Meadow View

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

We identified continued shortfalls with the environment, such as fire safety management and safe storage of substances which may be harmful to people. There continued to be improvements required in how some areas of people’s medicines were managed, including the management of people’s creams. Where people's needs had changed, this was not always promptly reflected in their care records. We now found there were limited opportunities for staff to share learning across all teams, or during regular supervision with their line managers. Some staff were not always confident if they raised any safeguarding concerns these would always be addressed. The service internal audits did not always identify, or promptly remedy, the risks we found during our onsite assessment. For example, we found some areas of the home required additional cleaning and maintenance. The provider started to address these areas during our assessment. However, people told us they felt safe living at the home and processes were in place to help to ensure people were supported when they first moved to the home, and if they wanted care from other health and social care services. Staff continued to be safely recruited and we found some areas of medicine management had improved. For example, people’s medicinal patches were now rotated when administered.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they were always informed if people had been involved in any incidents, such as falls. One relative said, “[Staff] give me any information and there have been one or two things where they carried out an investigation.” The relative told us their family member and they had been involved in deciding what action they wanted to take, to reduce the risk of reoccurrence of incidents.

Staff did not always have opportunities to reflect on learning across shifts. Leaders were not always supported by the provider to take action to reduce risks to people, such as fire risks, in a timely way. We also found learning had not been taken in respect of the safe storage of substances which may be hazardous to people. Staff practice meant lessons learned communicated by the provider were not always followed. However, some staff gave us examples where learning had been shared at meetings at the start and end of their shifts.

Processes for ensuring learning taken and timely actions were achieved were not always robust. This included where feedback had been provided by statutory agencies. The provider had systems in place to communicate leaning across their locations, but processes had not ensured learning was followed. The registered manager took action to address these concerns as a result of our feedback. However, some processes were in place to monitor and review people’s individual safety incidents and people’s care needs and to take learning from these.

People and relatives were supported by the provider when they transferred between services. People told us support was also provided by ancillary staff, so they would receive the care they wanted at times they wished. Relatives were complimentary about how staff monitored their family member’s health when they transferred between services.

Staff told us they received enough information about people’s wishes and needs when they first moved to the home, and when they were discharged back to the home after any time spent with other care providers. Staff told us essential safety information was sent to other health and social care providers when people moved between services. However, staff were not always confident people’s hospital information documents were always sent with them. There is no evidence of harm to people as a result of this.

Other health and social care professionals advised us staff made appropriate and timely referrals to them, and described an open and honest approach, where leaders considered if they could provide the care people wanted. Other health and social care professionals gave us examples showing how information sharing had led to improved outcomes for people.

Processes were in place for receiving and sharing information with other health and social care providers. Systems considered if people’s needs had changed if they had been staying away from the home and this information was communicated to staff. The registered manager confirmed they did not have a system in place to check hospital information documents were consistently shared with hospital teams. However, there is no evidence of any impact for people in relation to this.

People and relatives were positive about the measures taken to keep people free from abuse. Relatives gave us examples showing how people, relatives and staff worked together to find solutions to any safeguarding concerns.

Some staff were confident leaders took appropriate action when these were reported. Other staff told us action was not consistently seen to be taken when they escalated concerns internally. Two staff we spoke with did not know the breadth of other agencies they could communicate safeguarding concerns to.

Staff practice meant areas of the home which needed to be consistently locked were not. This may increase risk to people. However, staff reassured people when they wanted this and responded to people’s care needs in a timely way.

The risk people would not be safeguarded from harm was increased because checks on staff practice, such as ensuring appropriate areas of the home were consistently locked and good fire management was followed, were not robust enough. In addition, some of the processes used to engage and reassure staff their concerns were responded to did not always work. However, some systems and processes were working more effectively. For example, in relation to reviewing incidents and obtaining specialist support for people.

People and their relatives told us their views on the best way to manage people’s risks were sought and listened to. People gave us examples showing how staff worked with them to maintain their independence, whilst balancing this with their risks. People also told us staff helped them to manage risks around their well-being.

We received conflicting information from staff about how people’s risks needed to be managed. This included in relation to people’s risks when eating and the frequency of checks for people who were at risk of falls. The provider’s representative told us, “Our biggest safety issue is we have a lot of falls. We are going to change our quality assurance to include more information technology to do the analysis. There is a lot more work to be done on this process.” The registered manager began to review people’s care records during our assessment, to ensure staff had the guidance they needed. A member of staff told us that following the first day of our on-site assessment, they had received further training to ensure risk assessments were accurately completed. They advised us they had not previously received training on the risk assessments tools before. However, staff gave us examples showing how they involved people in decisions about managing elements of their care so they would feel less anxious.

