- Care home
OSJCT The Meadows
All Inspections
29 January 2019
During a routine inspection
Rating at last inspection:
At our last inspection we rated the service good. Our last report was published on 12 August 2016. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
People’s experience of using this service:
• People living at The Meadows continued to receive safe care from skilled and knowledgeable staff.
• People and relatives told us staff were kind and dedicated. They said staff knew people well and treated people with dignity 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.
• The Meadows remained well-led. People, relatives and staff were complimentary of the registered manager’s leadership. The provider had effective quality assurance systems in place which were used to drive improvement.
The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection remained “good”.
More information is in our full report.
Why we inspected:
• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.
Follow up:
• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.
31 May 2016
During a routine inspection
There was a registered manager in post. 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 2008 and associated Regulations about how the service is run. The registered manager worked closely with the deputy manager and the area operations manager.
People who were supported by the service felt safe. Staff had a clear understanding of how to safeguard people and protect their health and well-being. People’s medicines were stored and administered safely.
The service had enough suitably qualified and experienced staff to meet people's needs. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care.
The registered manager and staff had a good understanding of the Mental Capacity Act 2005. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.
People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.
People’s nutritional needs were met and people benefited from a good dining experience. People were given choices and received their meals in a timely manner. People were supported with meals in line with their care plans.
The atmosphere at the service was calm and friendly. Staff we spoke with were motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.
People had access to activities and stimulation opportunities. Activities were structured to people's interests. Staff knew how to best support people and what activities and changes to the support would suit the needs of people.
Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.
Leadership within the service was open and transparent at all levels. The provider had quality assurance systems in place. The provider had systems to enable people to provide feedback on the care they received.
The registered manager informed us of all notifiable incidents. The registered manager had a clear plan to develop and further improve the home. Staff spoke positively about the management support and leadership they received from the registered manager.
22 April 2015
During an inspection looking at part of the service
We inspected this service on 22 April 2015. This was an unannounced inspection.
The Meadows is registered to provide accommodation for up to 68 older people who require nursing or personal care. At the time of the inspection there were 65 people living at the service. The home is arranged into three units; Bluebell, Poppy and Primrose.
At a comprehensive inspection of this service in December 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds with four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with four compliance actions. After the comprehensive inspection, the provider wrote to us to say what they would do to continue making improvements to meet the legal requirements in relation to those breaches. We undertook this focused inspection to check that the provider had followed their action plan and to confirm that the service now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for OSJCT The Meadows on our website at www.cqc.org.uk.
People were supported in a dignified way and staff responded to their needs in a timely way. People had care records that provided sufficient instructions to staff on how to support them and these were regularly reviewed to reflect people's changing needs. Records relating to people's care were stored securely and completed when care took place to reflect an accurate record of care received. Staff had received outstanding and refresher training to enable them to meet peoples needs.
Although the required improvements had been made we have not changed the overall rating for this service because we want to be sure that the improvements will be sustained and embedded in practice. We will check this during our next planned comprehensive inspection.
22 December 2014
During an inspection looking at part of the service
We visited The Meadows on 22 December 2014. The Meadows is registered to provide accommodation for up to 68 older people who require nursing or personal care. At the time of the inspection there were 65 people living at the service. The home is arranged into three units; Bluebell, Poppy and Primrose. This was an unannounced inspection.
We previously inspected the service on 14 May 2014. The service was meeting the requirements of the regulations at that time.
Prior to this inspection we had received concerns about how people’s pressure area care was managed, the levels of staffing, and the cleanliness of the home.
A pressure ulcer (also known as pressure or bed sores) is a wound that can develop due to pressure on that part of the body. People were not always protected against the risk of developing a pressure ulcer because some people’s pressure relieving mattresses were not on the correct settings, repositioning charts were not consistently completed and processes were not in place to ensure people had creams applied that promoted their skin integrity as prescribed.
People liked the food. Mealtimes were relaxed and unhurried. People who had lost weight were referred for specialist advice. However, staff were not always knowledgeable about the diets people required and some records relating to this were inaccurate. Some improvements were required to ensure all people had their nutritional needs met.
Some people told us there were not enough staff to meet their needs. Call bells were answered promptly most of the time but staff did not always assist people straight away when they answered the bell. People told us this sometimes meant their dignity was not upheld as they could not get to the toilet in a timely way. The service had experienced a high turnover of staff in the last year. There was an ongoing recruitment campaign and shortfalls in the rotas were covered by agency workers.
Staff felt supported and benefitted from the supervision and appraisal process but gaps in training meant they were not always supported to improve the quality of care provided to people.
Some care plans did not provide sufficient instructions to staff on how to support people. Other records in relation to people’s care were not consistently completed. On one unit information about people was not managed in a way that protected their privacy.
People felt safe and told us they liked living at the home and were treated in a caring and friendly way. People and their relatives were complimentary about staff. Some people and relatives felt the high use of temporary staff sometimes impacted on the quality of care they received. People were supported with their personal care discretely and in ways which upheld and promoted their privacy and dignity.
People were supported to make decisions about their care, to remain active and to maintain their physical and mental health. Where required staff involved a range of other professionals in people’s care to ensure their needs were met. Staff were quick to identify and alert other professionals when people’s needs changed.
Medicines were stored and administered safely. People were protected against the spread of infection and the home was clean and tidy.
