Meadows Court Care Home

Meadows Court Care Home is a residential care home providing accommodation and personal care to up to 22 people. The service provides support to older and younger people and people living with dementia. At the time of our inspection there were 18 people using the service.

Meadows Court Care Home are registered to provide care to people in their own homes, living in the community. However, the service was not providing this type of care at the time of the inspection or in the past 18 months. The provider told us they were applying to have this aspect of their registration removed.

Meadows Court Care Home is designed across two floors with bedrooms on both the ground and first floors. The service has 12 ensuite bedrooms and shared bathroom and toilet facilities. There are shared communal spaces such as lounges, dining room, conservatory and garden. The service also has a kitchen, laundry room and office on site.

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

Risk management was poor. People were not supported to have risks to their health and well-being assessed. Staff did not have sufficient guidance to understand how to identify when people’s health might be deteriorating and what to do. Where guidance was in place staff did not always follow this in practice which could lead to harm or improper treatment.

People were not supported to manage their medicines safely. Medicine records showed a significant number of discrepancies suggesting medicines were being administered incorrectly.

Recording of incidents and accidents was not consistent. Information was not accurately analysed to identify any increases of risk or deterioration of people’s health and well-being. There was a failure to learn lessons with a view to improving care following incidents occurring. This meant concerns about people’s health could go unnoticed.

Agency staff were living in the service. Not all recruitment checks had taken place to ensure the staff were of good character and suitable for their role. Risks to people in relation to staff living in the service had not been explored or assessed. This placed people at risk of harm or abuse.

People lived in a service where maintenance plans were not in place. This resulted in repairs not being addressed. Some of these such as damage to the flooring in the laundry and shower room could result in increases of bacteria and the spread of infection. Some areas where people lived also had a strong smell of urine.

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, however, the registered manager did not well understand best practice in this area. Records did not promote person centred care and identical information had been duplicated across a number of people’s records.

Quality assurance systems such as audits and surveys were ineffective in identifying areas for development and making improvements. We found significant failures in relation to registered manager and provider oversight of quality. This resulted in a failure by the provider to improve the service despite these concerns being identified at 4 previous inspections. This posed a risk to people’s safety, health and well-being.

Despite these findings, overall, people and relatives told us they were happy with the care they received.

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 (27 April 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to the management of medicines, management of risk, and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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 Meadows Court Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risks to people, staffing, medicines management and quality assurance at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Meadows Court Care Home is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 22 people. Meadows Court Care Home are registered to provide care to people in their own homes, living in the community. However, the service was not providing this type of care at the time of the inspection.

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

Quality monitoring systems were in place; however, they had failed to identify some of the shortfalls found at inspection. In addition, analysis and follow up of incidents had only just been developed, more time was required to ensure this was effective.

Staff knew how to manage risks identified in relation to people's care and support. However, care plans did not always reflect peoples current care needs.

Medicines were administered safely and in their preferred way. Safe recruitment processes were in place. Staff received training relevant to their role with competency checked regularly.

Staff demonstrated knowledge of how to keep people safe from abuse and described how they would raise a concern with the registered manager or other external agencies.

There were enough staff to support people and meet their needs. Systems were in place for people, staff and relatives to share their views about the service provided.

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 15 April 2021)

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a coronial investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of environmental safety and admission to the service. This inspection examined those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadows Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the assessment and management of potential risks to people's safety, infection control management and organisational governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Meadows Court Care Home is a residential care home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection. The service can support up to 22 people. Meadows Court Care Home are registered to provide care to people in their own homes, living in the community. However, the service was not providing this type of care at the time of the inspection.

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

Risks relating to people's care had been identified and risk assessments had been implemented to mitigate any identified risk. However further detail was needed in these assessments to ensure staff had clear guidance. Whilst accidents and incidents were reviewed, there was still no formal analysis of these.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were recruited safely and there were enough staff to meet people's needs. Medicine practices had improved since the last inspection, and people received their prescribed medicines by trained and competent staff. Measures were in place to reduce the risk of infection to people. Staff had received safeguarding training and understood their responsibilities to keep people safe.

There was a clear structure in place relating to quality assurance. Audits took place and identified areas of improvement. Action had been taken or was planned to improve these areas. The manager and provider had good oversight of the service. However, they did not have a good knowledge of the duty of candour and how this was used in practice. Staff told us they felt the service had improved since the last inspection and were optimistic about the future at the service.

