Archived: Meadow Lodge Care Home

Meadow Lodge is a care home providing accommodation and personal care people for younger adults and people aged 65 and over. At the time of the inspection 11 people were living at the home. The service can support up to 22 people.

People’s experience of using this service and what we found

The provider has a poor history of meeting the regulation. When improvements are made, they are not always sustained. The provider had a quality monitoring system in place, this was not always effective. Issues were identified and not acted on in a timely way or the system did not identify the issues.

The environment was not always maintained in a way that ensured people’s safety. Infection control practices were in place but not consistently effective. The management of risk’s to people was not always effective and placed people at risk of potential harm.

Medication was not always stored or managed safely. People’s care records were not always detailed, accurate and kept up to date.

Staff knew how to report concerns of abuse and there was enough staff to respond to people’s request for care. However, not all staff felt the service was well managed.

People told us they were happy with their care and felt safe living at Meadow Lodge.

Rating at last inspection and update.

The last rating for this service was Requires Improvement (Published on 12 November 2019).

Why we inspected

The inspection was prompted due to concerns about poor infection prevention and control (IPC) and whistleblowing concerns including concerns about the management of the service. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. We only looked at safe and well led during this inspection. We did not look at the key questions of effective, caring and responsive. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains as Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadow Lodge care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches in relation to safe care, premises and good governance. Full information about CQC's regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.

Please see the action we told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan for the provider to

understand what they will do to improve the standards of quality and safety.

Meadow Lodge is a residential care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

People’s experience of using this service and what we found

There were not always enough staff to meet people’s needs. Medication was not always stored safely as temperature checks were not completed. Risks to people were not consistently assessed. Staff knew how to report concerns of abuse and there were effective infection control practices in place.

Staff received training relevant to their role. People’s dietary needs were met and the decoration of the service met people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, records did not evidence that the Mental Capacity Act had been followed where people lacked capacity. People were not consistently supported to access medical appointments. Staff received training relevant to their role. People’s dietary needs were met and the decoration of the service met people’s needs

People were not always treated in a kind or dignified way. People were supported to make choices and people’s independence was promoted where possible.

Although staff knew people well, care records were not consistently personalised. There was a lack of activities available for people. Complaints made had not been investigated appropriately. People’s end of life care wishes had been considered.

Although there were systems in place to monitor quality, these had not identified the areas for improvement found at this inspection. Although people had been given opportunity to provide feedback, it was not clear if this had been acted upon.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 13 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about people missing medical appointments. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to people being treated with dignity and management oversight of quality. 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There were no breaches of legal requirements at the last inspection in August 2018. There were four conditions that had been imposed on the provider following an inspection in March 2018. This included, the provider to sending us an action plan each month of how they were meeting the regulations, the need for a deep clean of the premises, no admissions without CQC’s prior approval, to ensure that sufficient amounts of suitable and nutritious food should always be provided to meet the needs and preferences of people living at the home, and to take immediate action to obtain healthcare support for people with pressure sores or people losing weight. At this inspection we found the provider was meeting these conditions.

Meadow Lodge 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. Meadow Lodge is registered to provide care and accommodation to a maximum of 22 older people, younger adults and people with a diagnosis of dementia.

At the time of the inspection, there were 13 people living at the home. Two people who usually resided at the home were in hospital at the time of our inspection visit.

There was a manager in post who had applied for registration with CQC at the time of the inspection. 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 manager was present at the time of our inspection.

The provider understood their legal responsibilities, but had not formally notified us of some allegations of abuse, which were not raised by the provider, manager or staff, but other professionals. although, upon our request, had backdated these and forwarded them to us following our inspection. Systems for the governance of the service were more robust and the action plan we received from the provider following our previous inspection had been addressed. We did though identify some further areas where there was scope for improvement or resolution of issues that we made the provider/manager aware of following our inspection. With little exception, people had confidence in the manager, and were satisfied with the standard of care they received. People and staff could approach the management and express their views and these were acted upon. Staff felt supported by the provider and thought the service was improving.

People felt safe and we saw risks to people were assessed, understood and implemented by staff. There was sufficient staff to respond to people’s needs and keep them safe. Staff knew what constituted abuse and knew how to respond/report to allegations of abuse. People’s medicines were managed safely and given as prescribed. There have been improvements to the environment and these were continuing or being maintained in respect of their safety and cleanliness. New staff were checked to ensure they were safe to work with people.

