Streets Meadow

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

Everyone we spoke with told us they, or their loved one felt safe, and that staff knew people very well. Comments included, “I feel he is safe.” And “Absolutely he feels safe.”

The registered manager created a proactive and positive culture of safety, based on openness and honesty.

 People were protected from the risk of harm and abuse; safeguarding processes were clear and robust. There was a safeguarding reporting system in place that staff expressed full confidence in using. Safeguarding referrals had been made as required, including notifying CQC of specific events as required.

Risks to people were assessed, reviewed and managed well to ensure they remained safe. Care plans were detailed and provided sufficient guidance to staff to keep people safe.

Recruitment processes were safe and there were sufficient, appropriately trained staff in place to support people. However, deployment of experienced staff needed some consideration to ensure they were available when required to assist healthcare professionals.

Accidents and incidents were logged, and trends were identified to ensure risks had been mitigated. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Infection prevention and control measures were in place. However, during our visit we had identified face masks were out of date. The service took immediate action to ensure stock of Personal Protective Equipment (PPE) was audited. A 'head of house' had recently been appointed who would be responsible as the infection control lead. Health and safety audits took place regularly and any areas for action were addressed.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accidents, incidents and events were recorded on the provider’s electronic governance system. The registered manager was informed of each incident and undertook regular reviews to identify trends.

The provider had oversight and took action to prevent recurrence. For example, the provider had arranged for an external quality monitoring company to audit the service at Streets Meadow. An action plan was being worked on where minor shortfalls had been identified.

Lessons were learnt to continually identify and embed good practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Care plans and risk assessments were reviewed regularly and reflected people’s current needs. They made sure there was continuity of care, including when people moved between different services.

People’s needs and care requirements were detailed within their care plans and risk assessments. A summary was available if the person went into hospital or moved to another care home. This supported continuity in care for people. 

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly with the local authority safeguarding team as appropriate.

Safeguarding policies and procedures were accessible for staff to follow to ensure people were protected from avoidable harm. Records showed safeguarding referrals had been made as required, including notifying CQC of significant events.

We observed positive interactions throughout the assessment. Staff worked in safe ways. For example, staff told us they checked equipment to make sure it was safe to use, and staff knew what to do in an emergency.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them, such as pursuing hobbies during activities.

The service provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People told us they felt safe, and their risks were considered. People confirmed they felt involved in planning for their needs in relation to risks and keeping safe.

Staff told us about daily tasks completed to keep people safe. These included equipment safety, visual checks of the environment and reporting any concerns identified so these could be addressed. The registered manager told us of ongoing work to review care plans and risk assessments so risks could be managed using the least restrictive practices to ensure people were cared for safely whilst still maintaining their independence.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The premises were secure, and we observed checks taking place to ensure only authorised people could enter the premises. Staff understood and followed the service’s health and safety procedures. Health and safety audits took place regularly and any areas for action were addressed. Checks of the environment and equipment were undertaken in line with the provider’s policy and legal requirements.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us they ‘worked together well’ to provide safe care that met people’s individual needs. Comments regarding staffing levels included, ‘I see familiar faces all the time - so that is good.’ And ‘Mum has praised the night staff and said how kind they are.’ However, we received some feedback regarding staff not always understanding people’s individual means of communication. The registered manager told us person centred care training was being rolled out for all staff that included ways to communicate with people effectively.

The registered manager monitored and reviewed staffing levels to ensure staff were there when people needed them. A dependence tool was used to determine the level of staff required based on people’s individual needs. The provider had recently increased staffing levels at nighttime in response to people’s changing needs.

We observed the service to have a calm atmosphere and there were sufficient staff on duty to support people without rushing, and we noted call bells were responded to in a timely way.

The provider had effective processes in place to ensure staff had the necessary skills and competence to carry out their roles. Recruitment records showed staff were recruited safely. This included an enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was a robust infection prevention and control (IPC) policy in place and staff had a good understanding of IPC practice. There were dedicated domestic staff who followed cleaning schedules, and regular cleaning audits were carried out.

Upon arrival we were asked to wear a medical face mask as the service has experienced a few cases of influenza. The expiry date on the box of face masks was 5 December 2024. Once we brought this to staff members attention they ordered new masks and disposed of the current supply.

The service had informed appropriate healthcare agencies promptly about outbreaks of infectious disease such as influenza.

Throughout the day we saw cleaning tasks completed and documented by staff. Relatives described the home as being ‘Fairly clean. The cleaner is always there. And ‘Having been in other homes it is lovely.’

Staff knew the people they cared for well and recorded person centred information about them in care plans. A relative told us, “Dad doesn't like taking med’s. We have worked closely with the doctor and staff and he is now on liquid form [of medicines].” Another said, “Yes, they support him absolutely with his medication.”

However, medicines care plans and ‘when required medicine’ (PRN) protocols, were not always individualised or detailed enough to support staff to know when and how to administer medicines. For instance, they lacked detail of when to give one tablet or two; where people were prescribed transdermal patches, there were no written instructions to rotate the site where the patch was applied. As a result, records showed that patches had been repeatedly applied to the same area, posing the risk of damage to the skin. In addition, people’s ability and preference to manage their own medicines were not routinely recorded. Monthly medicines audits were undertaken, but these were not effective in identifying the issues found during the inspection. Temperature recording for the medicine fridge indicated that medicines within it, were not always kept within the manufacturers recommended range. This may affect the stability of the medicines. The service received support with reconciling medicines on admissions, medication reviews and pharmaceutical advice, from a care home pharmacist. Medication stock was audited monthly, and surplus was disposed of safely. Controlled drugs were stored, administered and recorded in line with the provider’s policy. We feedback these shortfalls to the provider and action has been taken to resolve them.