Meadow Lodge Residential Care Home

The registered manager had established effective infection prevention and control procedures which were understood and followed by the staff. The registered manager had introduced a screening process for visitors when entering the building, which included temperature checks as well as the provision of personal protective equipment (PPE). The registered manager had implemented new arrangements to enable people to see one designated family member in line with recent Government guidance.

Admission to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result and supported to self-isolate for up to 14 days following admission to reduce the risk of introducing infection. The registered manager explained people’s health and well-being was carefully monitored during this time. A regular programme of testing for COVID-19 was in place for staff and people living in the home. This meant swift action could be taken if any positive results were received.

There were plentiful supplies of PPE and stocks were carefully monitored. PPE was disposed of safely in clinical waste bins which helped reduce the risk of cross contamination. Staff had been trained in infection control practices and posters were displayed in the home to reinforce procedures. We observed staff were using PPE appropriately. There were sufficient staff to provide continuity of support should there be a staff shortage.

The layout of the service and the communal areas were suitable to support social distancing. The premises had high level of cleanliness and was hygienic throughout. The housekeeper and care staff were following an enhanced cleaning schedule and there was good ventilation. The atmosphere of the home was cheerful and calm. We noted several areas had been refurbished since our last visit, including the kitchen and a wet room. In addition, flooring had been replaced in bedrooms on the first floor and new chairs had been purchased for the lounge areas.

People told us they were happy living in the home and the staff were caring. One person told us, “It really is lovely here the staff are wonderful” and another person said, “All the staff are so happy and cheerful, and everyone is very helpful. I can’t fault it in any way.” We observed staff were attentive to people’s needs throughout the inspection. The registered manager explained significant emphasis had been placed on maintaining people’s morale and well-being during the course of the pandemic.

The provider’s infection prevention and control policies and procedures were up to date and audits had been carried out on a regular basis. The provider also had a business contingency plan and had developed guidance and risk assessments in relation to the current pandemic.

People’s experience of using this service: One person using the service told us, “It’s like home from home.” A relative said, “They are like a little extension of our family.”

We found there were management and leadership arrangements in place to support the effective day to day running of the service.

People told us they felt safe at the service. Processes were in place to make sure all appropriate checks were carried out before staff started working at the service.

Arrangements were in place to promote the safety of the premises, this included maintenance, servicing and checking systems. We found some areas were in need of attention and the provider was taking action to make improvements.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff had received training on safeguarding and protection matters.

There were some good processes in place to manage and store people's medicines safely. We found some good practice improvements were ongoing.

There were enough staff available to provide care and support; we were told staffing arrangements were kept under review.

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People's needs were being assessed, planned for and reviewed. Each person had a care plan. However, we found some shortfalls with person centred care planning, therefore we made a recommendation for improvements.

People were supported with their healthcare needs. Changes in people's health and well-being were monitored and responded to. Where necessary, people received appropriate medical attention.

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 at the service supported this practice.

People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.

Visiting arrangements were flexible, relatives and friends were made welcome at the service.

There were opportunities for people to engage in a range of group and individual activities.

People said they were satisfied with the variety and quality of the meals provided at the service. People’s individual needs and preferences were catered for. During our visit, action was taken to offer further choices. Arrangements to monitor an enhance people’s mealtime experience were ongoing.

People spoken with had an awareness of the service's complaints procedure and processes. They indicated they would be confident in raising concerns. Some progresses was needed in ensuring proper records would be kept of formal complaints.

There was a suitable standard of décor and furnishings to provide for people's comfort and wellbeing.

Arrangements were in place to encourage people to express their views and be consulted about Meadow Lodge, they had opportunities to give feedback on their experience of the service. There were plans in place to make improvements.

A variety of audits on quality, systems and processes were completed regularly. We were assured by the provider these would be further developed.

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

Rating at last inspection: At our last inspection the service was rated good overall. Our last report was published on 16 July 2016.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will plan a follow up inspection as per our inspection programme. We will continue to monitor the service and if we receive any concerning information we may bring the inspection forward.

Meadow Lodge is registered to provide accommodation and personal care for up to 14 older people. The home is a large semi-detached property located on the outskirts of Padiham. There is one shared and twelve single bedrooms; two have en-suite facilities. The home has two lounges, one with a dining area and a separate conservatory. Stair lifts provide access to the first floor accommodation. There is small car park to the front of the home and a garden area to the rear.

The service was managed by a registered manager. 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.

At the last inspection on 10 September 2014, we found the service was meeting the regulations which were applicable at the time. During this inspection we found the service was meeting the current regulations. However, we made a recommendation about the implementation of the Mental Capacity Act 2005 (MCA). Whilst there were policies and procedures relating to the MCA and staff had received appropriate training, the principles of the Act had not been embedded into the assessment and care planning processes.

People living in the home said they felt safe and staff treated them well. Care delivery was supported by clear up to date care documentation which was personalised and regularly reviewed. Staff felt the training provided was effective and ensured they were able to provide the best care for people. Care plans and risk assessments had been completed to ensure people received appropriate care. These had been written using information sought from the person or their relatives if appropriate. This meant information was person centred and reflected people's personal choices and preferences.

Medicine documentation and relevant policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing and on-going checks were carried out to ensure high standards were maintained.

Staff received training which equipped them for their roles and supported them in providing safe care for people. Robust recruitment checks were completed before staff began work. Staff demonstrated a clear understanding on how to recognise and report abuse and treated people with respect and dignity.

People were encouraged to remain as independent as possible and were supported to participate in daily activities. People were given choices and involved in day to day decisions about how they spent their time. People were asked for their consent before care was provided and had their privacy and dignity respected. People's nutritional needs were monitored and reviewed. People were given a choice of meals and staff knew people's likes and dislikes. Healthcare referrals were made appropriately to outside agencies when required.