Some actions which had been previously been identified as requiring completion to support people to manage risks had not been fully completed. This included in relation to ensuring areas which may contain hazardous substances were consistently locked, and the completion of all actions required to reduce the risk of the spread of fire.

The processes in place to ensure people’s individual risks were managed were not always robust and did not always provide staff with the information they needed to care for people safely. For example, systems had not ensured people’s care records consistently reflected people’s level of needs. Health screening tools did not always provide an accurate and up to date assessment of people’s known needs. Processes to ensure prompt action was always taken to reduce risks to people in respect of fire management had not consistently worked. Systems in use had not always identified people’s call bells were not within reach. However, some systems were in place to support the management of people’s safety. For example, the provider had put falls, safeguarding and medication policies in place. The registered manager had systems in place to check key areas of people’s safety and investigated any deaths and incidents such as falls at the home. The provider had processes in place to have oversight of this.

People enjoyed using different areas of the home. Relatives told us how important it was for their family members well-being to continue to have easy and safe access to outside space. One relative said, “[Meadow View] meets [Person’s name] needs, as it is all on one floor, and [person’s name] loves her garden.“ Relatives said their family members had access to the equipment and environment they wanted. One relative explained how their family member’s room had reflected their needs as they changed. Other relatives told us their family members were encouraged to bring in items which were important to them, such as items of furniture and pictures, so they would continue to enjoy them.

A member of staff with responsibility for maintaining the home told us urgent jobs relating to safety of the home were allocated to them to prioritise. However, at our last two inspections, published 22 May 2023 and 03 August 2023 we identified further improvements were required to promote good fire safety. In addition, another statutory organisation had identified actions to be undertaken in 12 October 2023. We found these actions had still not been fully completed when we carried out our onsite assessment at Meadow View on 23 and 25 July 2024. Leaders told us there had been a delay in the provider supplying items which were required to ensure safe management of fire risks. One staff member said, “It is a good building. I think with the residents there should be more alarms on back doors, [just so we know if [people] have gone into to the back yard].” However, staff told us they had the equipment they needed to provide good care. One staff member said, “Some of the [people] do have slide sheets and wheelchairs. There’s no delays for people because of equipment.”

Areas required to be secured were not consistently locked. This meant people had access to items which may be dangerous if ingested. We found 2 fire doors were propped open on the first day of our on-site assessment, and some other fire doors either needed maintaining or replacing. However, Staff encouraged people to choose where to spend their time.

Processes in place did not consistently ensure actions required to improve the safety of the premises were promptly undertaken. An effective system was not in place to ensure items relating to building maintenance were always promptly provided. Systems were either not in place or robust enough to promptly provide the registered manager with assurance all staff members required had attended fire drills. Processes were not in place to ensure an up to date fire risk assessment was always available in the home. Checks undertaken by senior staff on the premises and staff practice did not always identify or promptly drive through improvements required to maintain a safe environment. However, systems were in place to check equipment was serviced and processes were in place to provide maintenance support, should this be required in an emergency.

People told us there were enough staff to provide the care they wanted at the time they wished. People gave us examples showing how staff had sensitively used their skills to support them so they were promptly reassured. Relatives told us there was good continuity of staff and were positive about the knowledge and skills staff used when supporting their family members.

Some staff told us they were very busy, especially if there was any unexpected staff absence. One staff member told us they felt people’s needs had changed over time, and this was not reflected in the staffing levels. Other staff told us there was usually sufficient staffing, and in the event of a staff member not being able to work their shift this was covered by other staff, where possible. The registered manager had recognised the staff skill mix on some shifts did not always promote effective medication management. Interim measures had been put in place to address this prior to our assessment. Some staff felt the training was not always effective because a lot of it was completed on-line. However, some staff advised they were able to get additional support with their training when they wanted this. Further face to face training had been planned.

People did not have to wait long if they required support from staff. Where people needed care at specific times there was sufficient staff to do this. There was enough staff to support people at mealtimes. Staff were also available to offer people choices and to reassure people when they wanted this. For example, where people were anxious. People’s call bells were promptly answered.

Systems for ensuring long serving staff had access to regular supervision did not always work well. Processes for addressing skills gaps did not always work promptly. For example, in relation to skill mix of staff with medicines competencies. Systems were in place to determine staffing levels but these did not always reflect people’s current level of needs. We found no direct impact on people’s experience at this assessment. However, processes were in place to check staff were safely recruited. Systems were in place for the provider to confirm newly recruited staff had opportunities to undertake supervision and receive support at key stages of their probationary periods. Processes were in place for staff to obtain additional staff support in the event of significant events at the home.

