Meadows Edge Care 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

People and their families were not always encouraged or invited to participate in care reviews. Care records contained some conflicting information as when updating records old information remained in the care plan. Staff did not always follow best practice guidance for the management of skin integrity, monitoring bowel movements and monitoring of mood and signs of distress. People’s capacity and ability to consent to care had not always been considered in planning and managing their care.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not always supported to take part in care reviews we reviewed care records where documents ask, 'If care need were discussed with person or legitimate representative. 'An answer of. ’No’ was documented. There were also care records where this section was left blank. This meant there was a risk people were not supported in their preferred ways. We were informed that the service had made several attempts to contact relatives in order to involve them in their family members care reviews. This included, emails phone calls and notices around the home. We received mixed feedback from relatives some said that they had been invited to be involved in reviewing their relatives care needs, whereas others said that they had not been asked to be involved. One relative said they had attended a meeting at the home recently around reviewing their relatives care needs which had come as a surprise as their relative had been at the home for 3 years and this had been the first time they had been asked to be involved.

Care records were not always easy to read, the provider and manager were updating the care records to a new electronic recording system and staff were not fully using the new system. Staff were unsure where to direct us to we when we asked for information. The manager said that the care records were a work in process. We were not assured that staff were able to effectively access the information they needed to know how to manage people’s needs. Staff told us they would look in people’s care records to find out the care needs. However, we spoke with a staff member who was new to the service. At the time of our site visit they had not had the opportunity to review people’s care records to understand people’s care needs. During assessment we observed the new staff member to be supporting a person who needed a staff member with them at all times to ensure their safety .There was a risk that the staff member would not be able to effectively support the person as there was a lack of information available to demonstrate how to meet their needs.

We reviewed both the old system and the new system on site and asked for care records to be sent to us so that we could review them remotely. We found the care records did not always give the staff the information needed to be able to support people with their care needs. We found both systems had out of date and updated information. We found a person whose needs had increased following a fall and a possible decline in mental health, these changes had not been added to the person’s care record. There was a risk that staff would use the outdated information to support people. Additionally, language used in the care records was at times overcomplicated with medical terms that may not be understood by all staff. For example, intraparenchymal haemorrhage with intraventricular extension was recorded in one person's care records.

Staff did not always complete charts which would support them to know if people had either received planned care or would need additional support. For example, some people required their bowel movements monitoring in order for medication to be administered if required. These charts were not always completed. There was a risk that people would not be supported with medicines in a timely manner which could lead to health complications. Some people had charts in place to record their mood and any signs of distress. These charts were not always filled out with significant details. For example, one person’s chart stated they were vocal as a way of describing their distressed behaviour. This meant that reviews of medicines or what was working or not working to support the person may not be effective.

There were plans in place where the electronic recording system would identify if charts were not completed but this was not currently in use. There was no system in place to oversee if staff were completing charts to ensure people’s care was delivered safely and effectively.

One person’s relative told us that when they had brought to the staff’s attention their loved one needed to see a doctor the staff acted, and an appointment was made.

Staff said that teams within the home such as housekeeping and care teams worked well together and supported each other to meet the needs of the people living at the service. The home manager told us they were working to improve relationships with external health professionals. The home manager also told us they had recognised there were improvements needed to the way in which staff handed over information and that they were working with staff to ensure they handed over important information.

A health care professional told us that communication with the service could be difficult. A professional told us that when they ask how a person has been since there last visit, they are often told by staff that they do not know as they were not on shift the day before. The professional said they would expect the staff member to know how the person had been from a handover.

The home manager was new to the service although they were also the registered manager for another service owned by the same provider. They told us that they had recognised that staff handovers were not effective and that they were working with staff to improve this and ensure that all relevant information is handed over. They had also recognised that there were issues with communication between staff and the GP practise. The manager had introduced a tracker for staff to record when they are contacting the GP. They said they were working towards building a more open relationship with the GP service.

Most relatives we spoke with said they did not feel there were enough activities available to people. One relative said their relative was bored as they were not interested in what was on offer. We received mixed feedback about people’s dietary needs being met with 1 relative saying their loved one had visibly lost weight and were not aware of what was being done to support them with this. However, another relative said their loved one had put on weight and they were pleased to see them eating well.

The manager said there was an activities person employed but that they were not on the staff rota to confirm how many hours they worked. We asked staff about cultural dietary needs of people living at the service and were told that some people’s family would bring food in to meet their cultural needs, and that people were happy to eat English foods.

We reviewed people's food and fluid charts. Staff had been monitoring 1 person's intake as they had lost weight. They had been successful in supporting the person to regain weight which meant they no longer needed to monitor the persons in take. Consent to care and treatment

We observed a person having their movements restricted. This person was receiving support from a staff member during the day. They were sat in a chair with their feet on a high stool making getting up from the chair difficult. When they did try to leave the chair, staff encouraged them to stay. Staff did not effectively identify why the person wanted to stand or what their care need was or if not being allowed to move was causing them to be unsettled. This meant the person’s method of communication their needs were not understood, and they were not always getting their needs met.

Staff offered people who did not have capacity choices, such as what to wear. Staff said that if a person refused personal care they would try again later, as some people would refuse care due to their mood. This meant peoples choices were respected.

Most people at the service lacked capacity to consent to Meadows Edge being their place of residence and where they received care and treatment. The provider had applied and been granted Deprivation of Liberty Safeguards (DoLS) authorisation for these people. Care records were written so as to assume that if a person was on a DoLS then they did not have capacity to make any other decisions which is not in line with the Mental Capacity Act (MCA). One person's care plan referred to a best interest decision having been made around the person needing personal care should they frequently refuse care. However, there was no evidence of the best interest decision in the person’s care records, or how the staff should respond to the person refusing care. Care records talked about people having impairments relating to all aspects of daily living and personal safety. This approach did not support people to be able to give consent to care. There was a risk that new staff would read this and not give people options or ask for consent when giving care.