The registered manager took into account the views of people and their relatives about the quality of care provided through daily conversations, meetings and satisfaction surveys. The registered manager used the feedback to make improvements to the service. The owners worked closely with the registered manager and took an active interest in all aspects of the operation of the home.

We carried out this inspection to monitor the service's progress in complying with the regulations. At this inspection we found sufficient improvements had been made with record keeping at Meadow Lodge.

During the inspection we spoke with three people who used the service, two members of staff, the manager and the owners. We considered all the evidence we had gathered under the outcomes we inspected. We have used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

At this inspection we found sufficient improvements had been made with record keeping at Meadow Lodge.

We found attention had been given to ensuring the proper checks and appropriate records were kept to protect people who used the service from unsuitable staff.

We reviewed some of the records designed to support the effective management of the service. We found several auditing systems had been introduced to monitor the wellbeing and safety of people who used the service.

Progress had been made with medication records to promote safe and accountable medicines management. However, some improvements were needed to provide clear directions for PRN (when required) and variable dose medicines. The manager was asked to take action in response to this matter.

Is the service effective?

We spoke with three people who used the service. They indicated they were satisfied with the care and support they experienced at Meadow Lodge. One person told us, 'Everything is fine, it's lovely here'.

People spoken with indicated an awareness of their care records. However they had not been supported to sign an agreement with them. This meant there was no record to confirm their involvement, or consent to the care to be delivered.

Is the service caring?

Progress had been made with care plan records. We found they were personalised and addressed the individual care needs of people who used the service. However, we found the care planning process was lacking in screening people's capacity to make their own choices and decisions.

Is the service responsive?

Records and discussion showed people's health and wellbeing was monitored and they were getting attention as appropriate from health care professionals. We noted risk assessments in relation to skin integrity had not been transferred into the new care plans; however the manager was to take action in respect of this matter.

Is the service well-led?

There was a registered manager in post who had responsibility for day to day management of the service. The owners were also regularly involved with some aspects of management.

Systems were in place to assess and monitor how the home was operating and make any necessary improvements.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found some of the records were not properly kept, accurate or up to date. This meant people may be at risk of unsafe or inappropriate care and treatment. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People spoken with during the inspection did not express any concerns about the support they received with their medicines. One person said, 'I get my tablets at the right time'. There were some appropriate arrangements in place to manage people's medicines safely. However, we found better records and guidelines were needed to promote safer practices.

People told us they were involved informally with the selection of new staff, they said, 'They always introduce them to us' and 'They ask us what we think of them'. We found some of the required clearance checks had been carried out. However we found there were some shortfalls in the recruitment practices and the records kept.

Is the service effective?

People told us they were happy with the care and support they experienced at Meadow Lodge. They said: 'It's grand, I like everything about it' and 'The care is fine, they are there when I need them'. People were involved in discussions about care and regular reviews had been carried out. One person explained, 'They review things with us'.

Processes were in place for care workers to attain nationally recognised qualifications in health and social care. Staff spoken with, told us of the training they had received. They were aware of people's needs and gave examples of how they delivered support.

People spoken with said they were satisfied with the quality and variety of the meals and drinks provided at the home. They said, 'The food is alright', 'They tell us what it is, and ask if we would like something else, it's easy to say what we want', 'The food is good quality' and 'Drinks are brought at certain times, but we can have them whenever we want'. We observed staff supporting people during lunch time in a friendly manner, they encouraged people to eat and drink using a considerate approach.

Is the service caring?

We observed staff treating people in a kind, friendly and respectful way. People told us they were happy with the staff team they said, 'We are well looked after here', 'The staff are nice, wonderful', 'The staff are kind, never disrespectful' and 'The staff are marvellous'. However we found some care records were lacking in content and detail, which did not effectively support a person centred approach.

Is the service responsive?

We found arrangements were in place to assess people's needs and abilities prior to admission. This meant individual needs and choices would be considered and planned for before they moved into the home.

Records and discussion showed people were getting attention as appropriate, from healthcare professionals. One person told us, 'They are very good at contacting the Doctor'. Staff confirmed people had access to a range of healthcare resources.

Arrangements were in place to offer a range of individual and group activities. People spoken with were mostly satisfied with various activities, events and visiting entertainers.

Is the service well-led?

The service had a registered manager responsible for the day to day management of the home. The owners were also regularly involved with some aspects of management.

We found people were involved with decisions which affected them informally on a daily basis. One person said, 'They always ask if there are any problems, they are good that way'. People using the service and their relatives had previously completed satisfaction surveys. We were given examples of the manager and owners making changes and improvements, following discussions and requests from people using the service.

There were some systems in place to assess and monitor how the home was managed and to monitor the quality of the service. However, records seen by us showed not all of the shortfalls had been clearly identified. This meant the systems were not as effective as they needed to be.

We found people experienced some good care and support. They told us they were treated with respect. People were getting support with their healthcare needs and they had ongoing attention from health care professionals. However, we found some progress was needed with care assessments and care planning to make sure people received effective care and support.

People were being involved as far as possible in planning their care and were enabled to make decisions about matters which affected them. People were encouraged to maintain and develop their independence skills.

People told us they liked the staff. We found there were sufficient staff available to provide care and support, but this needed to be monitored and reviewed on an ongoing basis.

People said they were satisfied with the clean and comfortable accommodation at Meadow Lodge. However, we found some matters were in need of further attention.

People had no complaints about the services being provided at Meadow Lodge. They knew how to raise concerns and were confident they would be dealt with.