Meadow Rose Nursing Home

Meadow Rose Nursing Home is a care home providing personal and nursing care for up to 56 people. Meadow Rose is a purpose-built accommodation with three floors, each floor has a communal area and there is also access to a garden.

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

Risks in relation to restraint had not been adequately assessed, monitored and reviewed and staff had not received the appropriate training. Staff had knowledge of safeguarding, but some staff had failed to recognise and report a safeguarding incident. Some recruitment records required improvement.

At our last inspection we found the provider’s governance system required improvement. This remained a concern at this inspection and systems to monitor the quality and safety of the service had not identified the areas for improvement found at this inspection.

People and relatives told us they were safe. There were sufficient staff to meet people’s needs. Some people felt call bells could be responded to more quickly. Our observations were people did not wait to receive care and there was ongoing monitoring of call bells response times by the registered manager. Medicines were managed safely and infection control procedures were in place and followed by staff.

People, relatives and staff spoke positively about the management at the service and staff felt supported. The registered manager was open to feedback and following the inspection took action to address the concerns raised.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 03 October 2019) and there was a breach of regulation 17, good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the safety and care provided to people in relation to the use of restraint. As a result, we undertook a focused inspection to review the key questions of safe and well- led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service remains the same. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Meadow Rose Nursing 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 regulation 12, safe care and treatment and regulation 17, good governance at this inspection.

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.

Meadow Rose Nursing Home is a residential care home providing personal and nursing care to 53 people aged 65 and over at the time of the inspection. The service can support up to 56 people. The service accommodates people over three floors which were accessed by a lift in one adapted building. It provides care to older people and some younger adults, some of whom are living with dementia.

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

Risks had not always been fully assessed to keep people safe and protected. People told us they felt safe. Staff had received safeguarding training and knew how to escalate suspicions of abuse. Accidents and incidents were recorded, and action taken to minimise risk for the future. People told us they received their prescribed medicines. People told us, and we saw the home was clean.

Improvement was needed to ensure pre-admission assessments were completed robustly. Most people felt staff had the skills and experience to care for and support them. People's nutritional needs were met. People accessed health care when needed. The environment where people lived was well maintained and was clean and fresh.

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.

People told us they were treated with kindness and compassion by staff who supported them. Staff took opportunities to speak with people and had a caring, friendly approach. People's privacy, dignity and independence were respected by staff. People's equality and diversity needs were respected.

People were supported to take part in social activities. The provider had a complaint process which people were aware of to share any concerns.

The service was not consistently well managed. The systems in place to monitor the quality and safety of the service were in place but not consistent in identifying where improvement was needed for example in relation to risk management. The registered manager was known to people and made themselves available.

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 8 September 2017).

Why we inspected

The inspection was brought forward due to an increase in the number of safeguarding incidents and concerns shared by commissioners.

Enforcement

We have found evidence that the provider needs to make improvements. Please see the Well Led section of this full report. We have identified a breach in relation to Regulation 17, Good Governance at this inspection. You can see what action we have asked the provider to take at the end of this full 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.

Meadow Rose Nursing Home is registered to provide accommodation with nursing and personal care for a maximum of 47 people including people living with dementia and physical disabilities. At the time of our inspection 46 people were living at the home. Accommodation is provided over three floors. There are lounges, rest spaces and dining areas. Every bedroom is equipped with en-suite facilities.

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 and associated Regulations about how the service is run.

People were cared for and supported by staff that had received training to equip them with the required skills to meet people’s needs. Staff received supervision, providing them with appropriate support to carry out their roles. We saw staff treated people as individuals, offering them choices whenever they engaged with people. Staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible. Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments were not always up to date and consistently completed to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interest; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People spoke positively about the choice of food available. Staff supported people who were living with dementia to eat and drink to maintain their health and wellbeing in a caring and sensitive way. People were supported to access health care professionals to ensure that their health care needs would be met, although instructions left by healthcare professionals was not consistently followed.

People who lived at the home were kept safe. Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm. People were supported by sufficient numbers of suitable staff that had been recruited safely. People received their medicines as prescribed.

People and relatives told us that staff were kind, caring and friendly and treated people with dignity and respect. The atmosphere around the home was welcoming. People were relaxed and staff supported people in a dignified way. People and relatives told us they were well supported by staff and the management team and encouraged to maintain relationships that were important to people. People’s health care needs were assessed and regularly reviewed. Relatives told us the management team were good at keeping them informed about their family member’s care. People were supported by a small, dedicated activities team that provided opportunities to optimise people’s social and stimulation requirements. People and their relatives told us they were confident that if they had any concerns or complaints they would be listened to and matters addressed quickly.

The registered manager had introduced new management systems to assess and monitor the quality of the service provided. There were systems to gain feedback from people living at the home, relatives and visitors. This included resident/relative meetings, satisfaction questionnaires and regular reviews. People, their relatives, staff and visiting professionals told us the home had much improved and was now more organised and well-led. We saw the appointment of the new registered manager had had a positive impact on the overall management of the home.

Meadow Rose Nursing Home opened in December 2013 and has accommodation for up to 49 older people who require nursing care. There were 47 people living there at the time of our inspection.

We found that the management of the service was not robust and this affected the quality of the service people received. This was a breach of regulations.

The provider was not fulfilling their legal responsibility to keep us informed of all incidents that occurred in the home. This was a breach of regulations.

There was no registered manager in post at the time of our inspection. 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.

Whilst people felt they were safe we found that procedures were not always followed to keep people safe from harm. Senior staff were not always aware of what action to take to ensure people were safe from harm. We found that the systems and processes were not operated effectively to ensure that when safety issues relating to people’s care were identified appropriate acknowledgment and actions were taken to keep people safe.

We found that the service did not learn from incidents, so incidents affecting the safety of people were sometimes repeated.

People could not be confident that their complaints and concerns would be listened to and the appropriate actions taken to resolve them.

We found that the majority of people that lived at the home were living with dementia care needs and the environment was not suitable to support their needs. People’s privacy and dignity was not always respected by staff.

We found there were sufficient staff available to meet the needs of people, and resources were available to increase staffing numbers as necessary.

People received their medicines as prescribed and systems were in place to ensure medicines were safely administered.

People had a choice of food and drink and were supported to maintain a healthy diet. People had access to health care professionals to ensure their health care needs were met. People’s rights to consent to care and treatment was respected by staff.

People felt staff were caring towards them and their independence was respected. A range of activities were available for people to participate in if they wished and visitors were welcomed at the service.

The action we told the provider to take can be seen at the back of the full version of this report.