety concerns or risks, in the environment. The service was in good condition overall and it was clear the provider had invested in keeping the decoration and other equipment in good repair. We did see a lot of people in the dining room during the lunchtime and this did affect the delivery of hot food. The staff were made aware of this and advised this would be addressed to ensure a better experience was had. It was explained that the areas for additional dining, had refurbishment work underway; these were separated off to limit any impact or noise. However, once completed this would ease the pressure on the current dining situation.

People were complimentary about their environment and the layout of the home. Two people felt the call bells were responded to quickly, whilst others said it could take a while, especially in the morning or at mealtimes. One person said, “I rarely need to call them, but when I do they come quickly.” We did receive some mixed views from people about the quality of the food, and on occasion, the temperature it was served. Overall, relatives told us the service was well-maintained, well-kept and clean.

Staff told us they were generally happy with the overall environment and the measures in place for supporting and delivering safe care. Staff explained they had recently made some changes with the menu's and their food providers and they were receiving more positive feedback from people about this. We were told how risk assessment reviews had recently been required for people choosing external events; in order to ensure people’s safety should they wish to attend community events. The registered manager stated they have regular quality monitoring audits, which are completed and reviewed at regular intervals. The findings from those were then fed into their overall improvement action plan, to support the delivery of safe care.

The provider had well organised arrangements in place to check the safety of the service. Checks were carried out regularly and there was evidence of building/ equipment defects being found and appropriate action taken, to remedy them in a timely manner.

We received a varied response from people regarding staffing. One person said that, "The regular staff are well trained but they do seem to be very busy" another said, "Sometimes, there are enough staff, other times a lot of agency staff” and "“The regular staff are good but some of the agency staff could do with more training”. One relative who said they visited regularly told us,” There are enough staff, they are very responsive and always available, with no difference seen whether we visit at weekends or evening".

Staff told us that overall, there were enough staff to meet people’s needs and that they worked well together as a team. The registered manager advised staffing levels met the needs of people using the service, and they kept this under regular review. Staff said there had been a lot of training in the last few months, but they have had time to do this. They told us how specific training sessions had recently been advertised. The registered manager also told us how leaders within the staff teams were being supported, to further develop their skills and management experience and that recruitment was ongoing, to further develop the staff team.

During the on-site visit, we saw there appeared to be adequate staffing available to support individuals as required. Staff appeared busy; however, care did not appear to be rushed. Some residents told us staff sometimes took a while to respond to their call bells, but they did not give the impression that the delays were for very long. The manager told us they did their own call bell tests to see how long it took staff to respond. We saw there were some shifts during the week where additional support had been provided by agency workers.

The service had tools in place to ensure adequate staffing levels were maintained. We reviewed two weeks’ worth of staffing rotas. These showed staff numbers were adequate to meet the needs of people using the service. We reviewed the recruitment files for three care staff. The provider had completed the necessary checks to ensure staff were safe and suitable to work at the service. Processes were followed to ensure staff completed an induction and training relevant to their specific roles. The registered manager maintained oversight of what training staff had completed, to ensure they had the knowledge base to meet people's needs.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff promoted independence for people to manage their own medicines safely, where appropriate. We saw regular checks were in place to ensure that these people were not having difficulties. Staff had told us that some risk assessments were not always in place for residents who had creams stored in their rooms. However, at the time of inspection, no risks were identified. Warning labels for medicines with specific administration instructions were not always included on the MAR. It appeared that if a medicine had a lot of instructions, it would not fit within the allocated box on the MAR and would get ‘cut off’. We spoke with the deputy who advised they would address these issues immediately.

Systems were in place to ensure medicines were given as prescribed and recorded accurately, including controlled drugs. Accurate records were in place, detailing the application of medicated patches. Regular ‘patch checks’ were also completed by staff. The medicines policy in place, was relevant and up to date. Staff had received appropriate training and undergone competency assessments. Regular audits were undertaken and effective medicines ordering systems were in place. Medicines incidents were recorded, analysed and learnt from.

People told us they received their medicines safely. We saw people who had thickening powder added to their drinks because of swallowing difficulties; were administered this safely, and that records were completed accurately. One family member told us that their relative received all of their medicines when they needed them, had weekly access to their GP and they felt that staff really understood their healthcare needs. We saw the medicines rounds were organised, and the medicine administration record (MAR) was completed in a timely manner. This meant that people got their medicines when they needed them.