This unannounced comprehensive inspection took place on 6 June 2017. This was the first inspection for the service since registering as a new provider in December 2016.There was a registered manager in post who was responsible for the day-to-day running of the service. A registered manager is a person who has registered with the Care Quality Commission 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. There was a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.
Meadowbrook House is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 28 people living at the service. Some of these people were living with dementia. The service uses a detached house with two floors. There were only people living on the ground floor of the service at the time of this inspection.
The service had been operating under new ownership for five months and had recently undergone a great deal of renovation and re-decoration of the premises. New equipment and bed linen had been purchased and additional staff had been recruited.
We reviewed the systems for the management and administration of medicines. It was possible to establish that people had received their medicines as prescribed. There were no gaps in the medicine administration records. However, there was a quantity of medicines that required stricter controls which had been drawn up but not used. This was found in a locked medicine cupboard with a date on it of 8 May 2017. The registered nurse and the registered manager were not aware of the presence of this syringe. The service raised an incident investigation immediately and the service took action to amend their medicines policy to include the actions to take in such a circumstance. Internal medicine audits were being carried out to monitor the management and processes in place for the safe administration of medicines however, the presence of the syringe had not been identified.
Care staff were directed in care plans to record in specific files in people’s rooms, when they provided care and support for people. While there was no evidence that people‘s needs were not being met, some records were not always completed accurately by staff. Some skin checks, weights and food records contained gaps where staff had not recorded care that was directed in people’s care plans. Some guidance in care plans was not consistent with information provided in the shift handover records or in people’s room records. Staff told us they knew people well and often did not refer to records to check what care and support to provide. However, this meant that new staff and agency staff were not always provided with accurate information to refer to about people’s needs.
The manager held a record of staff training. This record had not been kept up to date. We requested a revised training record which showed there were many staff who required updates in mandatory training subjects such as health and safety and fire training. Some training, such as safeguarding adults and Mental Capacity Act 2005 had been planned for with training sessions advertised in the service for the coming weeks.
Some information requested by inspectors took time to be located by the manager. This was being held by the deputy manager who was not working at the service at the time of this inspection. Inspectors were also provided with inaccurate information by the manager at inspection, such as the number of people living at the service and the current status of staff training.
The manager had recently created new roles for staff with more responsibility. A head housekeeper and two senior carer posts had been recently created and taken by existing staff. These roles were to support the manager in the day to day running of the service. We have judged that these roles needed time to develop and bring about consistent change. There was a service development plan in place with set dates for specific actions to have taken place. Some actions were delayed, some had just been started. This had led to changes that were in process at the time of this inspection. Such as the provision of moving and handling training for staff and the commencement of audits of health and safety, infection control and the kitchen. It was not yet possible to judge the potential impact of these changes on people living at the service at the time of this inspection. We will review the progress of these changes at the next inspection.
There were many audits being carried out to monitor equipment, personnel files, room files, people’s weight records and medicines management. Some of these audits were not yet entirely effective at the time of this inspection but the manager told us, “It is work in progress, we are not quite there yet, but we are getting there.” However, some changes had already had a positive impact. For example, people told us the staffing levels had improved and visitors confirmed this.
People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. However, the manager had not recognised that family members can only sign consent forms on behalf of another person if they hold a lasting power of attorney for care and welfare. Consent forms were signed by family members with no such powers. We were assured this would be addressed immediately.
The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. One authorisation was in place at the time of this inspection. The conditions to this authorisation were being complied with, although the records to support this were not always completed by staff.
Meadowbrook House was clean and tidy with no malodours throughout the service. There were people living at the service who were independently mobile and living with a degree of cognitive impairment. The service had some pictorial signage to meet the needs of people living with dementia. Some rooms had dark blue painted doors to distinguish them from bedrooms, but did not yet have a pictorial sign to clearly indicate what the room was used for.
Staff were supported by a system of induction training when they began working at the service. Most staff had been provided with supervision. Some appraisals had been carried out by the deputy manager. There was a programme in place to ensure all staff received regular supervision and appraisals in the near future. Staff meetings were held regularly. These provided staff with an opportunity to be informed of any changes and raise any suggestions or concerns they had regarding the running of the service.
People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned to minimise the risk of harm.
The manager had not held any meetings for people who lived at the service or their families. During the inspection the manager handed out a survey for people and their families to complete. We were told the information from the survey responses would inform a planned meeting to be held in July 2017. The service development plan stated that the service should plan to hold such meetings every two months and be in place by the end of June 2017. Families that we spoke with following the inspection had not received such a survey.
The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. Many new staff had joined Meadowbrook in recent months, with new nurses planned to join the service in the weeks following this inspection. The service had one nurse post and one part time carer post vacant.
People were treated with kindness, compassion and respect. People were supported to have maximum 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. Staff were heard to ask people for their choices and wishes throughout the inspection. One person had made a choice to live in a very cluttered bedroom, which had led to an environment which was difficult for staff to keep clean. This person regularly went out to the local shops alone and enjoyed their independence.
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff checked what people ate to help ensure they stayed healthy. However, people’s food and drink intake was not always recorded as directed in their care plan. There was no evidence of such records being monitored, totalled and reviewed to help ensure people always had an adequate intake.
Care plans were in the process of being moved to the new providers format. Some care plans we reviewed had been started in the new format. There was guidance and direction for staff which was organised and accessible, although this was sometimes conflicting with other information provided such as on handover sheets and in room files. The handover sheets used at shift changes did not contain specific relevant information on people’s care needs, such as when staff should provide re-positioning and record food and drink intake or if a person had any skin damage. This meant that any new or agency staff were not provided with key information. Care planning was reviewed regularly and people’s changing needs recorded. However, there was no record that people, or their relatives if appropriate, were included in these reviews.
People and their relatives commented that there was little to occupy them. People had access to some activities. A 1000 piece jigsaw was laid out partially co