There was a pre-admission assessment which took place prior to admission. This needed to be embedded and used consistently. Staff received training. People were supported to eat and drink safely, in line with their preferences.

The provider’s developments of the environment were on going and there were plans in place to resolve outstanding works. Staff worked with other agencies to promote effective care for people.

People were supported to maintain their independence by doing things for themselves. Staff interacted positively with people and knew them well. People felt at home and staff supported them well.

Care plans had improved and provided information to staff on how to support people. The service was able to meet a variety of people’s communication needs and the registered manager knew how to source different resources to meet people’s needs. Activities in the service required improvement. However, there was a plan to develop this further. There had been no complaints about the service. However, the provider had a policy and the manager understood their responsibilities around this.

Rating at last inspection (and update)

The last rating for this service was inadequate (last report published 12 February 2021) and there were breaches of regulation found. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

This service has been in Special Measures since December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Meadows Court Care Home is a residential care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection. The service can support up to 22 people. Meadows Court Care Home is also registered to provide personal care to people in their own homes. However, due to the COVID-19 pandemic, the provider had chosen not to support people in their own homes at this time and would review this in the new year.

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

Medicines were not managed safely. People did not always receive their prescribed medicines Medicine stock was not accurate and reflective on medicine records. ‘As required’ medicines did not have guidance to for staff on circumstances of administration and personal information was not always recorded, such as allergies. Staff did not always receive medicine training and competencies levels were not clearly assessed. This meant people were at risk of not receiving their prescribed medicines.

Risks associated with people’s care had not always been identified, assessed, mitigated and monitored effectively. Care plans did not contain sufficient information to enable staff to support people safely. Timely action was not taken and advice was not sought where there was contradicting information.

Information was not available to guide staff on how to support people with health conditions and adverse events.

Staff did not always wear their personal protective equipment (PPE) correctly which posed a risk of infection. Recent infection control audits did not identify concerns. Staff did not try and maintain social distancing and the provider did not follow national guidance relating to admissions into the service.

Quality assurance audits were carried out but were not effective in identifying shortfalls or areas for improvement. Some areas of the quality assurance audits were not completed accurately. Some staff carrying out these audits did not have specific training in that particular area. Where areas needing improvement were identified, there was no action plan in place. There was a lack of oversight from both the registered manager and provider, who had failed to identify these concerns.

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 (20 June 2019). At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 June 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.

We undertook this inspection to look at the infection control and prevention measures the provider has in

place. This was because there was a COVID-19 outbreak in the home everybody living at the home had tested positive. We widened the scope of the inspection to include the key questions of safe and well-led because we identified concerns in those key areas.

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 requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadows Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, risk management, infection prevent and control, and governance at this inspection. For each of these breaches you can see what action we have asked the provider to take at the end the full version of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Meadows Court Care Home is a care home that is registered to provide support to 22 younger and older adults who may be living with dementia, mental health or physical disability. The service was supporting 19 people at the time of our inspection. In addition, the service was also providing domiciliary care calls to people in their own homes. One person was receiving support with personal care in their own home at the time of the inspection.

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

Care plans did not always reflect the care and support people needed, though staff were knowledgeable about people’s needs and how to support them with their own routines. Quality assurance systems had not identified the shortfalls in care plans in a timely manner and audits were not always completed or recorded. People, their relatives and staff were involved in the development of the service.

People were happy with the care provided as staff were caring and respectful. People said, “There are some good staff, very good. If I ask for anything they never refuse to help, they are excellent.” Staff respected people as individuals and supported people to maintain their independence. People told us staff maintained their privacy and dignity, though we observed some care practices did not always promote this.

People felt safe with staff and there was enough staff to meet people’s needs. Recruitment, induction and ongoing training processes helped ensure only suitable staff were employed and that they had the required skills and knowledge. Staff were supported by the management team and received supervision and attended team meetings.

People enjoyed the quality and variety of the food and could help themselves to snacks and drinks. People were supported to access healthcare services and their received their medicines as prescribed.

People’s rooms were personalised, and some signs were used to help people find their way around. People could access a range of activities and spent their time as they chose. We have made a recommendation about activities for people with dementia.

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.

Relatives and staff were happy with the management of the service; they could approach them at any time and were confident any issues would be quickly 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 22 September 2015). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the assessing, monitoring and addressing quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.