This inspection took place on the 16 and 17 May 2016 and was unannounced. At our last inspection of the service on 7 August 2014, the registered provider was compliant with all the regulations in force at that time.Meadowbeck is registered as a care home with nursing for up to 60 people including adults over the age of 18, older people and people living with dementia. The service is purpose built; set in its own grounds and offers accommodation over two floors. The service is located approximately two miles east of York city centre and is close to public transport routes. There are a number of local shops close by.
The registered provider is required to have a registered manager in post and at time of our inspection the position was vacant. The previous registered manager left their post in March 2016. There was a peripatetic general manager in place, who is referred to as ‘the manager’ in this report. Active recruitment for a permanent manager was taking place. 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.
During our inspection we found that the recording and administration of medicines was not being managed appropriately in the service. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).
Record keeping within the service needed to improve. We saw evidence that care plans, risk assessments, food / fluid charts, turn charts and end of life plans were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. This is a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of this report.
People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people’s needs. Staff had been employed following appropriate recruitment and selection processes.
We found the level of cleanliness in the service was satisfactory, but the infection prevention and control practices within the service did not follow best practice.
We have made a recommendation about infection prevention and control within this report.
The manager of the service had made improvements to the number of staff completing essential training, but there remained work to be done to improve the number of staff receiving regular supervision. This had been identified by the manager and was part of their on-going action plan.
Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty; the manager had completed a standard authorisation application for each person and these had been reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.
People were able to talk to health care professionals about their care and treatment. People told us they could see a GP when they needed to and that they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.
People had access to adequate food and drinks, but this was not always well recorded by the staff. We found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals, although one or two said they could be better.
People were supported to maintain their independence and control over their lives. The majority of people reported that the service delivered effective care, but two people raised concerns about staff skills in moving and handling. This was being investigated by the manager. People gave us a mixed response when we asked them if staff were caring and supportive. Some were very positive in their feedback, but others were more reserved and indicated that their care was satisfactory depending on who was on duty. The manager was aware of this and the quality of care was being improved through on-going staff training and development.
End of life care within the service was not appropriately recorded, although we saw the care and support being delivered to people was in accordance with their wishes and needs.
We have made a recommendation about end of life training for staff, based on best practice, in this report.
People and their families, had been included in planning and agreeing to the care provided. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions. We found that people’s care plans did not clearly describe their needs. We saw no evidence to suggest that people were not receiving the care they required, but judged that the care provided was not well recorded. This was addressed in the well-led section of this report.
People had access to external gardens and community facilities and most participated in the activities provided in the service. We saw that staff encouraged people to join in with social activities, but respected their wishes if they declined. Families and friends were made welcome in the service and there were unrestricted visiting hours each day.
People knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been managed. People had access to complaints forms if needed and the manager had investigated and responded to the two minor complaints that had been received in the past six months.
The manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the manager was making progress in improving the quality of the service.