Archived: Meadow View

Updated 15 March 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 3 and 4 December 2018 and was unannounced.

The membership of the inspection team consisted of three Inspectors.

Prior to our inspection we reviewed notifications we received from the service. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescale.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed this information to assist us with the planning of the inspection.

We spoke with three people who used the service. We also spoke with two care staff and the acting manager.

We reviewed the care records of three people. We also looked at records relating to the overall quality and safety management of the service, three staff recruitment files, medicines management, staff meeting minutes and staff training.

Updated 15 March 2019

This unannounced comprehensive inspection took place on the 3 and 4 December 2018.

Meadow View is a residential care home providing accommodation and personal care for up to four people with mental health conditions. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection, three people were using the service. The service is provided from a single, two storey domestic dwelling.

We previously inspected Meadow View in April 2018 where the service was given an overall rating of ‘Inadequate’. We found continued breaches of Regulations 11, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Oversight and management of the service was chaotic and disorganised. There continued to be insufficient governance arrangements in the service and therefore was still not effective in mitigating the risks to people's health, welfare and safety. We found the registered manager had failed to address all the issues raised at the previous inspection in July 2017 where the service was given an overall rating of Requires Improvement as we found ineffective systems for monitoring the quality and safety of the service, insufficient numbers of suitably qualified staff, a failure to ensure people's consent to care and treatment was obtained and their capacity to make decisions appropriately assessed in accordance with the Mental Capacity Act (2005). The registered manager did not operate safe recruitment systems and train staff appropriately to meet the needs of the people who used the service. Risks to people's safety associated with improper operation of the premises had not been identified and action taken to reduce these risks.

Immediately following our April 2018 inspection, we formally notified the provider of our escalating and significant concerns and our decision under Section 31 of the Health and Social Care Act 2014, to impose conditions on their registration as a service provider in respect of the regulated activity with immediate effect to restrict further admissions to the service. We requested the provider tell us by the 23 April 2018 what actions they would take to mitigate the risks we identified at this inspection. This included the immediate risks of scalding from un-covered radiators, exposed hot water pipes, un-restricted windows, staff training and competency assessments. We found shortfalls in the provider’s ability to safely meet people’s specific physical and mental health needs, substance misuse and safe moving and handling. We requested an action plan to ensure dependency assessments were carried out with appropriate numbers of staff available at all times to meet people's needs. We also requested written evidence of the action taken to ensure a robust system was in place for regular maintenance of the premises.

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 service has a registered manager who was also the provider and registered as manager at their other service. At the time of this inspection the registered manager was absent and not in direct day to day management of the service. 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 registered manager continued not to have a clear understanding of the fundamental standards and regulations in relation to managing a care service. Since our last inspection in April 2018 the deputy manager had been promoted to acting manager. They told us the registered manager no longer directly managed the service but spoke to them on a regular basis by telephone with occasional visits. Since the acting manager had taken on this responsibility they had not been provided with a revised job description, sufficient training and were unable to demonstrate any understanding of the legal responsibilities they now held in relation to managing a care service.

At this inspection whilst we have acknowledged some areas of improvement, we found further work was needed to safeguard people from risks to their health, welfare and safety. For example, risks to people’s safety associated with the operation of the premises, risks from scalding, insufficient staffing levels, the management of people’s medicines and safeguarding people from abuse and improper treatment.

The leadership and governance of the service remains ineffective and unstable. Since our last inspection and in response to our concerns, support has been provided to the registered manager from the local authority quality improvement team. This support included a review of and guidance to improve care planning and safety audits. Whilst quality and safety audits had improved, it was difficult to see how these fed into the overall risk monitoring and used to drive planning for improvement in the long term.

There was a lack of effective systems in place to review concerns, safety incidents and safeguarding concerns to evidence learning from accidents and incidents and the action taken to prevent the risk of harm to people who used the service.

At our last inspection we identified people were not cared for in a clean, hygienic or well-maintained environment. The registered manager had not identified a number of infection control issues in checks and audits. Some action had been taken to improve the cleanliness and hygiene in the service, for example in people’s bedrooms. However, further work was needed to ensure the premises was properly cleaned and maintained. We continued to find areas of the service, unclean with the potential for the spread of infection.

Staffing numbers were not always sufficient to meet people’s needs. Staffing arrangements did not always provide sufficient staff to plan and provide access to ad hoc community activities. Further work was needed to ensure staff were recruited safely in accordance with the provider's own policy and procedure. Not all staff had received training in understanding the needs of people with mental health conditions.

Improvements were needed to ensure peoples’ medicines were managed safely. Staff did not always follow people’s care plans for dispensing medicines. For example, where people were prescribed antipsychotic medicines.

We have made a recommendation a review of care and support plans is carried out to ensure that people's autonomy and opportunities to enhance their life skills and personal development are clearly reflected and monitored.

The Mental Capacity Act (MCA) 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered and acting manager did not fully understand their role and responsibilities. Support and risk management plans indicated that each person had capacity to make decisions. We have made a recommendation that further consideration is needed as to potential fluctuating capacity for people to make decisions when heavily intoxicated under the influence of alcohol or illicit drugs.

People had good access to healthcare support, and information in their care records reflected their care, treatment and support was being delivered in line with expert professional advice.

There were improved systems for assessing people’s views as to the quality of the service they received with satisfaction surveys carried out. However, further work was needed in response to complaints to ensure clarity was provided as to how the complaint had been resolved and if the complainant was satisfied with the outcome.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report and one breach of Regulation 14 of the Health and Social Care Act 2008 (Registration) Regulations 2009.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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