High Meadows

High Meadows is a residential care home providing personal and nursing care to up to 45 people. The service has four units. However, one of the units, with six beds, was not in use. The service provides support to older people, people with physical disabilities and people living with the experience of dementia. At the time of our inspection there were 32 people using the service.

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

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were followed and there were enough staff to meet people’s needs. Medicines were managed safely. Staff followed appropriate infection control practices to prevent cross infection.

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.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 June 2019). 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

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service is good. This is based on the findings at this inspection.

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

Follow up

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

We found the following examples of good practice.

Staff and people using the service had COVID-19 risk assessments. However, the COVID-19 risk assessment for staff was a general one and the COVID-19 risk assessments for people who used the service did not have risk indicators such as age and ethnicity. The provider took immediate action and emailed us updated risk assessments after the inspection.

The provider had clear procedures for visitors to help ensure infection was controlled and prevented. Information around infection control was well signed around the building and the provider undertook a number of checks before anyone entered the building. This included visitors completing a form, lateral flow testing and evidence of receiving vaccinations, as required.

The provider completed risk assessments for social distancing. We saw the environment and layout helped to promote social distancing and open windows helped to ventilate rooms. Staff worked in cohorts and zones to help reduce the spread of infection. People were supported to go out both independently and with others and return safely to the home. The provider had procedures in place to safely admit new people to the service and it was clear when people were isolating.

Staff and visitors wore and disposed of personal protective equipment (PPE) appropriately. Training records showed staff had completed training around infection control, and the managers undertook daily checks to ensure staff were wearing PPE correctly and following infection control guidelines. Team meetings and supervisions also indicated infection control was discussed.

Everybody in the home participated in regular testing. The provider followed the government guidance and supported people to test and isolate as required. The provider responded appropriately to people with positive test results. Information was shared with relevant agencies such as the local authority and healthcare teams to help ensure people received the treatment they needed. People and staff had received vaccinations to help keep them safe.

We observed the home was cleaned to a good standard and the provider followed enhanced cleaning procedures. Cleaning schedules recorded when cleaning had taken place and were audited monthly to help maintain a good standard of cleanliness and help reduce the risk of infection.

We found the following examples of good practice.

There was hand sanitiser available at separate parts of the service including the entrance. There was also a personal protective equipment (PPE) and sanitiser station at the entrances to the three units; for example, the dementia unit, nursing unit and residential unit, with prominent signage and instructions to explain what people should do to ensure safety.

Staff supporting COVID-19 positive residents sought support from other staff to get food and drinks that were left at the PPE station outside the door in order to reduce the need for staff to continually doff and don their PPE, which included full length gowns.

Weekly, comprehensively recorded infection control training updates were given by the manager to all staff.

There was a designated lead for cleaning and decontamination within the service and there were also designated cleaners on each floor with their own cleaning trollies.

There was a touch point cleaning schedule for each separate unit, with a cleaning schedule of eight times a day. Cleaning staff had to initial this form once they had completed the cleaning.

Communal areas such as outdoor spaces and garden areas were used creatively to help with infection prevention and control in good weather.

The service also carried out other risk assessments updated monthly such as the visitors and contractors risk assessments, personal care risk assessments, delivery of care and travel to and from work with public transport risk assessments. This was to ensure infection control and prevention risk was being identified and action taken to improve on any shortfalls.

High Meadows is a care home that is registered to provide personal and nursing care for up to 45 people aged 65 and over. At the time of the inspection there were 22 people living at the home. Some of the people were living with dementia or had physical disabilities. It is divided in to four units with two units on each of the two floors. When we visited only the ground floor was being used to accommodate people. The home is situated in a residential area of Pinner and is purpose-built. It opened in 2018 and this was its first inspection with the Care Quality Commission.

People’s experience of using this service:

People were happy with their care and support. One person said, “I would recommend it to everybody, in fact I have recommended it to a few people already.”

There were systems in place for the safe management of medicines. However, there was not always clear guidance for staff on when and where to administer people’s medicated cream or ointment when these were prescribed to be administered as required.

The risk management plans for supporting some people with their nutrition and skin integrity needs had been removed from the provider’s digital care records system, so it was not always clear how staff were to support them with these issues.

People had detailed care plans in place, but these were not consistently updated when there were changes to people’s care and did not set out how the service would meet people’s cultural, spiritual and recreational needs.

The manager addressed some of these issues during our inspection visit, but the systems to monitor the quality of the service had not been sufficiently robust to have identified or taken timely action on the areas for improvement we identified.

People told us that they felt safe and they were protected from the risk of infection.

Staff were caring, treated people with respect and promoted people’s dignity and privacy.

People and their relatives knew how to raise concerns or complaints and were confident they would be listened to. The provider sought feedback from people, relatives and staff and used this to develop the service.

The service provided a wide range of activities for people that were meaningful to them and they could choose how they spent their time.

Staff received induction, training and supervision and felt supported in their roles.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; 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 the last inspection:

The service was registered on 8th May 2018 and this is their first inspection.

Why we inspected:

This was a planned inspection based on the timescale to inspect newly registered service.

Enforcement:

We have identified a breach of regulation in regard to good governance at this inspection. Please see the action we have asked 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.