Home Meadow

Home Meadow is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Home Meadow accommodates up to 49 older people in a single-storey building. At the time of our inspection, 46 people were living at Home Meadow. The service is divided into 2 main units with 1 which accommodates people living with dementia.

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

The provider’s systems had not always identified where improvements were required, for action to be taken, to keep people safe from the risk of infection.

We have made a recommendation to the provider to monitor their processes, moving forward, to ensure timely identification and action is taken, when required.

People were at risk of dehydration due to ineffective daily reviews. Furthermore, appropriate risk reducing measures were not contained within care plans for people who required support with diabetes. We found no person had come to harm from these concerns. The registered manager and provider was responsive during the inspection time frame and undertook appropriate reviews.

People told us they felt safe. Relatives told us they felt their family member was safe and well cared for by staff. Staff received training to meet people’s needs and had undertaken specific training to help identify and reduce risks associated with falls, severe infections, and health deterioration.

Medicines were administered as prescribed; staff had completed training, and their competency had been assessed. Safe reporting and review systems were in place to monitor incidents and accidents if they occurred. Lessons learnt were reviewed and shared with staff. The provider undertook safe recruitment processes and there were enough staff to meet people’s needs.

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.

A registered manager was in post, and people, their relatives, and staff felt able to approach them with any concerns and were confident they would be acknowledged and acted upon. The providers systems, overall, allowed for quality monitoring to take place at the service which drove continuous improvements.

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 rating for this service was good (published 27 September 2018)

Why we inspected

The inspection was prompted in part due to concerns received about infection control and safeguarding processes. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements in their monitoring of risks associated with infection control. Please see the safe section of this full report. The provider had taken action to mitigate the risk of harm from this concern, however, further monitoring is required to ensure systems are embedded and sustained.

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.

Recommendations

We have made 1 recommendation to the provider at this inspection. We recommend the provider continues to monitor and review their infection prevention control monitoring processes. Furthermore, when risks are identified, timely responsive action should be taken.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Home Meadow on our website at www.cqc.org.uk.

Follow up

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

We found the following examples of good practice.

End of life visits were organised with a family member accessing their relatives room using the nearest entrance /exit so they did not have to walk through the home. This reduced the risk of them encountering staff and other people living at the home.

Video and telephone calls to family and friends were available to promote people’s social well-being. Relatives meetings via video calling had been set up to discuss the home, COVID-19 restrictions and updates including vaccinations.

In line with government guidelines external health and social care visitors had a series of checks completed before admission into the home.

The registered manager told us that the building could be zoned into different areas should an outbreak occur, and this planning had been considered.

Staff changed into their uniform and put on and off their personal protective equipment (PPE) before starting work. Lockers were available for staff to place their belongings in.

The home visited looked clean. A housekeeping staff member told us how they and their colleagues cleaned frequently touched areas such as handrails, chairs, tabletops, handles and furniture. This cleaning was observed during the inspection.

Home Meadow accommodates up to 49 older people in a single-storey building. The service is divided into two main units with one which accommodates people living with dementia.

This unannounced comprehensive inspection took place on the 7 August 2018. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was not 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.

A manager was in post and had commenced the process of applying to become registered.

Staff were knowledgeable about the procedure to report any incidents of harm to ensure that people were protected from harm.

Potential risk to people had been assessed and measures put in place to minimise the risks. Care records were regularly reviewed and revised when people’s needs changed.

The environment was clean and a safe place for people to live. Equipment was serviced and maintained as required. Staff wore protective clothing such as gloves and aprons when needed to reduce the risk of cross infection.

People were helped to take their medicines by staff who were trained and assessed as competent to administer medicines.

People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on staff to ensure they were suitable to look after people who used the service.

Staff demonstrated a good understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who are unable to make their own decisions.

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 received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed and staff followed their advice.

Staff knew people they supported and provided a personalised service in a caring way. Care plans provided information to staff on how to meet people care needs. People were given opportunities to make choices about their daily lives. They were able to choose whether or not to participate in a range of activities within the service and received the support they needed to help them to do this.

Information was available with regards to how to access support from an external advocate should this be required.

Regular meetings were held for people and their relatives so that they could discuss any issues or make recommendations for improvement on how the service was run.

There was a process in place so that people’s concerns and complaints were listened to and were acted upon.

Quality monitoring systems were in place and action was taken where improvements were identified. There were clear management arrangements in place.

Further information is in the detailed findings below.

The inspection took place on 18 April 2016 and was unannounced and carried out by one inspector.

A registered manager was in post when we inspected the home and had been registered since 18 February 2016. 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.

People were safe living at the home as staff were knowledgeable about reporting any harm. There were a sufficient number of staff employed and recruitment procedures ensured that only suitable staff were employed. Arrangements were in place to ensure that people were protected with the safe management of their medicines.

The CQC is required by law to monitor MCA and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was acting in accordance with the requirements of the MCA so that people had their rights protected by the law. Assessments were in place to determine if people had the capacity to make decisions in relation to their care. When people were assessed to lack capacity, their care was provided in their best interests. Furthermore, some of the people were subject to authorised DoLS applications and the conditions of these in date, authorised DoLS were being followed.

