We inspected Meadow Court Residential Home (known to the people who live and work there as ‘Meadow Court’) on 23 and 28 February 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming.Meadow Court is a residential care home for up to 37 people. It consists of one building with two floors. All bedrooms are single; 29 have ensuite facilities and eight have a sink but are located near a shared bathroom and toilet. On the ground floor there are two communal lounges, a TV room, a large conservatory and dining room. Both floors have shared bathrooms, toilets and shower rooms. The home has an enclosed courtyard area with seating.
At the time of this inspection there were 32 people living at the home; two of these people were using the service for respite care.
Meadow Court was last inspected in February 2016. At that time it was rated as ‘Requires Improvement’ overall. It was judged to be ‘Inadequate’ in the Safe domain, ‘Requires Improvement’ in the domains of Effective, Responsive and Well-led, and ‘Good’ in the domain of Caring.
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.
The home had a registered manager, although they had recently become the activities coordinator and were in the process of deregistering as manager with the Care Quality Commission (CQC). The plan was for one of the directors of the registered provider company to apply to become the registered manager. The director was managing the home at the time of this inspection. 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.
People’s care plans did not always contain measures to manage risks that had been identified. Some care plans we saw had not been updated after incidents had occurred.
Relatives had made decisions for people without the correct legal authorisation to do so. Staff knowledge, including that of the home manager, around the Mental Capacity Act 2005 (MCA) and how it was applied in a care home setting needed to be improved. These were concerns identified at the last inspection in February 2016.
People’s care plans did not always contain the person-centred detail staff needed to support them effectively. Some people lacked care plans for a specific health condition and two people receiving respite care at the time of this inspection had no risk assessments or care plans in place.
Concerns with medicines identified at the last inspection had been resolved. Most aspects of medicines administration and management were well managed, although we did find some problems with topical cream charts and the recording of the medicines room temperature.
Most aspects of the building’s utilities and facilities had been checked for safety, although we did identify some gaps. This included not checking water temperatures in the hand basins of people’s rooms. We found water temperatures recorded for communal bathrooms exceeded guidelines from the Health and Safety Executive. Fire drills had not been undertaken.
Improvements had been made to the quality monitoring systems at the home, but more work was required to ensure care plans were up to date and all accidents and incidents that occurred were analysed together.
People told us they felt safe at Meadow Court and their relatives agreed. Care staff could describe how to identify the different forms of abuse and said they would report any concerns to managers.
Concerns with the recruitment process at the home identified at the last inspection had been resolved. People and their relatives told us there were enough staff deployed to meet people’s needs, although they said they had to wait for support at times.
Information about falls had been analysed for trends and used to increase staffing at times of the day when people were identified as being at higher risk.
We found the home to be clean, tidy and odour-free. People and their relatives agreed.
Staff told us, and records showed they now had access to regular supervision. With the exception of MCA training, staff had received the training they needed to support people effectively. Care staff new to health and social care were enrolled on the Care Certificate.
Feedback from people and their relatives about the food served at Meadow Court was good.
People had access to a range of healthcare professionals to help meet their wider healthcare needs. Feedback we received from healthcare professionals who visited the home was positive.
Members of the management team had sought training on dementia-friendly environments and had made some changes to the home in accordance with what they had learned.
People and their relatives described staff as kind and caring. Care staff could describe people well as individuals.
People and their relatives were involved in designing and reviewing their care plans on a regular basis. We saw people had access to independent support with decision-making if they needed it.
We observed, and people told us, care staff respected their privacy and dignity. Staff also promoted people’s independence.
Care staff could describe what good end of life care involved. Feedback from relatives of people who had received end of life care at Meadow Court was positive.
People told us they had access to a range of activities which they enjoyed. Our observations during the inspection supported this.
One formal complaint received since the last inspection had been addressed appropriately. People and their relatives told us they felt able to raise concerns with staff if they needed to.
People, their relatives and staff were given opportunities to feedback about the service at regular meetings. Feedback about the management team from people, their relatives and staff was positive.
Notifications had been made to CQC regarding any relevant accidents, incidents or events, as is required by the regulations. The ratings from the last inspection were not prominently displayed at the home when we arrived. This was because the entrance area had been decorated shortly before the inspection; we saw this was put back in place during the inspection.
We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. 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.