This inspection was carried out on 7 and 11 August 2017. At our inspections in March 2015, January 2016 and December 2016 we found the service was not always well led. Systems to monitor and improve the quality of the service were not effective. The consistency of the quality of the governance systems operated by this provider has been a concern since 2015. Improvements have not been made to ensure the provider is consistently able to meet the requirements of the regulations. As a result people have not received care that is safe, effective, caring and responsive to their needs. Meadowview Nursing Home provides accommodation and nursing care for up to 42 people. At the time of the inspection there were 28 people using the service.
There was no registered manager in post. 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 had been three different managers since January 2017. The provider had recruited a new manager who was planning to make application to CQC to become the registered manager.
Medicines were not managed safely and risks associated with people's health needs were not managed effectively. Systems to reduce the risk of infection were not maintained. The environment and equipment were not always clean. Systems to reduce the risk of fire were not monitored.
People's needs were not met in a timely manner and staff were not deployed in a way that ensured people's needs were met. Staff did not have the skills to communicate in a meaningful way with people.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.
The quality of the food was not always good and people did not always receive food and drink to meet their needs.
Staff did not always treat people with dignity and respect. People told us staff were not always caring and people spent long periods without any interaction.
Care was not provided in a person-centred way. Staff did not always respond to people's requests for support in a timely manner.
People and their relatives were not confident to raise concerns. They felt that no action would be taken to resolve issues and were fearful of retribution if they complained.
Systems in place to monitor and improve the quality of the service were not effective. Where steps had been taken to gather feedback about the service no action had been taken to resolve the issues identified.
Staff felt supported through regular supervision and were positive about the training they received.
We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.