People and relatives were positive about the cleanliness of the home. One person described their bedroom as, “Very clean” and commented, “They come and clean in here and go over it with disinfectant all over the place.” We asked one person about staff usage to PPE during personal care. They said, “Staff wear what they need.” Relatives told us they were informed if there was an infectious outbreak at the home, and appropriate measures were introduced when they visited their family members to reduce the likelihood of the spread of infections. Relatives told us this included staff wearing PPE where required.

Cleaning staff were employed in the home and care staff also undertook some cleaning duties. A care staff member told us, “We do [cleaning duties]. If you see something, you clean it up." Staff told us they had sufficient time allocated to undertake cleaning allocated to them and said there was enough PPE and resources to support good infection control. Staff had received training in infection control. Staff told us the registered manager informed them if there was an infectious outbreak at the home. Staff we spoke with knew what action to take to reduce the likelihood of the spread of infection, should this occur. One staff member said, “We have separate areas [for donning and doffing] and bags in the rooms where people have got [infections] and disposal facilities.”

Some communal areas were in need of a deep clean to ensure good infection control practices were supported and porous items, which are difficult to clean, required repairing or removing from the home. We informed the registered manager and provider’s representative about this on the first day of our assessment. Some items required had been removed or repaired as required by the second day of our assessment, but dust and debris remained on the second day of our assessment in one communal area of the home.

The process for ensuring all areas of the home were clean was not robust. Cleaning schedules were not detailed enough to guide staff so they fully understood which areas they were required to clean. Cleaning schedules prompted staff to wipe down frequently used touchpoints every 2 hours, but staff practice meant the time this was done was not recorded. The system used did not give the registered manager the oversight they needed to be assured this was done. The registered manager and provider had a process in place to undertake checks on the cleanliness of the home, but these had not either identified or fully resolved the concerns we found at this assessment. However, processes were in place to ensure a designated infection control lead was on each shift and systems were in place to ensure there was a sufficient supply of PPE. Systems were in place to facilitate the cleaning of high areas within the home. Processes were in place to provide staff with guidance on infection control, and there were systems in place to undertake spot checks on elements of staff practice in relation to infection control.

Two people told us staff did not always observe them taking their medicines. One person said, “Generally they watch although occasionally I will take them to my room. But they [staff] are very careful with who does that, it is not a general thing.” However, relatives were positive about how their family member’s medicines were administered. One relative said, “[Staff] are good at giving pain relief. I always ask if [person’s name] has been given pain relief and am told they have. [Registered manager’s name] tells me if they have been put onto different medications.” Another relative told us staff had adjusted how they administered their family member’s medication, as their needs changed.

Staff raised concerns that people were not always observed taking their medicines and medicines were sometimes left in people’s bedrooms for them to take later. Another member of staff told us on one team there was only 2 staff members trained to administer medicines to people. The staff member said, “I do think they could do with more." The registered manager told us people had been without a trained medicines administrator on some night shifts for around 6 months. However, if people required medicines when a trained medicines administrator was not on site, the registered manager or senior staff returned to administer these. The registered manager had been working with an additional staff member to support them to become competent to administer people’s medicines.

Systems to manage people’s medicines did not always work well. There continued to be increased risk to people in relation to how their creams were managed. For example, we checked 2 people’s creams and found out of 4 items 3 of these had not been dated as required when opening and use by dates were not recorded. In addition, One person had some cream in their bedroom with a prescription label dated 17 June 2024 with instructions “Do not use for longer than 7 days.” Processes to ensure staff received the guidance they needed when administering people’s creams needed further improving. For example, to ensure staff consistently knew the thickness of cream to be applied. There was also limited guidance for staff to follow within the provider's medication policy in relation to safe management of creams. Systems for ensuring people’s risks assessments and care reflected the level of medicinal support they required from staff were not always robust. For example, in relation to self-medication for creams and if staff were expected to observe people taking medication administered. We told the registered manager and provider’s representative about this and they took immediate action to begin to address these concerns. However, improvements had now been embedded to ensure people requiring medicinal patches had these regularly rotated. Systems were in place to ensure people’s medicines were administered at the time prescribed. Processes were in place for staff administering people’s medicines to be kept up to date with any safety alerts from MRHA. Systems were in place to ensure any queries about people’s medicines were escalated to pharmacist or people’s GPs.