Meadow View

Meadow View is registered to provide accommodation and personal care for up to 42 people, including people living with dementia. At the time of our inspection visit there were 32 people living at the home. The home is split into a large main building which provides care to people on a permanent basis. There is a separate building known as ‘The Poppies’ which provides respite care. Respite care is planned or emergency temporary care. Some people living at the home were living with dementia. People have use of a communal lounge and dining area, as well as occasional seating throughout corridors. People’s bedrooms are ensuite and there are further communal bathroom facilities located around the home. People can access outside spaces.

People's experience of using this service and what we found

At our last inspection, we found significant improvements were required around managing people’s risks and risks within the environment, medicines management, quality of record keeping and quality assurance processes. At this inspection, some improvements in medicines management an understanding people’s risks had improved. We found some improvements to the provider’s quality assurance systems.

However, we found the provider's systems and processes to monitor the quality of the whole service people received, continued to require improvements to embed those systems into everyday practice. We found some actions identified as improved, had not been improved consistently. We found the provider remained in breach of a regulation.

People received their medicines from trained staff. Medicines were stored safely and securely. People were assessed and protocols were in place for medication prescribed to be taken on an 'as required basis.’ Time critical medicines were administered in line with their prescribed instructions. However, some medicines such as topical creams and pain patch medicines required better recording to ensure staff administered these medicines safely.

Infection, prevention and control practices had improved. People’s bedrooms, communal hallways and lounge areas were clean and uncluttered.

The provider had sufficiently trained and suitable staff on shift to meet people’s needs. The registered manager was not required to cover kitchen duties as this had been recruited to. Vacancies were still advertised however regular staff picked up shifts were required. Agency staff were utilised but this had reduced since our last visit. Staff told us they worked well as a team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Relatives were pleased with the support and care their family member received. Relatives were complementary of the staff, how their met their family members needs and wishes and they were also complementary of the management of the home.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 19 May 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but these had not become embedded into everyday practice. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The providers action plan told us what they would do and by when to improve. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow View on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified a repeated breach in relation to regulation 17 (good governance) at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Meadow View is registered to provide accommodation and personal care for up to 42 people, including people living with dementia. At the time of our inspection visit there were 31 people living at the home. The home is split into a large main building which provides care to people on a permanent basis. There is a separate building known as ‘The Poppies’ which provides respite care. Respite care is planned or emergency temporary care. Some people living at the home were living with dementia. People have use of a communal lounge and dining area, as well as occasional seating throughout corridors. People’s bedrooms are ensuite and there are further communal bathroom facilities located around the home. People can access outside spaces.

People's experience of using this service and what we found

Known risks relating to people’s health and welfare and environmental risks were not managed safely. In some cases, when quality assurance checks were completed, improvement actions were not made, or insufficient actions failed to keep people safe.

We checked examples of people’s care plans and found these were not always accurate or they held conflicting information. Some risk assessments although completed, needed additional information to ensure the risks and actions people needed, were fully documented. This meant staff did not have accurate information to manage people's risks safely.

Fire safety needed improvement. People were at risk because fire safety checks that identified potential issues in November 2022, mainly went without action. Fire doors to people’s bedrooms and communal areas did not always close, some closed to fast or were defective so any potential risks to control the spread of fire, or to stop people being harmed, were ineffective.

Risks associated with people’s health and welfare were not always considered, reviewed or reflected a person’s current needs. Records and actions that were required to be completed, were not always recorded, so we were not confident risks were managed safely. Oversight and scrutiny of those records through effective checks, went unchecked.

Infection, prevention and control practices required improvement. During our visit, some people in the home had tested positive for COVID-19. The management systems to keep people and staff safe, were not aligned with latest government guidelines. On both inspection days, we saw the registered manager and care staff, not wearing face masks. In some cases, we saw staff grouped together, some not wearing their masks. People were not always isolated or protected from others, so cross infection was not managed robustly.

The provider’s quality assurance systems were regularly completed, however they failed to identify the issues we found. Overall, the provider failed to operate and manage a robust and effective quality assurance system. Where similar issues had been identified at inspections across the providers other homes, there was limited evidence lessons had been learnt.

The provider had sufficiently trained and suitable staff on shift to meet people’s needs. However, some staff told us, it was not uncommon for shifts to run lower than planned numbers. The registered manager supported staff when required and the registered manager covered for the cook, 3 days a week. The registered manager told us this situation had been like this since August 2022 which could explain why, there was limited oversight of the service.

People received their medicines from trained staff. Medicines were stored safely and securely. People were assessed and protocols were in place for medication prescribed to be taken on an 'as required basis.’ Time critical medicines were administered in line with their prescribed instructions. However, some medicines required to help manage people’s anxieties, were not always given as directed and in some cases, without other distraction techniques being adopted.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was good (published 29 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the standards of care, a lack of management oversight and infection control when supporting people during an outbreak of COVID-19. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow View on our website at www.cqc.org.uk.