People’s choice of, and the quality of the meals available had improvement, and we saw people could have more food at meals times if wished. People’s right to consent was sought by staff and any restrictions on their liberty were agreed with the local authority. Staff were appropriately trained and the provider reviewed staff training frequently. People could access healthcare services as and when needed, and the provider monitored people’s health to ensure this access was promoted as needed.

People were supported by staff that were kind and caring. Staff were seen to treat people with dignity and respect. People's independence was promoted by staff and they were encouraged to express their views and make choices about their daily living. People’s contact with relatives and friends was promoted.

People’s care plans reflected their needs, wishes and preferences, with people and their representatives involved in their individual care planning. Staff understood and people’s needs, preferences and wishes and would try to ensure these were followed. People had access to leisure opportunities and staff encouraged their involvement with them. People could raise complaints and these were responded to by the provider.

As the service was rated ‘Inadequate’ we placed the service in special measures following the November 2017 inspection. We asked the provider to send us an action plan each month of how they were meeting the regulations. We placed four conditions on the provider’s registration, telling the provider that a deep clean of the premises should be undertaken and that no-one should be admitted to the home without CQC's approval, and that sufficient amounts of suitable and nutritious food should always be provided to meet the needs and preferences of service users. In addition, we told the provider they must take immediate action to obtained healthcare support for people with pressure sores or people losing weight.

Services in special measures are 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 improvements are 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 the service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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 and is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We inspected this service again on the 23 and 24 August 2018. The inspection was unannounced on the first day. On the second day of the inspection the provider and manager were informed we would return to the home. The inspection was to check on whether the provider had made the necessary improvements.

Meadow Lodge 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. Meadow Lodge is registered to provide care and accommodation to a maximum of 22 older people, younger adults and people with a diagnosis of Dementia.

At the time of the inspection, there were 13 people living at the home. Two people who usually resided at the home were in hospital at the time of our inspection visit.

There was no 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. A manager had been appointed at the home, and had applied to register with CQC as the registered manager, which was still under consideration by CQC.

We found improvements had been made at the home since our previous inspection. At our previous inspection we found the provider and registered manager did not always manage risks to people's safety, and people were placed at unnecessary risk. At this inspection we found risk assessment procedures had been improved, however, environmental risks continued to be managed inconsistently. Further improvements were required to ensure people were always supported safely.

Infection control practices had improved and the home was cleaner than before. However, we found improvements still needed to be made to ensure people were protected from the risk of infection, especially at weekends when cleaning staff were not on duty. We found at sometimes during the day unpleasant smoke odours continued to disseminate throughout the dining area and hallway.

People had access to sufficient amounts of food to maintain their health and weight. However, we continued to find the meals provided did not always meet people's preferences. Action was taken to refer people to health professionals when needed, to gain treatment when their health needs changed.

Staff were available to take care of people's immediate care needs but did not always have time to spend with people.

Care records had been improved since our previous inspection visit and medicines were managed safely. People were involved in the planning and review of their care. Care records were individual to the person and people’s specific communication needs were met.

Staff had received updated training to enable them to support people effectively.

The manager and staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and supported people in accordance with the Act. Staff were aware of who needed support to make decisions about their care and welfare.

People were not always treated with dignity and were not consistently given choices in their daily lives. There continued to be a lack of stimulating activities and support to people, to engage them in hobbies, interests and events that might increase their wellbeing.

The provider had taken action to improve the service and had acted on the concerns raised in previous inspections. However, improvements needed to be sustained and built upon to ensure people always received good quality care that met their needs.

Where the provider was identifying areas that required improvement, action to improve the home and the quality of care people received had been taken.

This service has been in Special Measures since January 2017. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements had been made and is no longer rated as ‘Inadequate’ overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Meadow Lodge 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. Meadow Lodge is registered to provide care and accommodation to a maximum of 22 older people, younger adults and people with a diagnosis of Dementia. At the time of the inspection, there were 17 people living at the home.

There was no 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. A manager had been recruited and was in the process of applying to register as a manager.

The overall rating for this service is ‘Inadequate’ and the service 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 will no longer be in special measures.

