The Meadowcroft Care Home

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

This was the first inspection of the newly registered service, where we assessed all 8 quality statements related to this key question. The rating for this key question is "Requires Improvement," meaning some aspects of the service were not always safe, posing an increased risk of harm. We found that risks to people were not always effectively mitigated and that medicines were not managed safely. This was a breach of regulation with respect of safe care. Staff described being well supported with training and being able to approach the registered manager at any time. Staff supervision and appraisal had not been taking place in line with the provider's policy. However the manager was aware of this issue and had an action plan in place to make improvements in this area. The provider demonstrated a positive culture of learning from mistakes. Care plans were informed by pre-assessments from both the provider and external professionals. People were kept safe from avoidable harm, and staff were trained in safeguarding and risk management. Staff followed best practices in infection prevention, including COVID-19 guidelines, and their suitability for adult social care was thoroughly assessed. Further details are available in the evidence category findings below.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us the culture in the care home was beginning to change for the better under the leadership of the new manager. A relative said, “I can see that the new manager is putting more structure and processes in place to improve the service.” Another relative added, “The culture in the care home is changing for the better with the new manager.”

Managers and staff told us any incidents, accidents, safeguarding concerns or complaints involving the people they supported were always logged and analysed to learn lessons and improve. For example, incidents were routinely reviewed to determine potential causes and to identify any actions they needed to take to reduce the likelihood of similar incidents reoccurring. Staff confirmed information about any lessons learnt were always shared with them during meetings with their line managers and fellow co-workers. The managers encouraged an open and transparent culture where people receiving a service, their representatives and staff could all raise concerns without fear. We reviewed the provider's incident and accident logs and noticed that 3 months worth of incident and accidents had not been reviewed. We brought this to the attention of the manager to clarify. They were not aware of these incidents but assured us they were going to review them.

The provider learnt lessons when things went wrong. Information about incidents, including lessons learnt, were shared and discussed with staff during regular meetings. However, we discovered that some accidents and incidents had not been reviewed for a period of about 3 months. This was between June to August. This meant that the provider was not always consistent in their incident and accident review process which could pose a risk to people's safety.

People told us they were invited to participate in an assessment process prior to moving into the care home. People told us they received the personal care and support that was planned in accordance with their initial needs assessment.

Managers and staff told us that they carried out pre-admission assessments and received information about people’s support needs when they received referrals for new placements. This meant they were able to identify if they could support people in the best way. The manager confirmed these initial assessments were used to help staff develop person-centred care plans for everyone they supported.

External health and social care professionals told us the provider always collaborated with them to establish and maintain safe systems of care.

People’s care plans were based on assessments conducted by the provider and various external health and social care professionals. These care plans included detailed information for staff about how to support people with their personal, social and health care needs. We saw care plans had been developed for everyone currently living at the home. People using the service had transferred into the home from the previous provider and many of the staff who had worked there had also transferred. This meant people continued to receive continuity of care from the same group of staff who were familiar with their needs, wishes and daily routines.

People told us they felt safe living at the care home. One person said, “I do feel safe living here.” A relative added, “My [family member] feels safe and at ease with the staff who work at the home.”

Staff were aware of safeguarding reporting procedures. They knew how to recognise and report abuse and were able to articulate how they would spot signs if people were at risk of abuse or harm. Staff received safeguarding adults training as part of their induction which staff confirmed was routinely refreshed. One member of staff told us, “I would let the person in-charge know straight away if I ever witnessed anyone who lived here being abused.” Another added, “I would liaise with the home manager if I saw anyone being abused here and I know they have a responsibility to inform the local authority’s safeguarding team and the CQC about any such incidents.” The managers understood their legal responsibility to immediately refer any safeguarding incidents or concerns to external agencies and bodies including, the relevant local authority, the CQC, and where necessary, the police.

We observed that staff knew exactly what to do to protect people from harm and abuse.

Robust systems and processes were in place to protect people from the risk of abuse. The provider had clear safeguarding policies and procedures in place which were up to date, in line with relevant legislation and were accessible to all. Managers worked well with external agencies, such as local authorities, the police and the CQC, and acted in a timely way to ensure people were safeguarded and protected from further risk.

