As part of this inspection we spoke with eleven people who used the service, three relatives and four members of the care team. We also spoke to a registered nurse on duty at the time of our visit, the registered manager and the provider's head of compliance, who arrived at the service during our visit. We looked at records including people's personal records, medication records and records kept in relation to the management of the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:
Is the service safe?
Ten of the eleven people spoken with told us that they felt safe living at The Meadows and that they were treated well. One person told us that they hadn't always been cared for in a safe way. One person explained: 'I am more than satisfied, they treat me very well.' Another person told us: 'You can't fault the staff, I do feel safe here.' One person explained: 'If they hit my legs on the bed or the hoist, they say sorry. [When staff were transferring them from their chair to their bed] A relative told us: 'I feel mum is safe, if I can't come at least I know she's looked after.'
We talked to staff to determine whether there were enough staff on duty to meet the needs of those in their care. We were told there were not. One care worker told us: 'No there could be more, mornings are a very busy time. More people need one to one help and more people need two carers now, it's hard.'
People who used the service expressed their concerns about the numbers of staff on duty. One person explained: 'When you ring your bell for help, sometimes it's 10 minutes, sometimes half an hour to 40 minutes, especially in the evenings when I want to go to bed.' This meant that the people who used the service were not always kept safe from possible injury and their dignity was compromised.
The manager completed a pre-assessment of people's needs before people moved in to the service to make sure their assessed needs could be met. One person told us, 'xxxx [the manager] came to see me and asked lots of questions.'
Records kept to monitor how much fluid people had consumed during each day were not up to date and repositioning charts (used for people unable to move themselves in bed) showed us that people were not being assisted as directed in their care plan. This showed us that people were not protected from the risk of dehydration and the development of pressure sores.
A safeguarding incident involving one of the people who used the service had not been reported to the local authority safeguarding team. This meant that it had not been investigated under safeguarding procedures to ensure that the person who used the service had been kept safe from harm.
Staff we spoke with knew what to do if they suspected that someone was being abused. One care worker explained: 'You report it to your senior and the nurse, then the manager.' Another care worker told us: 'I would report whoever was involved to the nurse or the manager.'
On checking the medication records we found that on one day, the registered nurse had failed to sign to say that they had dispensed two people's medicine. On a second day they had failed to sign one person's medicine. Medication that had been stored in the medication fridge was out of date. Forticreme [food to supplement people's diets] were not being stored in line with manufacturer's instructions.
Is the service effective?
We spoke with eleven people who used the service to find out if they were satisfied with the care and support they received. Some told us they were, others told us they were not. One person told us: 'I would like to get out of bed more, I hate bed, I don't know when I will get out today, it is up to the carers.' Another person explained: 'The staff are alright, we pick out clean clothes every day and my teeth are sterilised in steredent every night.'
Relatives told us that they were happy with the care and support their relative received. One relative explained: 'Mum always looks cared for and the carers are lovely.' Another relative told us: 'The carers are brilliant, very kind.'
Care plans provided care workers with information about people's care and support needs though these were not always accurate or had not been followed. This meant that people had not received the care and support they needed.
Although an assessment of need had been carried out for the people who used the
service, there was no evidence to confirm that they, their relative or their advocate, had given their consent to the care or support received.
Is the service caring?
We observed staff going about their work. They treated the people they were supporting in a kind and respectful way. Due to limited staff availability we found that not all the tasks that needed to be carried out had been. This included for two people their nail care and for another, the removal of dropped food from their bed sheets when they had finished their meal. This compromised the dignity of the people who used the service.
The people who used the service told us that, on the whole they were treated with respect and we observed staff knocking on doors and calling people by their preferred name. One person told us: 'Some of them [care workers] treat us with respect, others not so. Some of them are really sharp.' Another person explained: 'I am treated with respect; I have a laugh with them.'
Is the service responsive?
The needs of the people who used the service had been assessed before they moved into the service and they and their relatives/advocates had been involved in this process.
Relevant professionals had been involved in people's care. Records showed that visits had been arranged when necessary. These included visits from their doctor, their dentist, the local speech and language team and the tissue viability nursing team. This ensured that people who used the service received the care and treatment they required.
On checking the records belonging to one of the people who used the service we found that they had not been provided with the treatment they required for a pressure sore for over ten days. This was rectified on the day of our visit. The nurse in charge carried out the treatment and updated the records. The local safeguarding team were informed.
Is the service well-led?
A monitoring system was in place but the effectiveness of this was questioned because of the shortfalls that were identified during our visit.
Care plans had been reviewed on a monthly basis. This enabled the staff team to monitor people's needs. Where changes in people's health and welfare had been identified; these documents had been updated to reflect this. Risk assessments had not always been reviewed monthly. This meant that the people who used the service were at risk of having their health and safety compromised.
Staff meetings had been held. This provided the staff team with the opportunity to have a say on how the service was run. A meeting for the relatives and advocates of those who used the service had also been held. This gave relatives and advocates an opportunity to have a say about the service that was provided. The people who used the service were given the opportunity to discuss any concerns on a day to day basis. One care worker explained: 'We ask them if they have any concerns and then we would take them to the manager.'
Staff on the whole felt supported by the management team and told us that they felt able to talk to someone should they have a concern of any kind. One care worker explained: 'I feel 100% supported.' Another care worker told us: 'You can talk to some of the nurses or the manager.'