Risks were not managed to ensure people were safe. Where risks were known, action had not always been taken as required to ensure people were safe. Infection control practices were poor and the home was visibly unclean with unpleasant smoke odours throughout the dining area and hallway. Staff were available to take care of people’s immediate care needs but did not have time to spend with people. Medicines were not always managed or stored in a safe way.

Staff had not received the appropriate training to enable them to support people effectively. People did not have access to sufficient amounts of fresh food and meals provided did not meet people’s preferences. Action was not always taken in a timely way to ensure that people had access to healthcare services when required. Staff knowledge of Deprivation of Liberty safeguards varied.

People were not always treated with dignity and were not consistently given choices in their daily lives. People’s specific communication needs were met and people had access to advocacy services where required.

People were not consistently involved in the planning and review of their care. Care records were not always individual to the person. People felt that their complaints were not listened too and there was a lack of activities available for people.

The provider had failed to ensure that the concerns raised in previous inspections had been acted upon. Quality assurances systems in place were ineffective at identifying areas for improvement and this had led to people receiving poor care. Where people had given feedback on their quality of the service, this was not acted upon. People did not speak positively about the provider.

At our most recent inspection we found that improvements had been made in relation to Regulations 11 and 14, but no improvements had been made in relation to Regulations 12 and 16. The regulation specified in the Warning Notice had not been met. During our most recent inspection we also found a breach of Regulation 9, Person Centred Care.

Meadow Lodge 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. Meadow Lodge is a care home without nursing that can accommodate up to 22 people. At the time of our inspection 19 people were living at Meadow Lodge, some people lived there long term and others lived there for short periods of time such as respite care. This included a number of people who lived with dementia.

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. Meadow Lodge did not have a registered manager in post when we inspected. An acting manager had been appointed but they were not available to us throughout the inspection. During the inspection process the inspection team were supported by the provider and senior care staff.

People were not safe. Although people and relatives said they felt the service was safe, we found risks to people were not managed well and not always known or clearly understood by staff. Risks to people were not consistently assessed and therefore people were not kept safe from the risk of harm. Recording of these risks was not always evident, and in some cases the recording had not been reviewed as needed to reflect changes in people’s care needs. People were not kept safe from risks associated with some aspects of the environment. People did not have access to a safe open space. Risk assessments were not in place to support people to safely access the garden.

People were put at risk of increased infection as facilities and systems were not available for staff to maintain good hygiene People were put at risk due to poor prevention and control of infection. Bathrooms and communal areas were dirty. Medicines management had improved since our last inspection but there remained some areas of concern relating to ‘as required’ medication and when and how people were supported to receive pain relieving medicines.

Staff did not have time to spend with people, although we found that there were sufficient staff to meet people's immediate needs. Staff operated a task based approach to care. The provider operated a safe recruitment system. Staff understood their responsibility to raise concerns regarding potential abuse.

The provider had failed to ensure staff had the training or knowledge they needed to undertake their roles safely and appropriately. We found that whilst training had taken place, there were significant gaps in staff knowledge about current good practice. Some staff did not feel supported and the provider told us that supervisions of staff had not been consistently offered. We found that staff understood they needed to offer people choices and gain their consent but people told us this did not consistently happen. We found that people’s wishes in relation to being resuscitated or not, had been taken into consideration, but the process for doing so was not robust.

Some improvements had been made in relation to how people’s nutritional needs were met, but several people told us they did not like the food. The provider had failed to ensure robust monitoring of people’s food and fluid intake. People told us they did not have many choices of food. We found that people were given food but not encouraged or supported to eat it in all cases. We looked at the menus and saw that there was a variety of foods, but people told us they did not enjoy it. People did not have sufficient access to drinks that met their preferences. The provider had failed to adequately explore ways of making the home more dementia friendly. People had access to health professionals when their health needs changed, however the provider’s systems could not assure us that all people’s healthcare needs were met well.

People were not supported in a consistently caring manner. Staff did not always support people in a dignified way and people's rights to privacy were not always respected by the staff. People’s independence was not actively promoted. Staff did not have time to build meaningful relationships with people.

People did not always receive care that was responsive to their individual needs. People’s care was not person centred and did not reflect their preferences or meet their needs. People were not supported to follow their interests or participate in meaningful activities. The environment of Meadow Lodge was not suitable for all people who lived there. Community relationships had not been maintained or developed. The service had not implemented accessible information to an acceptable standard. We found that people at the end of their life did not have their needs reassessed as their needs changed. We found that equipment needed to support people’s comfort and well-being was not always provided in good time.