People shared mixed feedback about the staff. Some were positive, stating that staff knew how to manage risks and keep people safe. One relative commented, “Staff have learned how to cope with my [family member's] challenging behaviours and manage the associated risks. They have the right levels of knowledge and skills to do this well.” Another relative added, “I regularly visit my [family member] and see that staff practices are safe, especially during transfers, which are always done safely by two staff members. Staff are attentive and manage the risk of falls extremely well.” External healthcare professionals also noted that staff were skilled in supporting and managing the risks their clients might face. One stated, “Staff keep their knowledge and skills up to date and relevant in preventing and managing risks for our clients.” However, some relatives expressed concerns that their family members were not being fully supported to maintain their independence. One relative mentioned, "My family member has been assessed and placed in a wheelchair to prevent falls, even though they can still walk independently." The provider assured us they were working with external health providers to ensure people's independence was maintained and regularly reviewed.

Staff were aware of the potential hazards people might face and how to prevent or manage those risks. One member of staff told us, “Residents that are bed bound will be at risk of pressure sores, so we have pressure relieving mattresses in place and staff ensure these people at risk are turned at regular intervals. Staff said they were confident using the equipment in the care home, such as mobile hoists. One member of staff told us, “I’ve had training on all the mobile hoists we have here and we make sure staff never use this equipment on their own.”

We observed several instances of two staff supporting people to stand and transfer safely to a wheelchair.

We found that the care planning in relation to assessed risk and associated records needed to improve. The risk assessment for one person who had been identified as being at high risk of pressure sores stated that their skin was to be monitored daily. Staff told us that they would evidence this through the daily care notes they were completing. When we reviewed the care notes, the condition of the person’s skin was not explicitly stated. Their skins observation chart had not been completed either. We also reviewed fluid chart records for people that were on ‘fluid watch.’ We reviewed records for the date range, 24 June 2024 to 24 July 2024. The target daily fluid intake was 1500ml, we found none of the 6 people on fluid watch were achieving this, the lowest being, on average, 625ml and the highest 955ml. Although we found that no apparent harm had come to the people, we could not be assured that the provider had effective systems to maintain accurate, complete and detailed records in respect of people using the service and the overall management of the regulated activity. Despite the above concerns, there was some areas of good practice. There were a number of meetings that took place to oversee risk within the service. Nurses’ meetings also took place every month and there were daily stand-up meetings. Clinical governance meetings with GP had started in July and were scheduled to take place every month. We reviewed the minutes from July and topics of discussion included falls, infection control, ambulance call outs, weekend out of hours support and residents on end of life care.

People told us the care home's physical environment was safe and always kept clean. A relative remarked, “The environment of the care home is kept beautifully clean.” Another relative added, “It is a purpose built care home and the layout is good, with lots of private and communal space for people to enjoy.”

Managers and staff told us people lived in a suitably adapted and safe environment.

We saw the premises were kept free of obstacles and hazards which enabled people to move safely around the home. Cleaning staff were a visible presence in the care home, maintaining the environment to a good standard of hygiene.

There were effective arrangements to monitor the safety and upkeep of the premises. Regular checks were completed to help ensure the safety of the home’s physical environment and their fire safety equipment. There was clear guidance available to staff to follow to help them deal with emergencies. For example, in relation to fire safety, we saw personal emergency evacuation plans were in place to help staff evacuate people in an emergency. General risk assessments were regularly reviewed and updated including reference to equipment used to support people, such as mobile hoists. This equipment was regularly serviced and maintained. Maintenance records demonstrated that the environment was maintained to a good standard. These included fire alarm call points, emergency lighting, fire extinguisher checks. Current certificates for gas safety and electrical appliances were seen. Lifts and baths servicing took place regularly and visual checks were completed for bed rails, window restrictors and other equipment.

We received mixed comments from people about staffing levels in the care home, although most of the feedback was generally positive. Typical comments included, “Staff do seem to be in a rush all the time and there isn’t always enough staff available”, “I have always seen good staffing levels whenever I do my rounds at the care home, even if I come at odds times of the day when attending to an emergency” and “The new manager has ensured continuity of staffing within the units which has helped staff become more familiar with people’s needs. They [staff] respond quickly and go wherever they are needed and there is enough staff on duty whenever I visit.” People told us staff who worked at the care home were well-trained. A relative told us, “Staff are well-trained and know what they’re doing.” An external health care professional added, “All the clinical staff are experienced nurses and keep up to date with their training.”