Staff were supported and trained to do their job and demonstrated how their training was applied to their practice.

People were supported to access a range of health care professionals. Health risk assessments were in place to ensure that people were supported to maintain their health. People were provided with adequate amounts of food and drink to meet their individual likes and nutritional and hydration needs.

People’s privacy and dignity were respected and their care was provided in a caring and attentive way.

People’s hobbies and interests had been identified and a range of activities supported people with these. People’s care records and risk assessments were kept up-to-date. A complaints procedure was in place and this was followed by staff. People knew who they would speak with if they needed to raise a complaint. Complaints were responded to the satisfaction of the complainant.

The provider had quality assurance processes and procedures in place to improve the quality and safety of people’s support and care. Since our last unannounced comprehensive inspection of 15 April 2015 improvements had been made in relation to the management of staff; the management of people’s medicines; the standard of recreational activities and the maintenance of people’s care records.

The inspection was carried out by an adult social care inspector. The purpose of the inspection was to ask one of the five questions that we usually ask, is the service effective?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you wish to see the evidence supporting our summary, please read the full report.

As part of this inspection we examined 5 out of thirty-nine people's care records and other records in relation to consent. In addition, we spoke with three people, the registered manager, two members of care staff and observed staff at work.

People indicated that they were very happy with how they had been looked after. In addition, they confirmed that they had been actively consulted and had agreed to their support and care.

People's ability to give their informed consent about how they were to be looked after and treated, had now been formally assessed. Where people had been assessed not to have this mental capacity, there were clear, 'best interest' reasons made as to why they needed to be kept safe and well.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. DoLS applications had needed to be submitted. Relevant staff had an understanding when an application should be made, and how to submit one.

Effective improvements had been made since our last inspection of 26 June 2014. This meant that people's rights in relation to consent had now been fully protected.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and visiting relatives told us that they were confident that their family member was safe and well cared for. We observed that people appeared at ease in the presence of staff.

We looked to see whether there were the right levels of staff working at the service. There were sufficient staff to meet people's needs on the day of our visit. Staff were busy, but we saw that they were able to meet people's needs in a respectful and unrushed manner. We saw there were gaps in the rota in the following two weeks but that the manager had taken steps to address this in good time to ensure that staff numbers were sufficient.

The requirements of the Mental Capacity Act 2005 had not been followed. We found that the service did not have suitable arrangements in place to gain people's consent, assess their mental capacity or to ensure that decisions made on their behalf were made in their best interests.

The provider had effective systems in place to assess and monitor risks to people's health, safety and welfare.

Is the service effective?

People told us that they were happy living in the service. One person said, 'I am very contented.' Care records showed people's health and care needs had been assessed and that care was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

We saw that people were offered good quality, nutritious food which met their dietary needs. Kitchen staff and care staff were knowledgeable about the needs of people with specific dietary requirements. People's nutrition and hydration needs were assessed and systems were in place to ensure that the delivery of effective care in relation to this was monitored.

Is the service caring?

People and visitors we spoke with were positive about staff. We saw staff were attentive to people's needs throughout our inspection. Staff interacted kindly with people and gave people time to respond. We found staff showed patience when communicating with people who lived at Home Meadow. We observed the lunchtime meal and saw that staff provided appropriate levels of support where necessary to help people to eat and drink in a calm, patient and dignified manner that promoted their independence.

Is the service responsive?

We saw people were able to access support from other health and social care professionals when necessary. For example, where people were at risk of dehydration or malnutrition, they were referred appropriately for specialist support from a dietician or a speech and language therapist. We saw the recommendations were then followed, and regular checks of people's weights, nutrition, fluid intake, skin integrity and general wellbeing were carried out.

Is the service well led?

Effective systems had been put in place to assess and monitor the quality of services provided and to identify, assess and manage risks posed to the health, welfare and safety of people who used the service. There was evidence that the delivery of appropriate care was robustly monitored.

A proactive approach to seeking people's views about the service was in place and there were clear plans to ensure feedback was acted upon once the process was completed. We saw that complaints were dealt with appropriately and that the manager used comments from people to improve the quality of care that people received.

You can see our judgements on the front page of this report.

During this inspection on 4 June 2013, we noted that staffing levels had been reviewed and people's needs were being met in a timely way.

Care records provided information on how care and support needs were met by staff. We noted that daily records need to ensure they provide full details of the person's day., ensuring a clear picture can be provided on how their need are met.

Staff understood how to protect people from abuse and what to do if they suspected abuse had occurred. Complaints information was available in the hallway for people using the service and for people acting on their behalf. This made them aware of the process to follow in the event of them having any complaints about how the service was provided.

On entering the home and during our inspection, we noted that there was a strong odour, which did not promote people's dignity. The regional and quality managers told us that this was being addressed. They had recently employed a senior housekeeper who was putting new cleaning regimes in place.

The skill mix of staff was not appropriate to meet peoples need in a timely manner.