Archived: The Meadows Care Home

The service is registered to provide accommodation for up to 55 older people with or without dementia. At the time of our inspection there were 53 people using the service.

There was a registered manager in post. 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.

This service was last inspected on the 24 November 2014 and was found to be requires improvement in three areas: Safe, responsive and well led. At the last inspection we had concerns about staffing levels and the support staff received which we felt sometimes resulted in people not getting the care that they received. We identified one breach around inadequate staffing levels.

At our most recent inspection we identified a number of improvements to the service and felt the home was well managed and staff reported that there was high morale and staff vacancies have been filled, which means continuity of care for people. The home had the staffing levels it had calculated it required and a generous allocation of activity hours to support people’s emotional well-being. However, a number of relatives had raised concerns about the care provided, specifically on the ground floor where several relatives told us people’s personal hygiene was not always met and people were not sufficiently stimulated.

On the day of our inspection there were lots of social activities being provided upstairs. But on the ground floor the majority of people were in their bedrooms, which was not the case on the first floor. Staff said this was because people were not in as good a health as those upstairs, but we felt more could be done to help people stay connected to others and take part in day to day activities.

There was a good range of activities for those offered them, which meant those people were sufficiently stimulated throughout the day. But we felt that not everyone was being included and that more could be done by care staff to engage people in activities around their routines and things that were meaningful to them.

Risks to people’s safety were monitored and clearly documented and staff knew people’s needs well. Staff received training in safeguarding vulnerable adults and knew who to report concerns to.

People received their medicines safely, but there were a number of things we identified which needed addressing to improve medication practices.

The homes recruitment processes were sufficiently robust. New staff were supported through an adequate induction processes and received training and support for their job role. We did identify gaps in staff’s knowledge and gaps in training but these were being rectified (by the manager?).

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberties Safeguards (DoLS). The MCA ensures that, where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People’s health care needs met were met and the manager had good relationships with other health care professionals.

People were supported to eat and drink but we were concerned about the accuracy of the records.

Staff were caring and regularly engaged with people. However, some of the interactions/language were not appropriate for the needs of people using the service.

People’s independence and safety were promoted as far as possible.

Staff were responsive to people’s needs but we did identify gaps in records which meant we were not always confident that people needs were responded to appropriately.

There was a complaints procedure but we found people’s concerns were not always recorded so we could not see if actions taken were appropriate.

The service was well managed and the manager spent time supporting her staff and listening to relatives to try and improve the care. We felt that sometimes the care provided was reactive rather than proactive and a more robust way of reviewing people’s needs would help identify things earlier.

There was a good quality assurance system but increased opportunities for relatives to participate in meetings would be beneficial. Perhaps improved communication between them and the home would help.

We observed the care being provided and spoke with people about their experiences of the service. For some people we saw evidence that their needs were being met and people were well. We noted that three people had been transferred from another registered service owned by the same provider. They told us they were unhappy at the Meadows and were looking forward to go back to the other service which had been closed temporarily. We have written separately to the provider about this issue.

We inspected this service on the 16 May to follow up on a warning notice served on the 12 April 2013. This was served following the inspection on the 7 March 2013 because we identified continued and serious breeches of regulation 9, Care and welfare of people who used the service. Following the inspection on the 7 March 2013, we also made compliance actions for staffing levels, supporting workers, and assessing and monitoring the quality of the service. These compliance actions will be followed up during an additional inspection to the service. During the inspection on the 16 May 2013 we looked at five people's care records and noted that improvements had been made to the planning and delivery of the service to ensure people using the service received good care. The service was not fully occupied. The provider had agreed voluntarily not to admit any one to the service until such time that they are able to meet people's needs in a satisfactory way.

The area manager wrote to us on the 21 January 2013 telling us what actions it would take to become compliant and said it would achieve this by the 31 January 2013. During the inspection on the 7 March 2013 we found continued concerns with care and welfare of people using the service, staffing levels, staff support and the assessment and quality of the services it provided.

During this inspection we looked at six care plans and others records relating to people's health and welfare. We spoke with staff, a visitor to the home and a number of people using the service and observed the care being provided. We found gaps in staffing levels which meant people were unoccupied for long periods of the day and did not receive appropriate supervision at mealtimes. Staff were not appropriately trained to meet the individual needs of people using the service. Care records contained gaps so we could not be assured care was being delivered as planned and there were poor management systems so the provider was not identifying this for themselves.

One person told us, 'Staff are wonderful here, they rush about, there is not enough of them especially in the evening. There is not much to do here.' Another person said 'Staff are lovely, nothing is too much trouble, staff are busy. There are some activities, bingo and cards, but not much else.'

We spoke with four relatives. One said, 'We don't visit very often but feel that my relative's needs are met." Another relative said their family member was not encouraged to go to the dining room and spent all their time in their room. They therefore believed they were isolated.

We looked at two care plans and records in four people's rooms. People's needs were recorded but not all the documents were up to date.

Staffing records were adequate. However there was no evidence that outside agency workers received an induction so we could not be assured that they were sufficiently knowledgeable about the service.

We found gaps in the management of the service so could not be assured the provider had effective systems in place to identify shortcomings