Meera House Nursing Home

Meera House Nursing Home is a residential care home providing personal and nursing care for up to 59 older people who may also live with dementia. At the time of our inspection there were 48 people using the service.

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

Since the last inspection we found that improvements had been made. Care plans were personalised, there was an activities coordinator in place and the home had been decorated and new furniture purchased.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to people’s individual needs. Staff knew how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Care plans were personalised and included people’s specific medical conditions, so we were assured that people’s needs were being met by the service. Medicines were managed 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.

The provider had ensured staff were in post to meet people’s care and support needs. Staff had received an induction at the commencement of their employment to ensure they had the required knowledge to meet people’s needs. The provider had a system in place to ensure training was refreshed annually or as required. Staff received regular supervision from the manager.

People’s relatives gave positive feedback about the support their family members received from staff. The provider had systems in place to monitor and assess the quality of the care and support provided to people. Policies and procedures reflecting current best practice were in place to underpin this. People’s views about their care were sought on a regular basis.

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 12 November 2021) and there were breaches of regulations. 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 concerns about the environment of the service, fire safety, cleanliness, staffing levels, and poor staff awareness of safeguarding. . As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

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

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meera House Nursing Home 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.

Meera House Nursing Home is a care home with nursing. It is registered to provide accommodation with personal and nursing care for 59 older people who may also live with dementia. At the time of this inspection, there were 39 people using the service.

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

We found that communication with people living in the home could be improved. Some people did not feel listened too and supported to be involved in their care and other areas of the service.

We found that medicines were not managed safely.

Care plans were not always personalised and in place for people’s specific medical conditions. So, we could not be assured that peoples’ needs were fully met by the service.

There were a significant number of maintenance issues that needed addressing in the home, some of which impacted on people’s well-being.

Some people told us there was not enough for them to do.

The internal environment did not support peoples’ orientation within the premises. There was a lack of signage, and the décor and lighting in some areas could be improved.

There were some audits that had not been carried out and others had not been completed within the provider’s timescales. This had not been identified or addressed by the provider.

Some people were not satisfied with the variety and quality of the meals.

Arrangements were in place to protect people from abuse. Staff had received training on how to safeguard people from abuse and were aware of the procedure to follow if they suspected that people were subject to abuse.

Staff told us they received the support and training they needed to undertake their roles and responsibilities. People told us that staff were kind.

Staff recruitment records showed that the provider ensured that workers employed by the service were suitable for the work they were undertaking. People's religious, cultural and other needs and preferences were supported. The service had recruited staff members who were able to communicate with people using their preferred language.

Staff told us that although they were busy at times, there were suitable numbers of staff to ensure people received the care and support they needed.

The care home was clean. Suitable infection prevention and control measures and practices were in place to keep people safe and prevent people, staff and visitors catching and spreading infection including COVID-19.

The manager was approachable and provided staff with leadership and direction. They were responsive to our feedback during and following the inspection.

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 15 December 2020).

Why we inspected

We received concerns in relation to incidents, fire safety, staff supervision, data protection and quality assurance. Following a meeting with the host local authority, the provider agreed to a temporary suspension of admissions to the home, whilst the provider made necessary improvements. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

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.

Enforcement

We have identified three breaches in relation to safe care and treatment, person centred care, and good governance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People’s experience of using this service:

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with the corona virus pandemic, falls, medical conditions such as diabetes and pressure sores.

The service followed safe recruitment practices and records contained the required documentation. The staffing levels were adequate to ensure that people’s needs were attended to.

There were arrangements for safeguarding people. Care workers had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

There were suitable arrangements for the administration of medicines. Medicine administration record charts (MAR) and the controlled drugs register had been properly completed. Medicine audits had been carried out.

There was a record of essential maintenance and inspections by specialist contractors. There was a current safety inspection certificate for the electrical wiring and portable appliances. Window restrictors had been installed and were engaged in bedrooms we visited. This is needed to prevent scalding. Suitable fire safety arrangements including personal emergency and evacuation plans (PEEP) and weekly alarm checks were in place.

The premises were clean and tidy. We however, noted that a few areas of the home showed signs of wear and tear and repairs. The home had started taking action to rectify these areas.

Suitable infection prevention and control measures and practices were in place to keep people safe and prevent the spread of the corona virus and other infections. Staff had received appropriate training. They had access to sufficient stocks of personal protective equipment (PPE). The infection control nurse from the local health authority had visited the home and made several recommendations. Action had been taken in response to them.

Care needs of people had been attended to. There were suitable arrangements for caring for people requiring care for specific conditions such as diabetes and pressure sores. Appropriate care plans were in place. However, a small number of the care plans lacked information regarding personal details such as likes and dislikes and people’s past history. This is needed to ensure that care staff are better informed of the individual needs of people.

Relatives were regularly updated regarding the running of the home and the care of people. Checks and audits of the service had been carried out by senior staff of the company to ensure that the home was well managed and deficiencies promptly responded to.

