The Meadows Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked at 4 quality statements under the Well Led key question: Capable, compassionate and inclusive leaders, Freedom to speak up, Governance, management and sustainability, Learning, improvement and innovation. At our last inspection we identified a breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Not enough improvement had been made at this assessment. We found the provider’s systems had failed to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of people. This was a continued breach of Regulation 17.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During our visit we saw the manager was visible within the service supporting and guiding staff, however, staff we spoke with told us they did not feel supported and told us the manager was always in their office. They had not had regular supervisions to provide them with guidance and support and to discuss their performance and development. The manager told us the provider visited the service regularly as part of their quality assurance measures, this included visit from the operations director and the quality manager.

The service has been without a registered manager since October 2023. However, a new manager had been recruited and following our assessment has started the process of becoming registered with CQC. The provider had not had sufficient oversight of the service since the last inspection to drive the improvements and fully address the shortfalls identified at the last inspection. The shortfalls we found during this assessment were similar to those found at the last inspection. Systems were not effective in ensuring staff were provided with opportunities to provide feedback to leaders and have one to one meeting with their manager.

Not all staff were confident their voices were heard. One staff member told us, “Management are no help at all, they do not listen to staff”. Another said, “I have been asking for training, it’s still not happened, even after incidents”.

The provider had a safeguarding policy in place; however, the policy was not always followed by the service leaders. We found that not all safeguarding incidents were reported externally in accordance with the provider's policy. The provider had failed to ensure staff had adequate forums such as staff meetings and one to one supervisions to enable them to discuss any concerns or training needs. The new manager had started to plan team and individual meetings with staff.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider told us our feedback had not come as a surprise to them, however, they had not identified the concerns we found through their own quality assurance processes, nor were they recorded on the care home improvement plan. The operations manager and manager talked to us about their vision for the future of the service, which included recruiting and retaining staff.

At our previous inspection we found breaches of regulation. We found similar concerns at this assessment. The provider did not always recognise their regulatory responsibility to ensure they notified CQC of incidents and accidents at the services. For example, we found incidents of unexplained bruising and skin damage had not been reported. The provider had failed to ensure effective systems were in place to monitor and mitigate risks to people including environmental risks. Care records had not been consistently reviewed. We identified concerns around medicines management and risks to people's health and wellbeing. This meant people did not always receive safe and good quality care. Satisfactory pre-employment checks were not always completed when staff were recruited to work in the home. This meant the provider could not be assured they were suitable to work with vulnerable people. The provider had not maintained effective systems to obtain feedback from service users, relatives and staff to inform improvements at the service. During the assessment we requested the provider took urgent action to mitigate risks to people we had identified.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The nominated individual told us there was a care home improvement plan in place, we reviewed this, however, found this had not been kept up to date. For example, the provider visit had not been completed since July 2023, actions did not always have a completion date, or updates recorded. They have updated the ongoing action plan since our assessment started and this indicated a better oversight of the risks to be mitigated.

The provider had not evidenced learning from previous inspections or successfully implemented and sustained improvements. Systems in place to ensure staff training and competencies were kept up to date were not effective. Staff had not received regular supervision or appraisals. This meant the provider did not have good oversight of staff individual performance and learning needs. Since our assessment the provider has told us of the changes they have made to improve the quality and safety of care provided.