Archived: The Meadows Care Home

Updated 2 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 August 2016 and was unannounced. A further visit was carried out on 24 August 2016 which was announced. The inspection team consisted of two adult social care inspectors, a specialist professional adviser with a nursing background and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Prior to the inspection we reviewed information we held about the home, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

Before the inspection we also contacted the local authority commissioners for the service, the local authority safeguarding team, the clinical commissioning group (CCG) and the local Healthwatch to gain their views of the service provided. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

During the inspection we spoke with 20 people living at the service and 10 relatives. We also spoke with the registered manager, the regional manager, the residents’ experience manager, two qualified nurses, one senior care worker, one personal activity leader (PAL), eight care staff, and two members of catering staff.

We reviewed 14 people's care records and records for eight staff. We also reviewed supervision and training information and records relating to the management of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 2 December 2016

This inspection took place on 22 August 2016 and was unannounced. This meant the provider and staff did not know we were coming. A second day of inspection took place on 24 August 2016 and was announced.

The Meadows Care Home is registered to provide nursing or personal care for up to 69 people, some of whom may live with dementia. At the time of our inspection there were 46 people living at the home, 19 of whom required nursing care.

A registered manager was in place 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.

At the last inspection of the home in March 2016, we asked the provider to take action to make improvements. This was because we found the provider had breached a number of regulations. We found the quality of the service had not been monitored effectively to ensure issues relating to people's care and welfare were identified and investigated in a timely manner. Staffing levels were not sufficient to safely meet the care needs of the people who used the service. Staff did not always have the time for meaningful one to one contact with people. There was a lack of continuity of qualified nursing staff. The registered provider was not following the requirements of the Mental Capacity Act (MCA) 2005 to support people to make decisions about their care. Some decisions had not been made in line with the MCA, such as for the administration of medicines covertly and the use of bedrails to keep people safe. People had been placed at increased risk due to staff not following the advice of health care professionals. Systems and processes to maintain complete and accurate care records were ineffective. Safe recruitment practices had not been followed. People were not supported to ensure their nutrition and hydration needs were met in a dignified manner. The meal time experience lacked co-ordination and was disorganised. People's food and fluid charts were not always completed or accurate.

During this inspection we found the provider had made improvements in some areas. The overall rating for this service is now ‘requires improvement’ so the service is no longer in special measures. We have made recommendations about the management of some medicines, dining arrangements, the specialist needs of people with dementia, activities and quality monitoring.

People said there was enough staff on duty, but relatives and some staff we spoke with felt more staff were needed. Since the last inspection the provider had recruited more nursing staff so there was now continuity of nursing staff.

Staff did not always have time to spend on a one to one basis with people. During this inspection we found this had not improved. We observed some occasions when staff spent some time on a one to one basis with people, but this happened infrequently as staff were mainly busy elsewhere.

Improvements had been made to the arrangements for people who required specialist diets. People with nutritional needs such as swallowing difficulties had a specific care plan about how they should be supported, which was shared with care and kitchen staff. People who required pureed foods were served these in a more attractive way than previously.

Improvements had been made to the safeguards that were in place for people who did not have capacity to make some significant decisions. People were encouraged to make their own day to day choices. The registered provider was following the requirements of the Mental Capacity Act 2005 (MCA).

People were supported to access health services when they needed these, but not everyone had a health action plan in case of emergency treatment.

People told us they felt safe at The Meadows. One person told us, “I feel as if I’m at home.” People spoke positively about the caring nature of staff. One person said they were “very happy” with the care they got and that “The girls couldn’t be nicer. They are very helpful and very kind.”

A relative told us, “We’re really happy with [family member’s] care. They’re very happy here. The staff treat [family member] like one of their own.”

Staff received training, supervisions and appraisals to support them in their job role.

Care records we viewed had been rewritten since the last inspection and showed people’s current individual needs. These were reviewed and updated regularly or when people’s needs changed.

People, relatives and staff had regular opportunities to provide feedback although it was not always clear what action had been taken as a result.

The provider’s quality monitoring processes had led to some improvements since the last inspection, but there were still areas for improvement.