25 May 2023
During an inspection looking at part of the service
The Meadows is a residential care home providing the regulated activity of personal care to up to 54 people. At the time of our inspection there were 53 people using the service.
The home is purpose built and designed around the needs of older people, some who may be living with dementia. It is located within a community setting. The home is run as 'four separate houses', three for 15 people and the fourth being for 9 people. The 4 houses are on the ground and first floor with lifts and staircases available. An additional 30 beds on the second floor are contracted to a community provider and do not come within the remit of the home’s registration. A small, enclosed garden was situated within the grounds.
People’s experience of using this service and what we found
People's care and support needs were assessed. However, risk assessments were not always regularly reviewed and in some cases lacked guidance for staff. This was rectified during the inspection and the provider added an additional measure on their IT systems to ensure risk assessments were reviewed in a timely and consistent manner.
Staff did not always follow infection prevention and control guidance to minimise risks related to the spread of infection. We observed some staff with painted and gel nails. We raised this with the management team. Infection control procedures were in place and staff used personal protective equipment (PPE) effectively.
Although people’s mental capacity had been assessed for their ability to consent to aspects of their care, assessments did not always record decisions made in line with guidance. Staff knowledge around mental capacity was inconsistent. Staff told us they had mental capacity act training and the management team confirmed this. The management team informed us they would be providing refresher training for all staff.
Staff and relatives were positive about the culture and ethos of the service. The senior team led by example and were respected by staff. Staff understood how to safeguard people and when to raise concerns. People received their medicines safely and recruitment practices were in line with government guidance.
There was an established staff team that was motivated and well trained to carry out their roles effectively. There were enough staff to support people. The service was accessible and had been adapted to meet people's needs.
Records had been kept of all food and drink taken by those assessed as at risk nutritionally. The staff and kitchen were clear about who needed modified/enriched diets and ensured they received this and recorded it. People were supported to maintain their nutritional needs and referred to appropriate health professionals when needed
People were supported to have maximum choice and control of their lives and staff did always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. These concerns were highlighted to the management team who resolved the concerns during the inspection process.
The systems for quality assurance and monitoring were not always effective and had not identified the shortfalls we encountered during the inspection. Records in relation to people’s consent to care, did not always record information sought in line with guidance. Mental capacity assessments for people were in place but did not always record who was involved in the decision making process. We discussed our concerns with the deputy manager and the management team during the inspection. The management team informed us, they had rectified their systems and processes to ensure the shortfalls were addressed
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 11 May 2019)
Why we inspected
This was a planned inspection due to the age of the rating. You can see what action we have asked the provider to take at the end of this full report.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.