The complaints process at Meadow Lodge did not meet people’s needs and did not support people to have their voices heard. The provider had failed to investigate complaints or respond appropriately to people's concerns.

Systems used to monitor the quality of the home were not effective at identifying concerns and protecting people from risks to their health, safety and well-being. The governance system at the time of our inspection was not robust and in most areas it was ineffective. There had been very little improvement in the quality of the service or actions taken by the provider to mitigate risks.

The overall rating for this service is 'Inadequate' and the service is therefore 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, it 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.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can see what action we told the provider to take at the back of the full version of the report.

At our last comprehensive inspection in April 2016, we found that the registered provider was in breach of regulations. This was because the registered provider’s systems and audits had failed to identify the shortfalls we found related to staff practice and competency. These were related to the prevention of infection, compliance with the requirements of the Mental Capacity Act 2005 and protection and promotion of people’s privacy. We were advised that there were systems in place to audit the safety and quality of the kitchen equipment and routines. However, we saw that there had been inconsistencies with fridge and freezer temperatures there were no records to show what action had been taken to ensure that food storage was still safe. In addition we found that whilst feedback from people about their experiences of the home had been sought it had not been analysed or used to inform practice or to drive up improvements to the service. Following the inspection we met with the registered provider and they submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this unannounced inspection on the 20 and 21 June 2017 to check that the registered provider had followed their own plans to meet the breaches of regulations and legal requirements. Although the registered provider had started work to address the areas of improvement as identified in their plan, some actions were still outstanding or had not been completed as had been planned. The provider remains in breach of regulations as they had not taken the action required to ensure that effective systems would be in place to assess and monitor that the service would consistently deliver high quality, safe care. There were areas of further improvement required in respect of risk management, infection prevention, management of medicines, compliance and understanding of The Mental Capacity Act (2005) and The Deprivation of Liberty Safeguards (DoLS), nutrition, activities, the complaints procedure and the leadership and governance of the service.

The home had a registered manager who was present throughout the inspection. 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.

Whilst staff knew how to protect people and reduce risks associated with their specific conditions but the management of risk was not robust. The management of infection control and prevention and the cleanliness of the environment did not protect people from the risk of harm. Staff were not consistent with their explanations of the fire evacuation procedures. The management of medicines was not robust and always safe. People we spoke with told us they felt safe living at the home. Staff knew how to report any concerns so that people were kept safe from abuse.

People’s capacity was not always assessed and considered when decisions needed to be made to ensure their rights were protected in line with legislation. The registered provider had not ensured that the staff team knew which people were subject to a Deprivation of Liberty Safeguards (DoLS).

People who lived at the home told us they were not happy with the quality and variety of food provided. People were not consistently supported by staff to access health care when needed. Health care records did not contain sufficient information and guidance for staff to follow. Staff told us that they received regular training to enhance their knowledge and skills.

People were supported by staff who they described as kind and caring and we saw some caring and compassionate practice. Staff demonstrated a positive approach for people they supported; however, we saw instances when people’s privacy and dignity were compromised.

People and their relatives told us that they had not been actively involved in their care plan and the reviewing process. Care plans had not been updated in line with people’s changing needs. There was a lack of person centred activities available for people. People and their relatives told us they felt confident to raise concerns but most people told us that their concerns were not responded to and changes were not made. There were no effective systems in place to ensure complaints were responded to in an appropriate and timely manner.

The quality and monitoring checks in place were not robust or effective and this had resulted in a number of shortfalls not being identified and resolved. Leadership within the home was inconsistent and had failed to ensure positive outcomes for people who lived there. Some people, their relatives and staff were not confident that the home was well-led. Whilst the home had improved the way they sought feedback from people, concerns raised had not been utilised to drive continual improvement and actions had not consistently been taken.

We identified that there were 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 back of the full version of this report.

The service was last inspected in April 2015 when we found the service was not compliant with one of the regulations we looked at. The provider did not have suitable arrangements in place to ensure people who use services were protected against the risks associated with poor standards of hygiene and infection control. We asked the provider to make improvements to the risks of infection and at this inspection we found some improvements had been made. At the last inspection we noted that systems in place to monitor the quality of the service had improved and were more effective than they had been in the past. At this inspection we found that the progress had not been consistently sustained.

