Long Meadow

Long Meadow is a residential care home providing personal care to up to 41 people. The service provides support to older people and younger adults. At the time of our inspection there were 34 people using the service

People’s experience of using this service and what we found

Systems to help protect people from abuse had not always been operated effectively. Not all relevant care plans and risk assessments required to help keep people safe were in place. Monitoring and assessment of people’s behaviours that challenged was not always consistent or effective. Equipment had not always been provided to ensure people received safe care. Accident and incident reporting and monitoring of behaviours that challenge were not always operated effectively.

Measures to prevent and control infection were not always effective as there was not always enough housekeeping staff to complete planned cleaning tasks. Staff had not always been deployed to ensure people received the care that was planned and needed. Not all agency staff had received appropriate support when they first started at the service. Other staff had completed training relevant to people’s healthcare needs.

Not all assurances were in place to show people received suitable food and people were not always offered meal choices.

Records were not always complete and accurate and the provider had not always followed their own safeguarding policy. Systems to help improve the safety and quality of services and reduce risks were not always effective. The provider had not always been able to provide a person-centred care care experience for people.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People’s healthcare assessments had been regularly updated. People saw other healthcare professionals when needed and had access to healthcare services. The home had been adapted to meet people’s needs and the provider had ongoing plans in place to refurbish parts of the home.

Policies were in place for the management of infections and outbreak such as Covid-19. Other actions had been taken since our last inspection to secure windows and ensure action plans were followed to ensure fire safety was maintained. Visitors were able to freely visit people living at Long Meadow. Recruitment processes were followed to help the provider recruit staff safely. Medicines were managed safely.

A new manager was in post and they intended to register with the CQC. Meetings were planned with staff and relatives to help keep them informed of relevant information and involve them in the running of the service. The provider understood and acted on their duty of candour to be open and honest when things had gone wrong.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 December 2022).

At our last inspection we found breaches of the regulations in relation to the systems used to ensure people received good quality care, are protected from abuse and receive safe care. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to people’s safe care, the use of equipment, staff competence, staffing levels and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Long Meadow on our website at www.cqc.org.uk

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have found breaches in relation to safe care, safeguarding, staffing and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is inadequate and the service is therefore in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means we will start processes that will prevent the provider from continuing to operate the service.

For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Long Meadow is a residential care home providing personal and nursing care to up to 41 people. The service provides support to older people, some of who are living with dementia. At the time of our inspection there were 33 people using the service.

People’s experience of using this service and what we found

We found several concerns around the management of people's medicines, including people not receiving their medicines safely and record keeping. People were at increased risk from the environment; fire safety and infection prevention and control risks were not always managed. People's health-related risks were not always consistently monitored, increasing risks to people. The provider had not always made safeguarding referrals to the local safeguarding adults team. This meant people were not always protected from the risk of abuse. We found there were enough staff to meet people's needs and staff were recruited safely.

The provider did not always follow their accidents and incidents, infection prevention and control and falls policies. This meant procedures to promote people's health, safety and wellbeing were not always operated effectively. Audits on people's medicines did not always promote sustained improvement where concerns had been found. Relatives mostly felt staff cared but shared concerns about people's personal items going missing. The staff did not always receive consistent supervisions to reflect on their practice. However, the provider held regular team meetings and sought feedback from people using the service and their relatives. The provider worked in partnership with external healthcare professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from concerns we received about staffing. However, we have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider took action to mitigate risks to some of our concerns during the inspection, however concerns remained in other areas.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Long Meadow on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed. We have identified breaches in relation to people’s safety, safeguarding and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Long Meadow is a residential care home providing personal and nursing care to up to 41 people. The service provides support to older people and people with dementia. At the time of our inspection there were 26 people using the service. The home is split over separate floors, each with communal lounges and dining areas.

People’s experience of using this service and what we found

People were supported by enough staff to meet their needs. Staffing levels were regularly reviewed and senior staff were involved in the calculations of staffing levels.

Rota’s showed staffing levels did not fall below the required levels. Whilst agency staff were regularly used to cover any short staffing, people and staff were generally positive about the agency staff used.

Domestic staff were able to complete their cleaning tasks as they were not required to routinely cover care shifts.

Feedback from staff following our last inspection was that staffing levels had improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 March 2022) and there were breaches of regulation. CQC issued the provider with a warning notice in relation to Regulation 18 (staffing).

The provider completed an action plan after the last inspection to show what they would do and when to improve. At this inspection, we found improvements had been made and the provider had complied with the requirements of the warning notice which related to Regulation 18 (staffing).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Long Meadow is a residential care home providing personal and nursing care to up to 41 people. The service provides support to older people including those who are living with dementia. At the time of our inspection there were 25 people using the service. The care home accommodates people across two floors, each of which has separate adapted facilities and communal areas.