Enforcement

Following our visit, we asked the provider to respond to the immediate concerns we found at our visit. We continued to seek their updates and assurances they had mitigated the immediate risks to people.

We have identified a breach in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded .

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The provider had assessed the risks of COVID-19 thoroughly.

There were robust procedures to prevent visitors from spreading infection. Visitors completed self-declaration forms, had their temperature taken and were supported to wear appropriate personal protective equipment (PPE) before being allowed entry. A booking system was used to manage visitor numbers.

People were supported to keep in touch with their family and friends through telephone and video calls.

Changes were made to the layout of the home to enable social distancing.

Staff received infection prevention and control training.

Meadow View is a single storey purpose built residential home providing personal care to 42 older people. There were 38 bedrooms, four of which could be used as shared rooms. At the time of our inspection there were 34 people living at the home. The home is split into a large main building which provided care to permanent residents, and a separate building known as ‘The Poppies’ which provided respite care. Respite care is planned or emergency temporary care. Some people living at the home were living with dementia.

People’s experience of using this service and what we found

People and relatives told us people were provided with safe care and treatment at Meadow View. Risks to people's health and well-being had been identified and assessed. Records contained guidance to staff on how to manage risks to keep people safe. Staff knew about people’s individual risks and how to minimise these.

Most people told us there were enough staff. Difficulties in recruitment and retention had meant the service had relied on staff working extra hours to ensure the home maintained safe staffing levels. The provider had acknowledged the challenge faced with recruitment and had implemented a number of strategies to resolve this issue. There was a robust recruitment procedure which prevented unsuitable staff from working with vulnerable adults.

People told us staff were kind and caring and treated them with dignity and respect. Staff told us they took pleasure in their role and enjoyed working at the home. We saw warm and friendly interactions between people and staff, and there was a friendly atmosphere within the home. Records showed staff had received enough training and staff felt confident in supporting people well.

People had enough to eat and drink and gave positive feedback about the food. Guidance was provided in care plans for staff about how to encourage people to maintain a healthy diet and their nutritional needs had been assessed. People could eat when and what they wanted to.

People received their medicines as prescribed. Medicines were ordered, stored, administered and disposed of safely. Good infection control processes were followed.

People's needs, and preferences had been assessed before they moved into the home. People’s care and support was planned in partnership with them, those closest to them and appropriate health professionals. Records showed referrals had been made to other healthcare professionals when necessary to ensure people remained well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager completed regular checks to ensure the home was meeting their legal requirements. This included checks on the environment, people’s health care and the quality of care provided. Where improvements were identified, action had been taken or was planned. People knew how to complain and were confident they would be listened too. Staff provided positive feedback about the management of the home.

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

Rating at last inspection

The last rating for this service was good (published 13 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Meadow View is a single storey purpose built residential home which provides care to older people including people who are living with dementia. Meadow View is registered to provide care for 42 people. At the time of our inspection there were 31 people living at the home. Meadow View also provides a personal care service to people living in six individual bungalows situated next to the home, registered separately by the same provider. At the time of our visit, these bungalows were unoccupied so no care provision was provided.

Meadow View was last inspected in May 2016 and was rated as ‘requires improvement’. We returned to check if required improvements had been made in the reporting of safeguarding incidents and the overall governance and management of the home. At this inspection, we found improvements had been made.

There was no registered manager at the home, but a manager had been in post since December 2016. They were in the process of completing their registration with CQC. 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.

People and relatives were complimentary about the care and support they received. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were encouraged to make their own decisions where possible and care was given in line with their expressed wishes. People were supported to maintain relationships and keep in touch with those people who were important to them.

Care plans were detailed and contained accurate and up to date relevant information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions as well as reviewing their care to ensure it continued to meet their needs.

Where people were assessed of being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities and had time to refer to people’s records to ensure they continued to provide safe and effective care. Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

People’s care and support was provided by a consistent, trained and caring staff team and there were enough available staff to be responsive to their needs. People told us they felt safe living at Meadow View and relatives were confident their family members received safe care and treatment. Staff knew how to keep people safe from the risk of abuse. Staff understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

Some people were supported to pursue various hobbies and leisure activities and people had enough activities to keep them stimulated. The manager had plans to improve the activities programme to make it more person focussed and to better support those people living with dementia.

People had meals and drinks that met their individual requirements and people who required it, received support from staff.

People told us they could raise concerns or complaints if they needed. Information in the home advised them how to raise complaints and expected timescales and action. People said the new manager was approachable and if concerns were raised, felt assured action would be taken.

People and relatives feedback was sought by completing provider surveys and regular attendance at meetings held in the home. The manager told us they protected time every week for people, relatives, or staff to come and see them to share any feedback or concerns.

After a period of managerial changes that affected the direct management of the home, people and staff spoke positively about the new home manager. The manager had effective processes to ensure staff felt listened to and heard and had plans to improve training, particularly in dementia care. The manager and regional support manager had plans to improve the governance and management of the home. They were continually evaluating and improving current systems and checks which improved the quality of service people received.

