High Meadows

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service was safe. People received their medicines in a safe way, although improvements were needed to some of the medicines risk assessments and protocols to make these clearer. We discussed this with the registered manager who agreed to address this following our visit. Whilst there were times when some people felt staff were not deployed well enough to meet all their needs, most people felt there were enough staff, and they did not have to wait for care. The registered manager agreed to look into the instances where people had raised concerns. For example, identifying whether there were any trends, specific parts of the building or time of day when this was an issue. There were appropriate systems to ensure suitable staff were recruited and that staff underwent a range of training, supervision and assessment. The risks to people’s safety and wellbeing had been assessed and planned for. Staff understood about providing safe care and had received relevant training. The environment was clean, well-maintained and safe. There were systems to assess, monitor and improve safety following accidents, incidents and safeguarding concerns. We did not assess all the quality statements within this key question. We did not identify concerns relating to those areas which we judged as being met at our last inspection.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their families told us they received feedback from the registered manager following any incidents and accidents. This included apologies, explanations of what had gone wrong and information about how the provider had learnt from these.

Staff told us they had regular meetings and discussions with the registered manager and other heads of department to discuss things that had gone wrong and any changes that needed to be made because of these.

Accidents, incidents and other adverse events were recorded and reported to managers and appropriate stakeholders. Records showed these had been investigated and lessons learned had been shared with staff to help improve practice. Where shortfalls were identified, staff had undergone extra training, care plans or assessments had been updated and where needed, referrals had been made to external partners for additional support.

People and their relatives told us they felt safe. They were aware of safeguarding procedures and knew who to speak with if they had any concerns.

Staff had undertaken training about safeguarding and the Mental Capacity Act 2005. They were able to explain their roles and responsibilities and demonstrated a good understanding about how to recognise, respond to and report abuse.

We observed the staff caring for people in a respectful way. They were gentle, careful and made sure people were safe. They explained what they were doing and obtained consent before any interventions.

Systems were in place which reduced the risk of abuse. The provider had procedures designed to safeguard people from abuse. Staff were familiar with these, and we saw the provider had responded appropriately to allegations of abuse. The provider worked with external agencies to investigate and respond to any allegations. The provider had applied for Deprivation of Liberty Safeguards (DoLS) when needed. For example, when people lacked the mental capacity to make decisions about their care and treatment and when there needed to be significant restrictions on their freedom. Where conditions had been imposed on the home as part of any DoLS, these had been monitored and met. The provider liaised with others to help ensure decisions were reviewed and remained appropriate.

People using the service and their relatives told us they felt confident with the way staff supported them. For example, when they supported them to mobilise and with eating and drinking.

Staff demonstrated a good understanding about how risks to individuals were managed. They told us they had relevant training to help them care for people in a safe way and in line with best practice.

We saw staff monitored and managed risks, ensuring people were safe when moving around the home.

Most risks were appropriately managed however personal evacuation plans needed clearer information recording. Whilst these contained guidance and personalised information, improvements needed to be made to ensure those responding to an emergency (such as the fire brigade) had information about each person’s needs and where their bedroom was. We discussed this with the registered manager who agreed to update the records. Staff had assessed risks to people’s safety and wellbeing. These assessments included clear and detailed plans about how the risks should be managed and mitigated. Risk assessments were regularly reviewed and updated when needed.

People liked the environment and commented positively about this. They were able to personalise bedrooms and bring their own belongings to the home.

The registered manager told us the provider had invested money in making improvements to the environment, both within the home and in the garden.

The environment was generally safe and well maintained. However, we found a small number of areas where improvements were needed. These included furniture that had been placed in a way which blocked access to an exit. We discussed this with the registered manager who agreed to address these issues. The building was well-lit, warm and appropriately ventilated. Furniture was in keeping with the décor and well maintained. There were plenty of communal areas for people to sit, relax and entertain visitors. Bedrooms had en-suite facilities. There were well-maintained grounds and gardens where people could spend time. People were provided with the equipment they needed to stay safe and comfortable. Regular checks ensured that equipment was in good working order and safe to use. There were handrails along corridors and a range of equipment to help people move safely and to access their beds, chairs, baths and showers.

Staff and the provider carried out regular audits and checks on the environment and equipment to make sure it was safe and any repairs were quickly dealt with and responded to.

Overall, people told us there were enough staff, however a small number of people and their relatives told us they did not think there were enough staff at times, particularly the weekends. They gave examples where they had sometimes had to wait for care. During our visit, we also observed that 1 person’s care needs were not met in a timely way. We discussed this with the registered manager. The majority of people felt there were enough staff. The registered manager agreed to look at whether staff deployment, or other factors were the reason behind some people waiting for care. They told us they were able to deploy additional staff to areas where there was a need or staff were busy, for example utilising supernumerary management support. The registered manager carried out audits of call bells and investigated any incidents when these were not responded to in good time. This helped them to identify whether staffing levels were sufficient. Most people using the service told us that call bells were answered promptly. They also commented that there was good staff retention so that the staff were familiar and experienced.

The registered manager explained they accessed a range of external training courses from the local authority and healthcare professionals. The staff told us they thought there were enough of them.

With the exception of 1 incident, which we discussed with the registered manager, we saw that staff were available to respond when people needed assistance.

The provider had tools for assessing people’s needs and ensuring enough staff were recruited and deployed to meet these needs. Systems for recruiting and selecting staff helped to make sure they were suitable and had the skills needed for their roles. There were checks on their identity, suitability and knowledge. The provider carried out interviews of potential staff, assessed their competencies and provided them with a comprehensive induction. All staff undertook a range of training which was regularly updated and reviewed.

People using the service and their relatives told us the home was kept clean. They were happy with the laundry facilities.

Staff had undertaken training regarding infection prevention and control. They were able to tell us about how they managed this aspect of their work. Staff told us they were provided with enough personal protective equipment (PPE).

Overall, the environment was clean and well maintained throughout, except for a small number of areas where deep cleaning was needed. For example, two areas within the kitchen were dirty. We discussed this with registered manager who agreed to address this.

There were systems for maintaining and checking cleanliness and for minimising infections. Staff carried out regular audits and the management team responded when deficits or problems were identified. There were suitable systems for laundry and waste disposal.

People told us that they were given their medicines on time and were given choices about this. Some people were administered medicines covertly (hidden in food or drink). The provider had not always obtained pharmaceutical advice to ensure medicines remained safe and effective when administered this way. People had the opportunity to self-administer their own medicines, and the service supported this.

Staff told us they had the training and induction needed to manage medicines safely. They explained their competencies were assessed before they started handling medicines.

There was not a clear process for managing medicines safety alerts. This meant that they did not always identify and respond to risks. For example, they had not assessed the risks relating to emollient skin creams. Some people were prescribed medicines to be administered ‘when required’. We saw that most people had protocols in place to support staff administer ‘when required’ medicines. However, these were not always person specific and lacked detail about people’s signs and symptoms. When staff had administered ‘when required’ medicines, there was inconsistence in recording of outcomes of administering these medicines. Some people were prescribed topical medicines such as creams and emollients. However, it was not always clearly documented where these were being applied. Records demonstrated that staff monitored the temperature of the medicines storage area and fridges and were able to explain the action they would take if the temperatures were out of range. However, on the day of inspection not all nursing staff were not able to demonstrate how they checked and re-set the fridge thermometer. Therefore, we could not be assured that the temperatures being recorded were always accurate. We discussed the concerns we identified regarding medicines management and records with the registered manager and they took action to rectify this issues. We were assured people had received their medicines as prescribed.