People’s experience of using this service and what we found

There was not always enough staff deployed at the service to meet the needs of people safely and ensure cleaning tasks within the home were carried out.

Guidance relating to risk management was not always in place or detailed enough to support people safely. Systems and processes in place to monitor the quality of the service were not effective in driving improvement.

The culture within the home was not always positive and staff did not always feel listened to. People and their relatives told us they had opportunities to feedback in the running of the home.

People and their relatives felt the service was safe and there were systems in place to protect people from abuse.

Medicines were managed and administered in accordance with best practice. People received their medicines as prescribed and the home consulted regularly with the pharmacy for people who had medicine administered covertly.

The home worked in partnership with a range of different professionals and ensured timely referrals when appropriate.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 10 April 2019). The service was inspected but not rated on 8 February 2021. The service has deteriorated and is now rated Requires Improvement.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control practices. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with staffing, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of this service and what we found.

¿The service was clean, tidy and well maintained. Regular and thorough cleaning took place throughout the service including touchpoint areas. Staff we spoke with were all happy that the environment was clean and safe to work in.

¿Procedures were in place to facilitate contact between people and their families, when this was allowed.

¿Processes in place for any visitors were clear, and included a temperature check, hand sanitizing station, and appropriate PPE offered for use.

¿Suitable arrangements were in place to ensure that anyone moving in to the service, did so safely. This included a negative Covid 19 test before moving in, and isolating for a 14-day period within the service.

¿Staff had access to sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. The registered manager had been proactive in ensuring stock levels remained good for the staff. We observed staff using PPE correctly throughout the service.

¿Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.

¿Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.

¿Regular checks and audits around infection control were completed to ensure the registered manager had oversight on the service, and could address any issues promptly if found.

¿People were cared for in a safe manner, and regular checks were made to ensure their pressure sore risks were kept to a minimum. Staff felt confident in managing people’s skin care routines.

Rating at the last inspection

The last rating for this service was Good (published 10 April 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider has in place, as well as pressure care management.

We found no evidence during this inspection that people were at risk of harm from these concerns.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Long Meadow on our website www.cqc.org.uk

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People were safe. A person said, “The staff come and check us at night. We are alright but its good they check us. They look after us.” There were enough staff on duty to ensure people’s needs were promptly met. People had their medicines on time. The home was clean and fresh throughout.

The staff were well-trained and knowledgeable. A relative said, “The staff are skilled and know what they’re doing.” People and relatives made many positive comments about the food provided. A person said, “The food is superb.” Staff worked closely with local GPs and community matrons to ensure people’s healthcare needs were met.

The staff team were caring and kind. A relative said, “The staff treat [family member] as an individual and are nice to them. They give [family member] hugs and hold their hand to make them feel special.” A staff member told us, “The best thing about it [Long Meadow] is that it’s a home not an institution. We are a family here and we get on well with residents and relatives.”

Staff met people’s needs in the way they wanted. A person said, “The staff do anything you ask for you. They look after me and they look after everybody else.” The home organised a wide range of activities for people. A person said, “A lot happens here.” We saw people listening to music while enjoying a knitting session, and later a visiting entertainer led a singing and movement session. People joined in and the atmosphere was happy and lively.

People, relatives and staff told us the registered manager was approachable and helpful. A staff member said, “[Registered manager] is fantastic – you can go to her about anything and she talks to people and relatives every day.” Staff worked closely with other health and social care professionals. A visiting healthcare professional told, “The home has got a lovely outlook, the staff are very caring, and the registered manager has her finger on the pulse.” The provider and registered manager audited all aspects of the home and made improvements where necessary.

For further information please see the full report.

Rating at last inspection: At our last inspection (report published on 31/05/2016) the service was rated as Good.

Why we inspected: This was a scheduled inspection based on the service’s previous rating.

Follow up: We will continue to monitor this service.

At our last inspection on 2 October 2013, we found that where people were unable to make informed choices about important life decisions, their best interests were not always being fully considered. Following that inspection we asked the provider to send us an action plan detailing when they were going to meet this standard. At this inspection we found the necessary improvements had been made and no further concerns were identified.

A registered manager was in post, although not present on the day of the inspection. 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.

People were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained, competent and confident to meet their individual needs. People were able to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were opportunities for additional staff training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

Up to date policies and procedures were in place to assist staff on how keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

Quality assurance audits and a formal complaints process were in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.