This comprehensive inspection took place on 21 June 2018 and was unannounced. The last comprehensive inspection took place 13 and 14 September 2016. The service was rated requires improvement in the key question is the service well led? We found one breach of regulation relating to the notifications of incidents because the registered person had failed to notify the Care Quality Commission of a safeguarding concern. We asked the provider to make the necessary improvements by November 2016.
On 15 February 2017, we carried out a follow up inspection to check that improvements to meet legal requirements planned by the provider after our September 2016 inspection had been made. We inspected the service against one of the five questions we ask about services: is the service well led? No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. On 15 February 2017, we found the provider was not fully meeting the regulation relating to notifications as they had notified us of seven out of eight incidents.
At this inspection we found the provider had met the regulation regarding notifications but was not fully meeting the regulations for the need for consent, safe care and treatment, good governance and fit and proper persons employed.
The Meadows Residential 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. The Meadows accommodates a maximum of 25 people. At the time of the inspection, 24 people were using the service.
The service is family run. The business owners were part of the management team and were active in overseeing the service. Another family member was the operations manager and there was also 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
During the inspection we found individual risk assessments were not always completed for areas such as risks related to falls, skin damage and pressure ulcers, malnutrition and moving and handling. Furthermore, window restrictors were not secure, some windows did not have restrictors and there were no risk assessments regarding this. This meant the risks associated with people’s care and well-being were not always identified so these could be appropriately mitigated.
Safe recruitment procedures were not always followed to ensure staff were suitable to work with people as gaps in employment that had not been explored, references were not always from the last employers and details of their criminal records checks at the time they started working at the service were not on file.
The principles of the Mental Capacity Act (2005) were not always followed as mental capacity assessments were not decision specific and we saw examples of relatives signing consent forms for people when they did not have the legal right to do so. Where people were able to make choices and give consent we saw that the provider and staff supported this.
Care plans mostly had appropriate information about people’s needs and preferences. However, we found information about their sleeping pattern and the times people liked to get up and go to bed, were not accurately recorded or not recorded at all.
The service had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective as not all risks had been assessed and mitigated and health and safety checks had not identified the issues with the window restrictors. Additionally, checks carried out on care records had not identified the issues regarding the completeness of these or the way in which some of the consent forms had been completed.
Incident forms recorded the details of the incident and the resulting actions. There were procedures for reporting and investigating allegations of abuse and whistle blowing. Staff we spoke with knew how to respond to safeguarding concerns.
Medicines were managed safely and staff had appropriate training.
The premises were well maintained and there were systems in place to identify any repairs needed. Staff we spoke with understood how to manage infections and wore appropriate protective equipment to reduce the risk of the spread of infection.
People’s needs had been assessed prior to moving to the service and care plans included people’s likes and dislikes. There were also records of end of life wishes and Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) forms to provide guidance to staff in such events.
Care workers had relevant training, supervision and annual appraisals to develop the necessary skills to support people using the service.
People's dietary and health needs had been assessed and recorded and were met.
People were treated with dignity and respect and we observed care workers communicated with people with care and encouragement.
The provider had a complaints procedure and addressed any complaints appropriately.
People using the service and staff told us the registered manager was available, listened to them and took action where necessary to act on their suggestions or concerns.
The provider received feedback and shared information through team meetings and completed satisfaction surveys.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the need for consent, safe care and treatment, good governance and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.