Lower Meadow

Lower Meadow is a purpose-built residential home registered to provide accommodation and personal care for up to 69 people, including people with dementia. At the time of our inspection visit there were 48 people living at the home. Care is provided across two floors. Communal lounge and dining areas were located on both floors. People's bedrooms were en-suite and there were further communal bathroom facilities located on each floor.

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

Improvements had been made since our last inspection. There was a new management team who were committed and motivated to improve standards and ensure positive outcomes for people. Staff, people and relatives confirmed the management team were visible and they felt able to approach them with any concerns or issues they had.

The governance and oversight of the service had improved, but we found further progress was required to ensure records accurately reflected people’s needs and records to evidence risk management were completed accurately.

There were enough staff to keep people safe. Staff told us staffing levels were sufficient but acknowledged there were times when they were very busy. They told us staff worked as a team to ensure people’s needs were met.

Risks to people’s health and wellbeing had been identified and records guided staff on what to do to minimise identified risks and help keep people safe. Staff understood their responsibility to report any concerns or poor practice and the manager had had made safeguarding referrals to external professionals when necessary. Any learning from accidents and incidents was shared with staff so they could understand where changes in practice were required.

Medicines were ordered, stored and administered safely.

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.

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 Requires Improvement (published 30 September 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to information received about staffing levels and a closed culture within the home. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We also checked the provider had followed their action plan submitted following our last inspection and to confirm they now met legal requirements.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from the concerns raised. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lower Meadow is a purpose-built residential home registered to provide accommodation and personal care for up to 69 people, including people living with dementia. At the time of our inspection visit there were 43 people living at the home. Care is provided across two floors. Communal lounge and dining areas were located on both floors. People's bedrooms were en-suite and there were further communal bathroom facilities located on each floor.

People's experience of using this service

Plans to manage people’s individual risks were not always reviewed and updated following changes in people’s health. Records related to people's care did not demonstrate all planned care had been provided safely, in line with people’s individual risk management plans.

Improvements were needed to ensure people received medicated creams and ointments as prescribed and staff needed more information to ensure ‘as required’ medicines were given consistently.

The provider had recently reviewed and increased their staffing levels and at the time of our inspection visit there were enough staff on duty to meet people’s needs and respond to their requests for assistance.

The home was clean and tidy and infection control practices minimised the risks of infections spreading.

Recent changes in management had impacted on governance, oversight and communication within the home. The provider had processes in place to assess and monitor the quality of care, but these were not consistent in identifying areas where improvements were required to ensure good outcomes for people. Where quality assurance processes had identified shortfalls in safety and quality, action had not always been taken to address them.

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 Requires Improvement (published 1 May 2019).

Why we inspected

The inspection was prompted in part due to information received about the management of risks and quality of care within the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained 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 Lower Meadow 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 breaches of regulations in relation to safe care and treatment and good governance at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

People’s experience of using this service:

•Changes in managers meant there had been no consistent leadership at the home.

•The provider was working towards a service improvement plan (SIP) to address the issues that led to the placement stop being imposed. Improvements in practice had not been consistently maintained when managers changed.

•Due to the high level of vacant rooms and significant changes in the staff team, we were not able to determine whether staffing levels would remain effective when the home was fully occupied.

•Improvements needed to be embedded into the culture of the home under the new manager and with the new staff team to ensure they would be sustained, particularly when new people started to move to the home.

•Overall medicines were managed safely and people received their medicines as prescribed.

•Staff had received safeguarding training and knew how to keep people safe protecting them from harm or abuse.

•People’s risks to safety and well-being were assessed, recorded and reviewed to reduce the risk of avoidable harm occurring.

•People made decisions about their care and were supported by staff who worked within the principles of the Mental Capacity Act 2005.

•Staff were suitably skilled to meet people’s needs.

•People received enough food and drink to meet their dietary requirements.

•People had access to healthcare as and when required.

•Care plans focussed on people’s individual needs so staff could provide a personalised response to those needs.

Rating at last inspection: At the last inspection the service was rated as good. (The last report was published on 22 August 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service is now rated as ‘Requires Improvement’ overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

We undertook this focused inspection on 24 July 2017 to check that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lower Meadow on our website at www.cqc.org.uk. At the time of our visit 56 people lived at Lower Meadow.

At this inspection, we found improvements had been made. This meant the provider was no longer in breach of the regulation. We decided to review the key question of whether the service was well led.

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 and associated Regulations about how the service is run.

Staff were complimentary about the management of the home and said they worked well as a team. Due to the re-development of the provider’s other homes, some people and staff had recently been relocated to, or away from Lower Meadow, as other homes re-opened following refurbishment.

Staff and management felt the transfer of people and staff into Lower Meadow mid-July 2017 had gone well and was well co-ordinated. People, staff and families were consulted and involved in discussions around the transfer between services.

Staff who had been relocated felt supported by the new staff team and said they worked well together. Staff said the integration was ‘seamless’ and some staff were positive of the provider who supported them with travel arrangements to their new place of work.

