Meadowview Care Home

At the last comprehensive inspection of the service in March 2017 the service was rated good.

Meadow View Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Meadow View Care Home is registered to provide care for up to 39 people, with accommodation in single or shared bedrooms over two floors. It is situated in the Castleton area of Rochdale, Greater Manchester. At the time of the inspection there were 37 people living in the home.

There was no registered manager in post. 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. The current manager is in the process of applying to be the registered manager.

At this inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was for fire safety. You can see what action we told the provider to take at the back of the full version of the report.

We also made two recommendations to support further improvement. We have made a recommendation about how decision making is recorded for people who lack capacity for specific decisions. We have made a recommendation regarding improvements required in relation to the Equality Act 2010.

Systems were in place to monitor the safety of equipment and required checks were up to date, including gas and electric safety checks.

Systems were in place to ensure sufficient numbers of staff were provided and people reported feeling safe.

Staff were aware of their responsibilities to safeguard people from abuse and risks to people's safety were assessed with guidance on how to minimise the risks. The service had a whistleblowing policy and staff reported feeling able to report poor practice if required.

Risks to people's safety were assessed with guidance on how to minimise these risks. Accidents and incidents were recorded and risk assessments were updated in response if required.

The home was clean and staff had received training and understood their infection control responsibilities. There was a business continuity plan in place to help staff respond appropriately to any emergencies that could arise.

People’s needs were assessed before admission and a support plan was put in place to meet these needs. This was reviewed and updated monthly. The service worked closely with other agencies to provide the care that people needed.

Positive feedback about the care staff and the standard of care was received during the inspection from three health care professionals. The local council had also reported improvements to the service within the past three months.

The premises were adapted appropriately for the people who lived there. It was dementia friendly and practice in this area was excellent. The home environment was tailored to support people’s safety, independence and well-being.

People’s nutritional and hydration needs were assessed and adhered to. The lunch time experience needed to be more person centred and communication of people’ specific dietary requirements needed to improve.

Relevant authorisations were in place where people were being deprived of their liberty. Care records show that capacity and consent had been considered when planning people’s care and support.

Staff felt supported and were provided with an induction to prepare them for the role and regular training was provided to support care staff to meet the needs of people effectively.

Staff interactions were kind, caring and respectful. People’s dignity and privacy was respected. Independent advocacy was promoted to help safeguard people’s rights.

Care planning did not fully consider the Equality Act 2010. Confidentiality and data protection was covered by the induction and staff training.

Care files were person-centred and included information about people’s likes and dislikes.

There had been some negative feedback about the activities available to people in the home. A new activities coordinator was in post and was supporting people to pursue their individual interests and plans were in place to improve access to the local community.

The accessible information standard was met. People were routinely assessed to ascertain what their communication preferences or abilities were.

There was an appropriate complaints policy and procedure in place and people told us they knew how to complain.

The home had an end of life policy that provided guidance to staff and the home actively involved family as much as possible.

The management team were committed and hands on. Staff, relatives and health and Social care professionals reported an open culture. Staff supervisions, team meetings and handovers were held regularly and staff reported feeling supported in their roles.

There was a positive impact from the new manager and the home was moving in the right direction.

At the last inspection of September 2015 the service did not meet all the regulations we inspected and were given a requirement action. This was because the administration of medicines was not safe. There were no protocols for ‘as required’ medicines and poor recording of any creams administered. The service sent us an action plan to show us how they intended to meet the regulations. At this inspection we saw the improvements had been made and the regulations were met. This unannounced inspection took place on the 06 and 09 March 2017.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

The home was clean and tidy. The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

People were given information on how to complain with the details of other organisations if they wished to go outside of the service.

Staff and people who used the service all told us managers were approachable and supportive.

Meetings with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

There were suitable activities to provide people with stimulation if they wished to join in.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service.

New documentation had been completed when assessing and planning people's care. Information was seen to be written in a sensitive manner and provided instruction for staff about the needs and wishes of people.

Suitable arrangements were in place when recruiting new staff. Systems offering on-going training and support for staff had also been developed. Staff spoken with felt supported in their work.

Systems to monitor and review the quality of service provided were being developed. This information should help the manager identify where improvements are needed.

The home continued to be managed by a manager who is not registered with the Care Quality Commission (CQC). The provider had not responded to requests from us about this issue. The current manager had tendered their resignation and therefore a new appointment needed to be made. The provider must ensure that the newly appointed person registers with the CQC without delay.

During this visit we did not speak to people directly about their experiences however we observed care and checked records to see what improvements had been made.

We found appropriate advice and support had been sought from the dietician ensuring people's nutritional needs were met. Records monitoring people's weight and their diet had also improved.

An observation of the lunchtime meal was seen to be relaxed and unhurried. People were offered a choice of meal and where necessary encouragement and support was provided by staff.

Improvements were still needed to care records so that information included people's preferences as well as show how they had been involved in the development of their care plan.

Opportunities for staff training had been offered in areas of protection providing staff with the knowledge and information needed to keep people safe.

The manager was reminded that relevant incident reports must be provided to the us, to show that appropriate action had been taken to ensure people were kept safe.