The registered manager was present during our inspection. 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.

We found that whilst there were some systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the service was consistently well led and compliant with regulations. Audits and monitoring systems needed to be improved; these included the monitoring of medicine management in line with practice guidance, monitoring and reviews of staff practices and the prevention of infection. In addition the service had not ensured they had effective systems in place to analyse feedback from people to develop and improve the service.

You can see what action we told the provider to take at the back of the full version of the report.

Through speaking with people and their relatives we found that people felt safe living at the home. Staff were aware of the actions they needed to take to ensure people stayed safe and were able to describe risk management plans for individual people. People were supported by staff who had received training on how to safeguard people from abuse and were protected by staff who had been safely and appropriately recruited. We found that some improvements had been made to prevent the risk of infection, however further improvements were needed. Medicines were administered as prescribed, however the safe management of medicines was not always adhered to in line with good practice guidance.

Most staff told us that they were provided with the appropriate training to ensure they had the right skills to meet the needs of individual people living at the home. However, some staff told us that they did not have the appropriate knowledge or skills to support people with their specific dietary needs. People told us they were offered a choice of meals at lunchtime, but expressed their views about the lack of variety.

Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care. The registered persons had not taken all of the necessary steps to ensure that people’s legal rights were being protected. People were supported to access relevant health care professionals who were appropriately involved in people’s care.

Staff were seen to be kind and caring, however there were times where people had their privacy and dignity compromised.

Some people told us that they were involved in the planning of their care and were asked how they wanted to be supported. People and those that mattered to them did not always contribute to the reviewing of care plans. Some care plans we saw did not include people’s interests. Some people did not have the opportunity to participate in meaningful and individual activities which they enjoyed. People were confident that their complaints would be listened to and acted on if they raised an issue.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We spoke to several people who lived at the home. People told us they felt safe. Comments included, 'I feel safe and fairly content' and 'The staff are gentle and keep me safe.'

We checked people's care plans and found most of them to be detailed, relevant and up to date. However, some records which related to people's health and mobility were sometimes inconsistent and incorrectly recorded. This meant that some people were at risk of receiving inadequate or inappropriate care.

People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience. Training records showed that care staff had nationally recognised qualifications in health and social care, been subject of Disclosure and Barring service checks (formerly CRB) and received regular training. This meant that staff had the appropriate skills to deliver safe and appropriate care and were suitable to work with older people.

We found that the home had satisfactory policies in relation to protecting vulnerable people. We checked staff training records and saw that most had received recent training in safeguarding vulnerable adults and that they understood their role in safeguarding people.

Medicines were not always safely or effectively administered. We looked at the administration of medicine records for one person and found that there were insufficient checks that a person was able to self-administer an inhaler effectively. We found that the person had not received the amount of doses they had been prescribed which meant their health condition was not managed appropriately. There were insufficient checks on the pain management for people with dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. At the time of our inspection no applications have been made under this legislation for any person living at this care home. We found that the provider understood their responsibilities in relation to the law.

We saw that a chair lift was fitted on the rear stairwell between the ground and first floor. The chair lift was in working order and well maintained. However, the location of this lift made the stairs narrow and difficult to pass. This was a potential safety hazard. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to these shortfalls.

We concluded that people were not always safe and protected from harm at this care home.

Is the service effective?

People told us that they were happy with the care they received and the care staff who supported them. We found that most of the care staff had worked at this care home for many years and knew the people they supported very well. Care staff told us that they were well trained, competent and able to safely meet the needs of the people who used the service.

We saw that people at the home had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

We found that regular internal audits of the home had been completed by the manager. Examination of records revealed that most of these checks and audits were current and up to date. However we found inconsistencies and conflicting information in some of the care plans. This showed that the process for reviewing care plans was not sufficiently robust and some people may be at risk of receiving inappropriate care.

We concluded that the service was not always effective in delivering safe and appropriate care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff were attentive, polite and sought consent from people before providing care and support. People commented, 'The staff are good they help keep me clean and shower me and they respect me' and 'The staff are gentle with me and keep me safe.'

We spoke to relatives of people who lived at the home. They were complimentary about the standards of care being delivered. Comments included, 'We are satisfied with my relative's care, the staff keep us informed and her health has improved greatly since she has been here.'

