Meadow View

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a breach of the legal regulations. The provider's oversight and governance systems were not always effective in promptly improving the quality and safety of the care provided. Although a range of checks were carried out, these were not always effective in identifying and mitigating areas of risk. Some staff did not feel investigations were always rigorous enough, or that outcomes were fully communicated across teams, so lessons would be learned. However, some staff described a more supportive working environment. Partners were complimentary about the care provided by staff and other health and social care professionals told us staff and leaders sought advice promptly.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff had mixed views on how well a shared direction and culture had been embedded at the home. Some staff said the culture within the service was not always supportive or positive. One staff member told us, “Sometimes you just feel like you are not appreciated enough. It shouldn’t be two teams but one team because we are all working at the same place." Staff told us there was limited opportunity for staff to attend meetings across all teams, and some staff members did not have opportunities to participate in regular one-to-one meetings with their line managers. However, other staff were more positive about working at the home, and how staff worked together to provide good care. Theses staff told us their suggestions were listened to. The registered manger told us staff were made aware of how they were expected to care for people through supervisions, staff meetings and “10 at 10” meetings. The 10 at 10 meetings were attended by a changing range of care and ancillary staff. We asked staff what the provider’s visions and values were. One staff member said, “Residents can always tell if you are feeling down. I would like to come into work every day and find a happy place but sometimes you come in and you find it is not." Despite such concerns, all staff described an ambition to do their best for people. One staff member said the focus was, “To prioritise the residents, look after their welfare, work in their best interests and gain consent and maintain their privacy and confidentiality." The registered manager said, “I want the best for people.”

Some processes for communicating the direction and culture of the home to staff did always work as effectively. For example, some staff did not have regular supervision meetings, others did. In addition, staff meetings were not always scheduled at times suitable for all staff teams to attend. Systems for obtaining feedback from staff on the culture and direction of the service did not always work well. Staff had been asked for their views on how the service through the provider’s quality assurance survey in 2023, but the registered manager had not received any feedback or action points from the provider. However, processes were in place to gather input from people and relatives to gain their views on the care provided through relative’s meetings and informal discussions. Systems were in place for updating relatives and other health and social care professionals about developments at the home and their people’s care, including newsletters, facebook articles, special events and direct contact.

Some staff did not feel leaders valued their contributions and some staff were not confident they would receive support from the provider. One staff member said, “You just feel that if you went to someone, they would not support you." Other staff members told us communication with the provider was limited. For example, not all staff knew about the range of rewards and recognition available to support them. One staff member told us some rewards, such as those linked to staff recruitment, did not always work efficiently. However, other staff told us leaders did take action when they sought support. One staff member told us, “[Registered manager] is as a manager should be, she is not friends with anybody, but she speaks up for you. She is not partial about anything; she is really good." Some staff told us they did not find training met their preferred ways of learning. However, the registered manager gave us examples of support they had given to established staff so they developed the skills required to care for people, at the pace which suited individual staff members. The registered manager said they were supported by the provider. However, some areas of support required from the provider, including assistance to maintain the safety of the home, had not always been promptly given.

The provider’s systems for ensuring staff feedback was actioned did not always work effectively. The processes used by the provider had not consistently ensured all staff were made aware of the range of rewards open to them. Staff meeting did consider staff training and support, but all staff did not have access to these or supervision meetings, regularly. However, processes were in place to support new staff through regular one-to-one meetings at key stages of their initial employment.

Some staff did not feel comfortable to raise concerns because they did not feel confident they would be listened to. One staff member told us, “I know people have raised issues in the past with [registered manager] and nothing gets done about it. Even if it gets to head office, it will get solved but not resolved." However, another staff member told us, “[Registered manager’s name] is very cooperative and they are listening, I am happy to talk to them about everything.” The staff member said, “[I could take things to] Head office, but [Registered manager’s name] does listen, so I have not needed to.” Staff told us there was no staff forum or freedom to speak up representative. The registered manger told us the provider’s representative was planning to introduce a staff forum over the next few months.

The systems in place for addressing whistle-blowing concerns and further supporting staff were either not robust or developed enough to ensure staff were confident their concerns would always be addressed. Processes were in place to investigate whistleblowing concerns and to provide outcomes to some staff, but we found outcomes were not shared with all staff. However, processes were in place to provide staff with information on how to raise any concerns they had.

Staff told us there were disparities with the support they received and information communicated to them. When we asked if they had opportunities to get together as a whole staff team one staff member responded, “We did before Covid but not since then." The registered manager confirmed some longer serving staff may not be aware of the range of benefits and rewards available to them. One staff member told us, “I would only hear about this through word of mouth.” One staff member described how staff could struggle with the on-line training and said, “The trainers do come down sometimes to help those people, but I don’t think they come down as much as they should." However, some staff were more positive about how their equality needs were met. One staff member told us, “I have never felt I have been outcast; they always treat me as a member of the team." The registered manager gave us examples of how the staff team came together to mark important events in staff’s lives, where staff may feel isolated. The provider’s representative told us they were intending to develop easy read versions of some key information to support staff further.

