Archived: Meadowfield

The home is a house that has been adapted to meet the needs of the people living there. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Meadowfield was last inspected by CQC in April 2017 when the service was rated as Requires Improvement. We had found that systems relating to service user finances had been improved and there was now a registered manager in post. At this visit we saw improvements had been made and the service was meeting all regulations at this time.

People told us they felt safe and there were sufficient staff to meet people's needs. We found that this was a consistent staff team who knew people well.

People received safe support with their medicines. Where people wished to manage their own medicines independently this was encouraged and there were checks in place to ensure it was carried out safely.

People had risk assessments that described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP and social worker.

The premises were homely, maintained in good order and suitable for people's needs.

Staff told us they felt well supported in their role; they received induction and training. Staff received regular supervision sessions and an annual appraisal.

People had choice and control of their lives and staff supported them in the least restrictive way; the policies and systems in the service supported this practice. People told us their privacy and dignity was very well respected and that people’s religious and cultural needs were also valued by the staff team.

Staff were aware of the importance of supporting people with good nutrition and hydration. We saw that people were encouraged to shop for and prepare their own meals.

People had access to healthcare services to promote their physical and mental health. We saw that people were supported to have annual health checks and to attend health screening appointments.

There were detailed, person-centred care plans in place, so that staff had information on how to support people. ‘Person-centred’ is about ensuring the person is at the centre of everything and their individual wishes, needs, and choices are taken into account.

People were able to take part in a range of activities of their choosing and which were meaningful to them. People were supported to look for paid employment, volunteering roles and training to support them to develop the skills for employment. People were supported to play an active role in their local community, which supported and empowered their independence.

There was a complaints procedure in place, should anyone wish to raise a complaint. People told us that any issues would be addressed but no one raised any concerns with us. Staff knew how to access advocacy services if people needed them.

There was a quality assurance system, which enabled the provider to monitor the quality of the service provided.

We received positive feedback about the registered manager, staff and the service as a whole. Comments from people, staff and visiting healthcare professionals indicated there was a positive, person centred culture within the service.

Meadowfield provides accommodation and personal care for up to five people with a learning disability and / or mental health needs. There were four people accommodated there on the day of our inspection.

There was no registered manager in post. A manager was appointed and was in the process of applying to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 using the service and a relative told us they felt safe and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe. A robust system to account for financial transactions made on behalf of people using the service was not in place. We identified some accounting errors and a bank account managed by the provider was not subject to internal or external audit. We previously made a recommendation about this.

The accommodation provided was suitably adapted for the people who lived there. The building was safe and well maintained. Risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring, although a legionella survey of the water system was not available for inspection. Minor maintenance issues were dealt with at the time of the inspection. The home was clean throughout.

We observed staff acted in a courteous, professional and safe manner when supporting people. Staffing levels were sufficient to safely meet people’s needs. The provider had a system to ensure new staff were subject to thorough recruitment checks, although none had been recruited since our last comprehensive inspection.

Medicines, including topical medicines (creams applied to the skin) were safely managed. People were supported to manage their own medicines where appropriate.

As Meadowfield is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. People’s mental capacity was considered through relevant areas of care, such as with decisions about finances, medicines and supervision when outside the home. Where necessary, DoLS had been applied for. Staff discussed proposed interventions before providing care to obtain the person’s consent.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were supported by their manager. Staff performance was supervised and assessed.

People’s nutritional and hydration (eating and drinking) status was assessed and plans of care put in place where support was needed. People were supported to access health services to ensure their medical needs were met promptly.

Staff displayed an attentive, caring and supportive attitude. We observed staff interacted positively with people. We saw that staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained. Staff were able to communicate effectively with the people living at Meadowfield.

Activities were accessed within the home, independently and via separate day services. Staff worked collaboratively with local day care services. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.

People using the service, a relatives and staff spoke well of the manager. Systems were in place to assess and monitor the quality of the service, which included feedback from people receiving care and oversight from an external manager. The manager and staff team had worked to address areas for improvement identified at a previous inspection, although some further work was still required.

The provider had met some of the assurances they had given in their action plan, however one area identified at our last inspection had not been addressed and an additional concern regarding the robustness of financial safeguards was identified. The provider was in breach of the regulation relating to good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadowfield on our website at www.cqc.org.uk.

Meadowfield provides accommodation and personal care for up to five people. Accommodation is provided over three floors in five single bedrooms. Access between the floors is by stairs only. At the time of the inspection there were four people accommodated in the home.

The service had a manager registered with CQC but they were no longer in post and had moved to manage another location operated by this organisation. A newly promoted member of staff was in day to day charge of the service. They told us they had commenced the process of applying to become a registered manager. The change in management had not been notified to CQC. 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.

Since our last inspection, an inspection of the homes electrical installation had been carried out and was found to be safe. Evidence that a water safety survey had been conducted could not be provided to us. Data sheets for hazardous chemicals used in the home were not readily available for staff to reference. Basic first aid items, such as a thermometer and plasters were not stocked. Many dry dressings were out of date; some by several years.

We found the provider had met some of the assurances they had given in their action plan, however two areas identified at our last inspection had not been addressed and an additional concern regarding the availability of basic first aid items was identified. The provider remained in breach of the relevant regulation relating to safe care and treatment.

We found that care was tailored to meet individuals' needs and ensured that risks to their personal safety were properly managed. People told us they were happy at the home and with the staff who supported them. They were asked their views about the service, and any comments and complaints were appropriately acted on.

There were enough experienced staff to make sure people received consistent support. However, arrangements for checking that staff had the necessary skills to give people their medication safely were not satisfactory.