We concluded that people mostly have a good experience of care which is delivered with compassion and with respect for their dignity.

Is the service responsive?

Records showed that meetings were held between staff and people using the service to discuss ongoing concerns and improvements at the home. This meant that people had the opportunity to express their views and experiences to inform and improve the service.

Customer satisfaction questionnaires had been sent out and completed by some people living at the home. This provided useful information to the manager of the home.

We found that few people living at the home were participating in activities of their choice. We saw that one person had indicated an interest in attending a day centre and another person in exercising regularly. We checked and found that neither of these persons had been given the opportunity to take part in these activities. This meant that the provider was not being responsive to the wishes of some people who live at the home.

We saw that significant improvements had been made to this home since our last visit in October 2013 and numerous bedrooms and communal areas had been redecorated and fitted with new flooring.

We concluded that people are listened to in a way that responds to their needs and concerns but that the delivery of activities could be improved.

Is the service well-led?

A check of records showed that the provider did not have an effective system to regularly assess and monitor the quality of service that people received. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance and the improvements they will make.

Previous inspections at this care home have shown that it has consistently failed to meet the appropriate standards of care and welfare required under the Health and Social Care Act 2008. Although some recent improvements have been made in relation to the building, further problems in relation to medication and monitoring care and safety; have raised serious questions around the management and leadership of this care home.

We concluded that this care home does not always have effective leadership at all levels to ensure that systems are in place to guarantee safe, effective, caring and responsive care is being delivered.

On 22 May 2014 we met with the provider of this home and discussed our concerns regarding their current non compliance and poor record of failing to meet the standards set by our regulations. We subsequently received assurances from the provider that an action plan had been created to address our concerns and of his commitment to returning the home to full compliance in the near future.

We found that since our previous inspection of this home, some improvements and repairs had been made. Four bedrooms had been redecorated and five rooms had been fitted with new carpets. However, it was apparent that the care home was still 'tired' and in need of further refurbishment. We noted that some rooms were uncomfortably warm and the previous problems relating to fluctuations in temperature had not been fully resolved.

We spoke to people about their home environment. Comments included, 'I would redecorate the home, it's tired' and 'The heat is sometimes quite overpowering.'

We concluded that although some improvements had been made to the care home, the concerns raised by us at our previous inspections had not been fully rectified and people were not cared for in safe, accessible and comfortable surroundings.

We examined care plans and found that people's needs were properly assessed and that care and support was planned and delivered in line with their individual care plans. People were complimentary about care staff. Comments included, 'The staff are nice to me,' and 'The staff are very good.'

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

People were complimentary about care staff. Comments included: 'They are very good, they stop and chat with me.'

We found since our previous inspection of this home that some improvements had been made. However our concerns such as fluctuations in temperature and the re-decoration of some rooms had not been addressed. The care home remained 'tired' and in need of refurbishment.

Records showed that in recent months several people had fallen over in the home. We found in some cases there were no plans or risk assessments in place to support people who were at risk of falling. We also found inconsistent recording in relation to people who were at risk of developing pressure sores. These findings demonstrated that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

We found that staffing arrangements had improved since our last inspection and that the practice of using 'unqualified' apprentices as carers had ceased. Several experienced and qualified members of staff had recently joined the care team at Meadow Lodge.

The findings of our inspection found that overall care and support of people was not delivered in a safe and appropriate way.

People were very complimentary about care staff. Comments included, 'They are very good to me"

Records showed that in recent months several people had fallen over in the home. There were no plans in place to support people who were at risk of falling and from a review of staffing levels we noted that at times there had been insufficient members of care staff available to support people with limited mobility.

Some people complained about the central heating system which they said was not working properly and resulted in extreme fluctuations in temperature (in certain parts of the building).

We found that since the previous inspection at this care home that some improvements had been made as outlined in the action plan in respect of management of medication, infection control, monitoring of care and the involvement of people regarding their care and support. Other issues as detailed in the last inspection report and subsequent action plan had not been addressed.

The findings of our inspection identified that, overall care and support was not delivered in a way that ensured people's safety and welfare, that the premises remains in need of refurbishment and there were insufficient numbers of suitably qualified, skilled and experienced members of care staff on duty at Meadow Lodge.