The systems in place had not ensured all staff felt they were equally listened to and supported across all staff teams. Processes for ensuring communication between staff and leaders needed to be improved. However, systems were in place to support staff with English as a second language, through translations of some key documents. Processes were in place to support overseas recruitment in a culturally sensitive way.

Staff told us they understood their roles and responsibilities, but we found there were instances where their understanding of the care people wanted varied. Staff were not always supported to know how to care for people by consistent, up to date guidance within people’s care records. Some staff told us they did not have regular checks on their practice. The registered manager confirmed they did not routinely check staff applied the learning they had undertaken. For example, through unannounced spot checks on staff practices across all shifts. Other staff said they did not have opportunities to exchange information across all teams, as they wished. However, some staff advised us they found handovers at the start and end of shifts gave them enough information to care for people.

The registered manger’s checks on risks to people, people’s care records and medicines continued to fail to identify and promptly address the concerns we found on this assessment. For example, there were instances where checks had not identified people’s dependency tools were inaccurate, or that people’s care plans contained conflicting information or had not been updated as their needs changed. The systems used by the registered manager and provider for had not identified the concerns we found in relation to infection prevention, or to ensure people’s call bells were always within reach. Improvement and further embedding of provider checks were still also required, to ensure all actions were identified and swiftly actioned. At the time of our assessment, a quarterly review by the provider to ensure all the actions identified had been completed had not yet been done. For example, in relation to fire risk assessments. We also identified additional gaps in the frequency of supervision for some staff, which had not been fully identified by the provider’s checks. Leaders began to address some of these areas during our assessment. However, the registered manager reviewed key incidents, such as falls. Processes were in place to gain the views of people and relatives about the care provided at Meadow View. The provider had oversight of these checks. Where any actions had been identified, these were either complete or were being progressed.

People and relatives told us they were partners in their care. One person said the registered manager was, “Very straight but [they are] looking to the left and the right to make sure everything is alright. [They are] here 7 days a week.” A relative told us how the registered manager had supported them when they went abroad for a substantial period of time. They explained how the registered manager had supported them to make sure their family member was still included in their day to day life, whilst they were away, by displaying photographs. The relative said, “[person’s name] felt included in what was going on. [Registered manager is] really understanding and really supportive, so I didn’t feel I need to be worried." Another relative said, “Some of the [staff] are very kind and patient with the residents and I think, wow, it was great how you handled that. They do recognise people at individuals. I am happy with [registered manager’s name] and the team.”

Staff told us they regularly worked with partner organisations. One staff member said where people needed emergency care, “We can contact 999 or 111 ourselves, we don’t have to wait [for senior staff]. The registered manager told us, “We have a good rapport with [other health and social care professionals], so there is a difference in people's well-being, health and safety.” The registered manager gave us examples of where joint working with other health and social care professionals had a positive impact on people’s well-being. For example, as a result of joint working, a health professional had visited the home, rather than the person having to attend the health and social care professional’s office. This had helped the person to manage their anxiety. The registered manager gave us examples of joint work undertaken with community and faith groups. The registered manager said, “People do engage with this.”

Health and social care professionals described an open and honest approach to joint working, which benefited people living at the home. One health and social care professional said because of this, “I can’t speak highly enough of them. My colleagues think this is a go to home as well.” Another health and social care professional said, “We have a good rapport and communication is good with them.” A further health and social care professional told us, information was communicated them promptly, and if they had any queries, [Registered manager’s name] is always straight back with the information needed keep me totally up to date.” Health and social care professionals were confident Meadow View staff followed any advice they provided. One health professional said, “They do ask [for advice], for example, if there is a new item for someone, or changes.” Another health and social care professional told us, “I have not had to offer advice, they know what they are doing.” Health and social care professionals gave us examples showing how staff had sensitively worked with people from marginalised groups.

Systems were in place for promptly communicating any changes in people’s needs to relevant health and social care professionals and relatives. Processes were in place to engage with community and religious groups. Systems were in place to ensure people’s health, medicines and mental health needs were reviewed with partners.

Staff did not feel investigations to support improvement were always thorough. One staff member told us, “In certain things maybe, but ‘no’ is probably the answer." Staff described a lack of communication between staff teams which meant lost opportunities to share learning and good practice between colleagues. A staff member told us because the staff teams did not mix, there were no opportunities to share what worked well for people and any difficulties each team was facing. Staff also advised they had limited opportunities to reflect on their practice and consider learning through regular checks by senior staff. However, staff told us there had been some occasions where some learning was communicated during handovers at the start and end of shifts. The registered had sought an external review regarding their management of falls.

The provider’s quality assurance systems needed to be further improved and embedded, to ensure opportunities for taking learning were maximised. For example, the provider’s systems had not ensured the registered manager had been given feedback from staff during 2003. Systems in place had also not ensured learning from concerns raised by staff had fully and promptly communicated across all staff teams. Records of provider checks were not available for the full period since our last inspection. Where more recent provider checks were available some areas of learning, such as care plans and staff supervision had been identified. We found at this assessment learning had not consistently been taken in respect of these areas. However, some learning had been taken as a result of the provider’s quarterly manager’s meeting discussions, including in relation to medicines optimisation processes.