The inspection was carried out on 4 and 5 April 2017 and was unannounced.The home was last inspected on the 14 September 2016 where we gave it an overall rating of requires improvement. We had identified the provider was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to a lack of person centred care. We asked the provider to make improvements and send us an action plan. At this inspection we found that improvements had not been made and that further concerns were identified.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Meadowbrook Care Home is registered to provide accommodation with nursing care for up to a maximum of 79 people. There were 50 people living at the home during our inspection. People were cared for in three units. These included the Garrett Anderson unit which provides supports to people living with dementia. The Mary Powell Unit which provides support to people with physical health needs and the Agnes Hunt unit which supports people living with neurological needs.
There was a registered manager in post who was absent during our inspection. 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.
There were not enough suitably trained staff deployed to meet people’s needs in a timely and person centred manner. There were staff vacancies and a high turnover of staff. There was a reliance on agency staff to cover the gaps in shifts. This added additional pressure to permanent staff as they had to show agency staff what to do as well as doing their own jobs. Staff felt stressed and morale was low.
Risks to people’s health and well-being had been assessed and guidance developed to advise staff on the equipment and support required to minimise risk. However, these were not always reviewed or followed by staff. The provider did not ensure that people’s environment was kept clean and hazard free.
People and their home environment were not always treated with respect and their dignity was compromised. People’s information was not always kept confidential.
People were not always provided with personalised care suited to their needs. Staff had limited time to spend with people other than when providing personal care and were task led. There was a lack of stimulation and many people sat doing nothing for most of the time.
The provider had not always followed the principles of the Mental Capacity Act and people were unlawfully deprived of their liberty. Staff did not always seek people’s consent before supporting them.
People did not always receive adequate support to help them eat their meals in a dignified manner. This placed people at an increased risk to their health and wellbeing. People had mixed views about the quality and choice of food available to them.
There was ineffective leadership at the home. People and their relatives did not find the registered manager approachable and lacked confidence in them and how the service was run.
Staff did not always feel that they were provided with the support and equipment they needed to enable them to do their jobs well.
The quality assurance systems the provider had in place to monitor the quality of care were not always effective in identifying and addressing concerns raised. The provider was keen to make improvements to the service and provided additional resource to achieve this.
The provider had systems to gather people’s, relatives and staff views on the service but their concerns were not always acknowledged or acted upon.
People were supported to take their medicines as prescribed. Only staff who had training on the safe management of medicines administered them.
People were protected from harm or abuse by staff who knew how to recognise and report concerns. The provider had safe recruitment procedures which ensured that prospective new staff were suitable to work with people living at the home.
You can see what action we told the provider to take at the back of the full version of the report.