The Meadows Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked at 4 quality statements under the Effective key question: Assessing needs, delivering evidence-based care and treatment, how staff, teams and services work together and consent to care and treatment. The provider had failed to ensure people’s needs were adequately assessed and regularly reviewed to ensure staff were able to support people in line with their current needs. People were not always involved in their care planning. Care plans were not always person centred. Staff did not always work collaboratively with health professionals. Guidance and instructions to mitigate risks and achieve best outcomes for people were not always followed.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Not all people were able to tell us if they were involved with their needs being assessed. One person told us they had not been involved in their needs being assessed, or their ongoing care needs. However, a relative told us they had a discussion when their loved one’s needs changed. Some people felt that their needs and preferences were not always met. One person told us, “They [staff] don’t have time to brush my teeth.” Another person said, “I’ve been here 6 years. They [staff] they don’t change my clothes when I spill something on them. My clothes aren’t always clean, but I feel clean as they do wash me”.

One member of staff told us care plans were not complete or up to date, despite this they were able to tell us about people’s individual needs, however not all staff were able to. We asked 1 member of staff what was in a person’s care plan regarding their meal preferences, the member of staff did not know. The provider had acknowledged care plans needed to be updated and monitoring charts needed to be completed at point of care and were working on this.

Care records were not routinely reviewed and updated. Care plans did not always include up to date information, for example, where people had experienced unintentional weight loss, care plans had not been updated to say what measures were in place to monitor and manage this. Where measures had been recorded for instance to undertake weekly weights, this had not always been undertaken. Processes were not in place to ensure people and their relatives, where appropriate, were involved in assessing people's ongoing care needs.

People did not always receive care and treatment that met their needs. This included people who required support with pressure relief, nutrition and hydration. We observed the lunchtime experience on both units. On the dementia unit, we found people were not supported to make choices and no explanation was given as to what food people were being served. Staff did not always support people who needed assistance to eat their meal. On the nursing floor the lunch time experience in the dining room was more interactive interactive, tables were laid with condiments, meals served reflected the menus displayed, the chef offered choices to people and served the meals to them. However, there were delays providing meals to people in their rooms and people were not always asked what they wanted. People living on the dementia unit were not always adequately supported to meet their hydration needs. Drinks such as squash or tea were offered regularly, however, staff did not encourage people to drink or monitor if drinks had been consumed. We received mostly positive feedback from people regarding food provided by the services, comments included, “The food can be good” and “I like the food but I don’t eat much of it”.

Staff did not always have the skills and knowledge to support people in their best interests. One staff member told us staff were rushed and basic care needs were not always met such as oral care.

Risk assessments had not been completed for people who were at risk of choking. The provider used recognised assessment tools such as Waterlow Score which is a risk assessment tool for identifying and managing pressure ulcer risk. However, records did not demonstrate support provided was in line with outcomes of assessments. For example, where people were identified as high risk of developing skin damage, we found there were gaps in repositioning records. One person had fallen and sustained an injury to their nose, however, the provider did not follow the care plan regarding the head injury. The falls care plan stated that in case of head injury an ambulance was to be called for a CT scan to rule out potential bleed due to being on blood thinners. There was no record of this happening. There was one person Covid-19 positive at the time of our assessment. However, no one had a Covid-19 risk assessment in place including the person in question.

People were not always supported to have access to external healthcare professionals, one person said “I used to get my ears syringed but not whilst I have been here. I can’t hear very well; I would like them doing”. Another person had fallen and hit their head, staff did not summons medical attention in accordance with the persons care plan.

Staff told us people were assessed prior to moving into the service to ensure their needs could be met. However, when we requested to see one person’s pre – admission assessment the paperwork could not be found.

Throughout the assessment we spoke with other stakeholders such as the local authority and funding authorities. The feedback we received supported our findings that the service did not effectively or consistently assess people's care and support needs in collaboration with community partners.

The manager was new in post and a new deputy manager had started in February 2024. The service was using agency staff to fill vacancies on the rota. At the time of our assessment the provider was recruiting to a number of vacancies. Daily handovers were held at each shift so important information could be shared and acted upon. We observed a handover take place, and information was shared that the nurse from the surgery had requested that 2 people had daily monitoring of the blood pressure so that the GP could review the medication they were taking. We reviewed the care records and found the instructions had not been followed.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People’s consent was not always obtained when providing care and support. There was a lack of evidence that relative, advocates and other professionals had been consulted on decisions.

Not all staff had received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff did not always recognise when people were being deprived of their liberty or when to make best interest decisions. This demonstrated a lack of understanding around the principles of the MCA.

Ensuring consent to care and treatment in line with law and guidance The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. People had capacity to make day-to-day decisions. We found the provider was not always working in line with the Mental Capacity Act. For example, where people could not make decisions and consent to their care, actions taken by the provider were not always the least restrictive option or in the person’s best interests; Records did not always evidence involvement of relatives or other professionals where appropriate, being involved in best interest meetings; Processes were not effective in ensuring DoLS applications were submitted in a timely manner. We found 3 people’s DoLS had expired before new applications had been submitted. This meant people were being unlawfully deprived of their liberty.