The home had a registered manager in place. 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 2008 and associated Regulations about how the service is run.
The registered manager had a clear understanding of the changes and improvements that were required. People, their relatives, visiting health professionals and staff recognised that improvements were taking place.
Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see the action we took and what action we told the provider to take at the back of the full version of the report.
14 May 2014
During a routine inspection
The home offered residential, nursing and dementia care. The home is part of The Order of St John Community Trust.
A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
People were cared for safely. Risk assessments were in place and regularly reviewed. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person told us 'everyone always asks for my consent even the cleaners ask if it's ok to come in and clean'.
There was enough appropriately qualified, skilled and experienced staff to meet the needs of the people who lived at this home at the time of our inspection. People living on Primrose and Bluebell unit told us that although care workers seemed busy at times they had time to meet their needs. The provider may find it useful to note that people on Poppy unit told us they felt there were not enough care workers on duty. One person said, 'there are never enough staff; the girls [care workers] are lovely but they are run off their feet. Another said 'they [care workers] look after me well but always seem really busy, I think they need more staff'. We saw that call bells were mostly answered promptly. We observed care on all three units and saw that care workers did not rush people during care tasks. We noted that although care workers were busy there was a calm and pleasant atmosphere throughout the home.
There were arrangements in place to deal with foreseeable emergencies. There was emergency lighting and plans for managing the person's needs in the event of a power failure. Each person had an emergency evacuation plan for use in the event of a fire.
We found that medicines were handled safely and securely. Appropriate arrangements were in place for obtaining and disposing of medicines safely and suitable records were kept regarding medication administration.
Systems were in place to make sure that managers and care workers learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.
The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had made three DoLS applications where it was in a person's best interest to do so.
Is the service effective?
The service was effective. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with care workers that they understood people's care and support needs and that they knew them well. One person told us. "they [care workers] know me and what I need them to do'. Care workers had received training to meet the needs of the people living at the home.
Is the service caring?
The home was caring. People we spoke with were complementary about the home. One person said, 'they [care workers] look after you. I can't fault it'. Another said, 'staff are smashing, they can't do enough for you'. A relative told us 'I think they are brilliant and [the person] is being well looked after'. During the SOFI observation we saw that people were given choices, supported to make decisions and care workers took time to understand people where they had communication difficulties. Throughout our inspection the atmosphere was pleasant and we observed many interactions between care workers and people that were caring, relaxed and friendly.
Is the service responsive?
The service was responsive. People's needs had been assessed before they moved into the home, regularly reviewed and reflected in the care plans. We saw evidence that care workers recognised when a person's condition changed or their health had deteriorated and sought the help and advice of other professionals. We spoke with visiting health professionals who told us they found staff to be 'very helpful' and 'make a real effort to follow any recommendations'. One professional told us that people's 'changing needs are identified and alerted to us quickly'.
Is the service well-led?
The service was well led. There was a registered manager in post who was visible and available for people and staff to raise any concerns. We saw that the provider took account of complaints, comments and feedback to improve the service. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the service was monitored on a consistent basis to ensure that people experienced safe and appropriate support, care and treatment.
17 May 2013
During a routine inspection
Relatives that we spoke with said they were happy with the care provided. One relative told us "I've been married for over fifty five years, do you think I would place my wife just anywhere". Another relative told us "I have peace of mind, since mother moved into the home. The care is very good". Another relative told us their relative had lived in the home for three years. During this time they had regular reviews of their relatives care and staff kept them informed of any changes.
People that we spoke with were complimentary about the standard of food provided and the choice. One person told us "the food is very good and there is always a choice". Another person told us "the food is nicely cooked and we are asked in resident meetings for our opinions and if there is any particular food we would like on the menus".
All staff had received training in safeguarding vulnerable adults from abuse. This was documented in training records.
People that we spoke with said there was usually enough nursing and care staff on duty to meet their needs. We saw evidence that audits were carried out on a regular basis,
28 June 2012
During an inspection looking at part of the service
We looked at the outstanding issues from a previous visit to the home 3rd February 2012. This was in regard to the training and supervision provided to staff to carry out their roles had not met the regulatory requirements. During this visit there had also been areas suggested for improvement. These were developing the quality of care planning for managing people with challenging behaviour and reporting significant events to the Care Quality Commission (CQC).
The home had been subject to two safeguarding investigations by the local authority since the visit by the CQC in February 2012. The issues of concern were around the training and knowledge of staff for safe moving and handling techniques and an allegation of inappropriate conduct of a member of staff.
We reviewed four care records and spoke with four people living in the home. We spoke with five members of staff and a member of the provider's management team.
We saw that staff spoke with the people respectfully and provided enough time for them to respond. We saw staff knocking on doors before entering bedrooms and ensuring that bedroom doors remained shut when carrying out personal care.
People told us that they were encouraged by staff to participate in activities provided in the home, equally their decision not to, was respected.
One person was particularly pleased about the care and support they had received during their stay in the home. We were told that they had 'done very well and life has improved and they had done a lot for me.'
The people we spoke with were complimentary about the staff working in the home. Comments made included, 'The carers were so good' and 'Staff very nice - can talk to them and they are friendly.'
3 February 2012
During an inspection in response to concerns
People told us the activities staff and volunteers provided a range of activities and outings. They said that arrangements were made to meet spiritual needs.