The managers acknowledged that contrary to the providers staff supervision and appraisal policies, they had failed to ensure staff attended quarterly supervision and annual work performance appraisal meetings with their line managers. They told us they had developed an action plan and made it a priority for all staff to have their overall work performance appraised within the next 3 months and for all staff to receive regular supervision meetings with their line managers from now on. We also received mixed feedback from staff in relation to staffing levels in the care home, although most said there were usually enough staff on duty to meet people’s needs and kept them safe. Typical comments included, “There’s not always adequate numbers of staff on duty to meet people’s needs, which often means we’re a little rushed”, “There is always enough staff” and “The managers use a dependency tool to work out how many staff we need, which does work. We are adequately staffed at the moment.” Staff received relevant training to support them in their roles. Staff told us they worked well as a team and were adequately trained. A member of staff said, “Greensleeves training is very good.” Another member of staff said, “My induction and all the ongoing training I receive is always relevant and helps me be the best carer I can.”

There were enough suitably skilled and experienced staff to support people. We observed staff were visibly present throughout our two day onsite assessment. For example, we saw people did not have to wait long for support from staff when they requested it. Staff were vigilant when people were moving around or undertaking activities and made sure people remained safe. Staff regularly checked in on people who chose to spend time in their rooms or in quieter spaces around the service to make sure people were well and asked if they needed anything.

Staff were not formally supported by their line managers, contrary to the providers own staff supervision and appraisal policies and procedures and recognised best practice. This was because staff had not had their overall work performance appraisal in the last 12 months and most staff had not had regular supervision meetings with their line managers. This meant staff did not have regular opportunities to reflect on their working practices and professional development. Staffing levels in the care home matched the days staff duty rota and were suitably deployed and available in sufficient numbers to meet people's needs. Managers used staffing dependency tools to make sure there were always enough staff to meet people’s needs safely. The suitability and fitness of staff to work in an adult social care setting had been thoroughly assessed. Staff recruitment files were clearly arranged. Recruitment procedures were robust which helped to ensure only staff that were checked as being safe to work with people were employed. The provider did this by carrying out checks on all new staff in relation to their identity, proof of address and Disclosure and Barring Service (DBS). DBS provides information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Training records showed staff attended relevant courses to support them to meet a range of people’s needs. Training was refreshed at regular intervals so that staff stayed up to date with current practice.

People told us staff kept the care home clean and odour free.

Managers and staff told us they had received up to date infection control and food hygiene training.

The care home was kept clean by domestic staff who we observed followed structured cleaning schedules. We saw staff consistently wear Personal Protective Equipment (PPE) and regularly wash their hands in line with recognised best infection prevention and control practices.

The care home continued to experience an ongoing issue in relation to bedbugs in one unit. We found the provider was following good practice and was managing the situation with the help of an external pest control company. This unit was also temporarily isolated to restrict the number of people who left or visited this unit, including staff, to minimise the risk of this infestation spreading to other parts of the care home. Furthermore, the provider followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. The provider’s infection prevention and control policy were up to date. The provider supported visits to the care home in line with the government guidance in place at the time of the inspection. The provider continued to access COVID-19 testing for people living and working in the care home when they showed signs and symptoms of COVID-19.

People told us staff supported them to take their prescribed medicines as and when they should.

Nursing staff authorised to handle medicines in the care home told us they had received medicines training and their competency to continue managing medicines safely was routinely assessed by their line managers. However, concerns were raised by a number of clinical staff about the new medicines supply partner which they had moved to in January 2024. Issues were raised about the stock and delays in receiving medicines. The provider acknowledged there had been some issues with the new supply partner which were being addressed at organisation level.

We found concerns with respect of safe management of medicines, which related to; staff practice and recording, accurate medicines care plans, prescription information for prescribed thickeners and the quality of medicines audits. For example, a recent medicines audits had identified higher than expected number of medicines errors but had not explored the reasons for this and identified actions to reduce reoccurrence. We observed staff had signed to record they administered medication when they had not done so. Although most care plans included detailed information about prescribed medicines and their administration preferences, some records contained ambiguous or contradictory details. For instance, one care plan indicated that a person's medicine should be crushed, contrary to the instructions on the medicine's label and the guidance from the community pharmacist, which stated it should be mixed with food. Staff we spoke with described how they would give the medicine in food, uncrushed. However this presented a risk if agency staff or new staff relied on the care plan to administer the medicines. Additionally, some records incorrectly stated that certain people should be given their medicines covertly (i.e., hidden in food or drink without their knowledge), which nursing staff confirmed was an error. Furthermore, some containers of thickener contained no prescription label, creating a risk that staff might not know to whom they were prescribed or the correct dosages. Lastly, we found inconsistencies in how nursing staff administered medicines, with some staff taking medicines from two blister packs at once. This practice increased the risk of medication errors and contradicted the provider's own medicines policy and recognised safe management practices.