Archived: The Meadows Care Home

Updated 29 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 July 2018 and was unannounced. A second day of inspection took place on 25 July 2018 which was announced.

The inspection team was made up of two inspectors, one specialist advisor who was a nurse and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed the information we held about the service. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We contacted the local authority commissioning team, Clinical Commissioning Group (CCG) and the safeguarding adult’s team. We reviewed the local Healthwatch website for information regarding The Meadows. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

A new provider was in the process of purchasing The Meadows. During the purchase period a management agreement had been made, whereby the new provider had day-to-day management responsibility and oversight of the service. However, at the time leading up to and during inspection and purchase period, Ultima Care Centres (No 1) Limited remained registered and was responsible for the service.

During the inspection regional managers and the managing director from the new provider were on site.

We spoke with 13 people living at the service and seven relatives. Also, with two regional managers, one managing director, and 13 members of staff of which three were nurses, one caretaker, seven care workers, one activities co-ordinator, and one ancillary staff.

We pathway tracked four people who were receiving a service, including their care and medicine records. We reviewed four staff files regarding recruitment and looked at staff supervision and training information.

We looked around the building and spent time in the communal areas. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 29 September 2018

This inspection took place on 23 and 25 July 2018 and was unannounced

The Meadows is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. The Meadows provides care for up to 69 people some of whom are living with dementia. At the time of our inspection 39 people were living at the service.

The home did not have a registered manager in place. 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 and associated Regulations about how the service is run. The manager had recently submitted their application to CQC for consideration and approval to become the registered manager. On the day of the inspection the manager was on annual leave.

The service is currently in the process of transitioning to a new provider. At present the new provider has daily oversight and management responsibility for the running of the service. However, the current provider remains legally responsible for the service until the sale of the service is completed.

Following the last inspection, we found that the provider was in breach of regulation 17 (Good Governance). We asked the provider to complete an action plan to show what they would do and by when to address those issues identified.

At this inspection we saw that the provider had not taken appropriate action and the breach identified at our last inspection had not been addressed. This has resulted in a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we also found breaches of regulations 9 (Person-centred care), 10 (Dignity and respect) and 18 (Staffing).

Care planning did not always examine the needs of people who used the service. Risk assessments and outcomes of these assessments were not person-centred in order to achieve positive outcomes for people.

We reviewed training records and found that 28% of training was out of date and that staff were not always supported with an appropriate induction once they commenced employment. Supervisions and appraisals were not always carried out, this was supported by records and also in discussions with staff.

The provider did not have a robust quality assurance process in place to check the quality of care provided and to drive necessary improvements.

Care provided did not always maintain people’s dignity.

You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives confirmed they felt safe living at The Meadows. They spoke highly of staff and care delivered and staff knew the people they care for very well.

Staff followed the provider’s procedures for safeguarding and were able to explain how they would keep people safe from harm or abuse. The provider had a recruitment process in place to ensure that only people who were suitable to work with vulnerable people were employed.

During both days of the inspection staffing levels were observed to be sufficient to meet the needs of people using the service. This was supported by a review of previous staffing rotas.

The service was undergoing a refurbishment. The provider was currently refurbishing two communal areas of the service, one into a ‘bar’ and the other into a ‘tea shop’. On the first day of the inspection we identified an issue with regards to refurbishment of the service and the use of unsafe equipment. This included a lack of a risk assessment regarding contractors being on site. We also saw electrical equipment in use which had been classed as unsafe for use following a portable electrical test (PAT) carried out on 8 June 2018.

Staff understood the principles of the Mental Capacity Act, 2005 (MCA) and ensured they gained people's consent before providing personal care and support. People were encouraged to be involved in decisions about their care.

Activities played a big part of daily life at the service and the provider employed a dedicated activities co-ordinator to support this. Internal and external activities were provided which people living at the service spoke very highly of. The activities co-ordinator had been very creative in their design of various activities which had a beneficial impact on people living at the service.

A complaints procedure was available and people were able to provide feedback of their views of the service. This included the opportunity for attendance at resident’s and relative’s meetings.

Staff that we spoke to confirmed that the manager was both supportive and approachable and very much hands on.

Lunchtime was a very pleasant and relaxed experience. The menu was varied and the food being served looked very appetising, was nicely presented and portions were of a good size. Staff asked people their preference prior to serving lunch. Staff supported people as necessary and encouraged people who were more independent.

Overall the premises were sufficiently clean, and the provider had a system in place to manage clean and dirty laundry. We saw that staff had access to personal protective equipment (PPE), and used this for the various tasks they carried out.

Certain areas of the service were very dementia friendly. For example, a reminiscence lounge on the first floor which contained lots of old artefacts which supported and encouraged conversation amongst people living with dementia. There was signage to help people find their way around and identify their own rooms.