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 8 May 2019) and there were breaches of regulation in relation to safe care and treatment and person-centred care. 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:

We undertook this focused inspection as we had concerns regarding the service and we wanted to check that people were well cared for. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good.

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

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.

Meera House Nursing Home is a care home with nursing operated by Meera House Nursing Home Limited. It is registered to provide accommodation with personal and nursing care for 59 older people, some of whom have dementia. This location is also registered to provide personal care for people living in their own homes. However, they did not have any people using this service at the time of this inspection. The care home provides care for people of Asian origin and most of the people living there are of the Hindu faith.

There were two registered managers in post at the time of our inspection. One of the registered managers was initially employed to manage the domiciliary care service. As they currently had no service users, this manager co-manages the care home with the second registered manager. A Registered manager is a person who has registered with the Care Quality Commission (CQC) 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 brought this inspection forward as we had received information of concern and feedback from local authority monitoring visits. These concerns related to the care of people and the management of the home. At our last inspection on 22 and 23 May 2018 we found a number of deficiencies and the service was rated “Requires Improvement”. At this inspection we noted that although improvements had been made and some deficient areas rectified, there were still some areas where further improvements are needed. Therefore, the service continues to be rated as “Requires Improvement”.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with falls, medical conditions such as diabetes and pressure sores. However, we noted that there were no risk assessments for people who used bedrails. This was later provided. One person who was at risk of choking did not have a comprehensive risk assessment. This was provided after the inspection. A person who had a history of depression and who was emotionally upset when we met them did not have a depression risk assessment. Comprehensive risk assessments are needed to ensure that care workers are informed of potential risks to people and how risks could be minimised to keep people safe.

The service followed safe recruitment practices and records contained the required documentation. Care workers told us they had received a comprehensive induction and training programme. Staff supervision and appraisals had been provided and these were recorded in the staff records. Meetings had been organised for care workers. We were, however, not confident that the staffing levels were adequate to ensure that people’s needs were attended to. This was because of certain deficiencies identified such as the slow response to call bells and those related to care documentation. The registered manager stated that a new deputy manager had been recruited and additional staff were in the process of being recruited.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The care needs of most people had been attended to. Care plans had been reviewed with people or their representatives. However, documented evidence indicated that some people’ s care needs had not always been attended to, particularly those needing pressure area care.

Checks and audits of the service had been carried out by the registered managers. Audits had been carried out weekly and these were discussed in weekly management meetings. We however, noted that these audits were not sufficiently effective as they did not identify and promptly rectify the deficiencies noted by us. A satisfaction survey carried out recently indicated that people and their representatives were mostly satisfied with the care and behaviour of care workers.

We looked at the arrangements for safeguarding people. The service had a safeguarding policy and a whistle blowing policy to ensure that people were protected from harm and abuse. Care workers we spoke with had been provided with training on safeguarding people and knew what action to take if they were aware that people were being abused.

There were arrangements for the administration of medicines. Medicine administration record charts (MAR) and the controlled drugs register had been properly completed. Medicine audits had been carried out.

With one exception, the premises were kept clean. Concern had been expressed regarding rodent activity. We did not see evidence of this at the inspection. We saw evidence that the home had a contract for pest control and the last report by the pest control contractors indicated that there was no sign of rodent activity either in the home or outside the home.

There was a record of essential maintenance and inspections by specialist contractors. Fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. The hot water temperatures had been recorded prior to people being provided with a shower. This is needed to prevent scalding.

We checked and noted that window restrictors had been installed in most bedrooms we visited. One bedroom and a toilet did not have window restrictors. Restrictors were fitted to the bedroom window on the second day of inspection. The registered manager stated that restrictors were fitted to the toilet soon after the inspection. One bedroom had water stains on the ceiling. The registered manager agreed to arrange for checks of the roof to ensure that there were no leaks.

The nutritional needs of people were met. People had been assessed and arrangements were in place to meet their dietary and cultural preferences. All people living in the home were of Asian origin and only Asian vegetarian meals were provided. People informed us that they were satisfied with the provision of meals.

The home had an activities organiser and there was a varied activities programme to ensure that people received social, religious, cultural and therapeutic stimulation. People were mostly satisfied with the activities provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. Mental capacity assessments had been carried out, but some details had not been provided. In addition, one DoLS authorisation had not been notified to the CQC. This was submitted soon after the inspection.

There were opportunities for people and their representatives to express their views and experiences regarding the care and management of the home. We however, noted that only one relatives' meeting had been held in the past twelve months. The registered manager stated that more would be held. This would enable people and their representatives more opportunity to discuss the care provided. Complaints made had been recorded and promptly responded to.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report

There were two registered managers in post at the time of our inspection. One of the registered managers was initially employed to manage the domiciliary care service. As they currently had no service users, this manager co-manages the care home with the second registered manager. A Registered manager is a person who has registered with the Care Quality Commission (CQC) 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 carried out this inspection following a safeguarding incident which was reported to us and the local safeguarding team. We looked at the arrangements for safeguarding people. We noted that the service had a safeguarding policy and a whistle blowing policy to ensure that people were protected from harm and abuse. Care workers we spoke with had been provided with training on safeguarding people. Following the safeguarding incident, the provider had taken action against care workers involved. The incident had also been reported to the police who were carrying out investigations into the matter.