Staff said Lower Meadow was a home they were proud to work in and said moving people from one of the other homes planned for re-development had a positive impact on people’s health and wellbeing.

People and relatives had opportunity to share their views and feedback, for example at planned meetings and staff said the registered manager was approachable, listened and was supportive.

The provider completed regular checks to ensure they provided a good quality service and looked at ways to ensure the service continuously improved. The registered manager understood their legal responsibilities to submit to us relevant notifications in a timely manner. Complaints were dealt with in a timely way and learning took place to ensure similar complaints did not reoccur.

This service was last inspected on 30 June 2014, when Lower Meadow was registered to provide accommodation and personal care for up to 47 people. We found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Lower Meadow reopened in May 2016 following a redevelopment and is now registered to provide accommodation and personal care for up to 69 older people, including people who are living with dementia. At the time of our inspection 58 people lived at the home.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager in post. Since our last inspection, there has been a change of registered manager. The new manager registered with us in May 2016 when the home reopened.

People enjoyed living at Lower Meadow and they considered it their home. People received care that enabled them to live their lives as they wished and people were supported to remain as independent as possible. People were supported to make their own decisions and care was given in partnership with their wishes.

Care plans contained relevant information for staff to help them provide the individual care people required, however care plans were not reviewed on a regular basis. People’s care and support was provided by a consistent, experienced and knowledgeable staff team who knew people well.

People were encouraged and supported by a caring staff team. People told us they felt safe living at Lower Meadow and staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions to take if they had any concerns for people's wellbeing or safety.

Staff received training to meet people’s needs, and effectively used their skills and knowledge to support people and develop trusting relationships.

People were supported to pursue various hobbies and leisure activities which enabled them to strengthen and build relationships within the home and wider community. Potential risks were considered positively so that people did things they enjoyed and kept in touch with those people who were important to them. Where potential risks to people's safety were identified, some of these were not always effectively monitored to make sure people remained safe and well cared for.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided.

People told us they could raise concerns or complaints if they needed to because the registered manager and staff were always available and approachable and people were confident they would be listened to.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. Some of these audits had not identified the improvements we found during our inspection visit. We found the reporting of some statutory notifications relating to serious incidents was not always effective. We found some serious incidents we should have been made aware of before the inspection visit, had not been completed and sent to us.

We found a breach 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 the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives, their friends and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: 'Oh yes, the staff are really good'. Another person told us: 'I am very well looked after because the staff are smashing.' A relative we spoke with said they were pleased with the support and care their relatives received.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff were able to describe when an application should be considered and who should be involved in the process. The registered manager told us that there was no one in the home that required a DoLS assessment. The registered manager was aware of the recent High Court ruling and was seeking guidance from the relevant authorities to see what impact this had on the service. We saw records that showed a number of staff had received training in mental capacity.

The home was clean and tidy with no unpleasant odours. The registered manager had cleaning schedules in place which made sure people's rooms and communal areas were regularly cleaned. People and relatives we spoke with told us they had no concerns about the cleanliness of the home or their relatives' room. A person told us: 'My room is cleaned every day, what more could I want.'

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

Employment records showed the provider had an effective system in place that made sure people received care from staff that were suitably qualified, experienced and fit for work.

We looked at a variety of records. Examples of the records we looked at were people's care plans, risk assessments, daily records, audits and quality questionnaires. We found these records were available and were stored safely and securely.

Is the service effective?

People had an individual care plan which explained what their needs were. Risk assessments were regularly reviewed but did not always reflect current risks. We found two examples where the risk assessments did not reflect people's current health needs. The registered manager told us they would make sure these were reviewed without delay. We spoke with two relatives who told us they had been involved in their relative's care planning and were also involved in care plan reviews that had been completed.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff who provided care at people's preferred pace. Staff were kind and attentive and responded appropriately to people's requests. Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, diabetic specialists and district nurses.

The service had systems in place to monitor the quality of service people received. Relatives meetings had been held and any improvements to the service had been made.

Staff said they had a handover at the start of each shift to update them of any changes in people's care needs since they were last on duty. Staff told us this helped them understand people's current care needs and what levels of support people needed.

People told us that concerns were listened to and acted on. People and relatives told us the staff and managers were very approachable.

Is the service well led?

The service had an effective system in place that assured them of the quality of service they provided. The service completed checks and sought the views of people who used the service. The registered manager acknowledged they needed to improve their records so they could evidence what measures they had taken that led to an improved service.

People who lived at the home told us, 'I am happy here, it's nice' and 'They look after me very well.'

We saw staff were kind and attentive when they delivered care to people. We saw people were supported and encouraged to maintain their independence.

We looked at four people's care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. They told us they had not had a formal meeting with the manager on a one to one basis since January 2013.

We found the service was well led and had systems in place to monitor the quality of service provided at Lower Meadow.