Meadow View is a single storey purpose built residential home which provides care to older people including people who are living with dementia. Meadow View is registered to provide care for 42 people. At the time of our inspection there were 29 people living at Meadow View. Meadow View also provides a personal care service to people living in six individual bungalows situated next to the home, registered separately by the same provider. At the time of our visit, these bungalows were unoccupied so no care provision was provided.

This service was last inspected on 9 May 2015 and we found two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. Breaches were found regarding a lack of mental capacity assessments and we found quality assurance systems were ineffective to monitor improvements. At this inspection we looked to see if the home had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found some areas of improvement had been made, for example with the completion of mental capacity assessments for people who lacked capacity, we found some improvements were required in other areas of the service although not serious enough to have breached regulations.

This service had a registered manager in post at the time of 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 and associated Regulations about how the service is run.

People told us they felt safe living at Meadow View and staff knew how to keep people safe from the risk of abuse. However, we could not be certain that we or the local authority had been notified of all potential safeguarding incidents that occurred at the home.

Staff knew what support people required and staff provided the care in line with people’s care records. Care plans contained relevant information for staff to help them provide the individual care people required. We found people received care and support from staff who had the knowledge and experience to provide care for people.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained and experienced staff.

Staff supported people’s choices and understood how the Mental Capacity Act (MCA) 2005 protected people who used the service. Staff understood they needed to respect people’s choices and decisions and where people had capacity, staff followed people’s wishes. Where people did not have capacity to make certain decisions, decisions were made on people’s behalf, sometimes with the support of family members. Where people did not have family or friends to help them with some of their decisions, independent mental capacity advocates provided support.

Deprivation of Liberty Safeguards (DoLS) are used to protect people where their freedom or liberties are restricted. The provider had submitted 14 DoLS applications to the authorising body which had been approved. These applications meant people’s freedom was restricted and provided protection to those people. The provider said they would continue completing further DoLS applications for other people whose freedoms may be restricted to see if this was the least restrictive method.

People told us they were pleased with the service they received. People felt comfortable to raise concerns but did not always know, who to discuss them with.

Staff told us they were not always confident the provider listened to them or addressed their concerns. Staff felt supported by each other and felt there was a good team spirit. Staff felt valued by the registered manager who they said, listened to and supported them.

Staff training was being updated but there was room for improvement in how training courses were made available to staff. This was partially due to staff not always attending training courses that took place on their planned days off because staff said it was unfair. Staff continued to feel unsupported by the provider in relation to training and development. Staff said this made them feel demotivated and that their efforts went unnoticed.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received. However some required further scrutiny and evaluation to ensure improvements were made, such as ensuring we received all statutory notifications for safeguarding concerns.

We spoke with the manager, three care workers and three relatives of people using the service. The manager and care workers told us of the new infection prevention practices, policies and procedures in place at the home. We also saw evidence of these practices were being followed during our inspection and saw that the home was clean and people well cared for. The three relatives we spoke with told us the home had been clean and was well maintained. One relative identified two infection prevention concerns which related to incidents she had witnessed. The manager was informed of these incidents so that they could ensure these practices were not repeated by staff.

We saw improvements had been made by the manager in relation to the completeness of people's care records. Information was available relating to people's care needs and risks. We pathway tracked these documents and found that the care plans and associated risk assessments had been followed in the two people's records we reviewed. However, we did note that some gaps of information remained in some of the documentation. This meant that people could be at risk if not all their information is present.

People's needs had been assessed, risks identified and personalised plans of care developed for each person. We saw that people and / or their relatives had been involved in their care and that where needed consent had been obtained. We saw that people's ongoing healthcare needs were met.

The home was seen to be clean and well maintained. We observed that not all the systems identified within the PrimeLife Infection Control Policy were in place to ensure effective infection control. We were told by the manager that these systems were about to be put in place and that staff would be trained in these processes.

Staff identified that they felt well supported by the manager and had been able to access training to assist them within their role.

We saw that the provider had an effective system to regularly assess and monitor the quality of service people had received. We also saw a system in place which identified and managed risks.

We reviewed the records outcome as it was triggered by the inspection visit. We reviewed two people's records and found that documented care did not always reflect current practice or there were some gaps in information relating to their care. We also observed that dates of staff training did not correspond to the staff training records.

We saw systems in place allowing people using the service and their relatives communicate their experiences of the care provided. Positive feedback had been given about the staff and care people had received through these surveys.

People's needs had been assessed, risks identified and personalised care plans developed. There was evidence of support by healthcare professionals to ensure people's ongoing healthcare needs were met.

The two staff we spoke with and the manager said there were sufficient staff available to accommodate people's needs. Staff training records showed minimal staff attendance at some training sessions provided during 2012.

The provider may like to note that staff appraisal was not in place. Staff appraisal is important as it supports staff and promotes their development. We saw evidence of staff supervision and were told that guidance in the form of a staff supervision policy was not available.

Although the home has a local policy on the 'Prevention and Detection of Abuse' we have asked that the provider may like to note that the home did not have access to the 'Warwickshire Adult Protection Procedures'.