This serious incident involving the abuse of a person who used the service indicated that safeguarding arrangements were not adequate. Following this the service had in place an action plan which included closer monitoring of care workers and further training for them.

Some relatives and care workers informed us that there were occasions when more care workers were needed so that people could receive better care. Although the registered managers informed us that there were sufficient care workers on duty, we noted that the staffing levels had not been reviewed with people, their representative and care workers.

There were suitable arrangements for the administration of medicines. Medicine administration record charts (MAR) and the controlled drugs register had been properly completed.

The premises were kept clean and tidy. The garden was attractive. We however, noted that no garden tables, chairs and umbrellas had been provided. Infection control measures were in place. There was a record of essential maintenance of inspections by specialist contractors. Fire safety arrangements were in pace. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. We however, noted that the hot water temperatures prior to people being provided with a shower had not been recorded. This is needed to prevent scalding. The registered managers stated that this would be carried out. They further explained that the shower heads of the home had been fitted with thermostats to prevent scalding and care workers checked the temperatures were within the safe limit and to the liking of people who used the service. We were informed soon after the inspection that records of shower temperatures had been logged prior to showers being given.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. Our specialist advisor who looked at nursing practice noted that nursing staff were knowledgeable regarding the care of people.

The dietary needs of people had been assessed and arrangements were in place to ensure that people’s dietary and cultural preferences were responded to. All people living in the home were of Asian origin and only Asian vegetarian meals were provided. People informed us that they were satisfied with the provision of meals.

The home had an activities organiser and there was a varied activities programme to ensure that people received social, religious, cultural and therapeutic stimulation. People were satisfied with the activities provided.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

The service followed safe recruitment practices and records contained the required documentation. Care workers told us they had received a comprehensive induction and training programme. We however, noted that regular supervision had not been provided for all care workers and appraisals had not been recorded for several care workers. Meetings had been organised for care workers. With one exception, the minutes of these meetings only recorded the views and feedback provided by management staff. It is important that the views of care workers are recorded so that action can be taken in response to any concerns expressed. We also noted that a care worker had expressed dissatisfaction and concern regarding their work. There was no record of action taken in response.

There were opportunities for people and their representatives to express their views and experiences regarding the care and management of the home. We however, noted that only two relative and residents’ meetings had been held in the past twelve months. The registered managers stated that more would be held. This would enable people and their representatives more opportunity to discuss the care provided. Complaints made had been recorded and promptly responded to.

Checks and audits of the service had been carried out by the registered managers. Audits had been carried out weekly and these were discussed in weekly management meetings. We however, noted that these audits were not sufficiently effective as they did not identify and promptly rectify the deficiencies noted by us. A satisfaction survey carried out in the past year indicated that people and their representatives were mostly satisfied with the care and behaviour of care workers.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report

At our last inspection on 3 October 2013 the service met all the regulations we looked at.

The care home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People using the service informed us that they were satisfied with the care and services provided and these met their cultural and religious needs. They said they had been treated with respect and felt safe living in the home. This was reiterated by relatives we spoke with. There was a safeguarding adults policy and suitable arrangements for safeguarding people.

Care workers were responsive and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and recorded. Care workers prepared appropriate care plans which involved people and their relatives. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. People’s healthcare needs were closely monitored. Care workers worked well with healthcare professionals to ensure that people’s needs were met. This was confirmed by people and relatives we spoke with.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings and one to one sessions had been held with people to enable them to discuss their care and the services provided. The minutes of meetings were available for inspection. The home had an activities programme which provided social and therapeutic activities and met their religious preferences.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs, religious and cultural preferences were met. People were satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people who spoke with us confirmed that they had been given their medicines.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their manager. There were enough care workers to meet people's needs. Teamwork and communication within the home was good. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity within a homely environment and providing a high quality of care.

People and their representatives expressed confidence in the management of the service. The results of the last service user and relatives satisfaction survey indicated that there was a high level of satisfaction with the care and services provided.

The premises were clean and no offensive odours were detected. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, drills, training and maintenance of fire equipment. We however, noted that the names of all staff present at fire drills were not always documented. The registered manager agreed that this would be done in future. A window restrictor in a bedroom on the first floor was not restricted sufficiently. We were informed soon after the inspection that this had been adjusted.

People and their relatives were aware of whom to complaint to if they had concerns. Complaints made had been promptly responded to. Regular audits and checks had been carried out by the registered manager of the home and officials arranged by the company.

There were processes in place to protect people who used the service from harm and abuse. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

People who used the service were protected from the risk of infection. The service had arrangements in place to manage medicines safely and appropriately.

People were protected from the risks of inadequate nutrition and dehydration.

There were enough qualified, skilled and experienced staff to meet people's needs. The staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

The home had an effective system to regularly assess and monitor the quality of service that people received and to identify, assess and manage risks to the health, safety and welfare of people who used the service.