About the service: Meadbank is a care home; people receive accommodation, nursing and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered for 176 people and 105 were receiving care at the time of our inspection on the days of the inspection.

The home is based on four floors, each named after a different London bridge (Albert, Chelsea, Lambeth and Westminster). Each floor has a private wing and the private wing is collectively called "London Bridge". The number of people and staff on each floor varied in response to their needs.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People’s experience of using this service:

Following the last inspection, we asked the provider to show what they would do to improve the key questions Safe, Effective, Caring, Responsive and Well-Led to at least good. At this inspection we found the provider had made good progress against all the breaches of regulations and had improved the outcomes for people because:

The provider had taken appropriate steps to identify and manage risks to people using the service. Where risks had been identified, the care plans contained clear guidance for staff on how to manage these.

The provider had taken steps to ensure any risks to the environment and equipment were being assessed and managed well. This was helping to keep people, visitors and staff safe.

The provider ensured there were sufficient staff on duty to support people safely and to have time to engage and communicate with people.

The provider had installed and implemented a new call bell system, which was working well. Staff were responding quicker to people’s calls for assistance.

Staff records showed that the number of staff who had now completed the training they needed to effectively carry out their roles and responsibilities had increased since our last inspection. Where gaps were found in training the manager was able to give us the dates when this training would take place.

People were treated with dignity and respect because personal care and support took place privately and staff spoke to people in a respectful way and maintained people’s confidentiality.

The provider had ensured that people’s rooms met people’s preferences for décor, music and/or television programmes.

Although we found the top floor which was mainly for people with dementia was not as bright or as aesthetically welcoming as the other floors, the manager has since written to us with a plan of improvements for this unit.

The service was much more responsive to the needs of people, including those who spent a lot of time in bed. The home had increased the number of activity team members and had improved the way it deployed this team. Activities were now scheduled over seven days per week.

People had person centred care plans that detailed the care and support they needed; this ensured that staff had the information they needed to provide consistent support for people.

The manager and staff demonstrated a commitment to provide meaningful, person centred care by engaging with people using the service, relatives and health and social care providers.

We found that the provider had taken a more proactive role in seeking people’s views and resolving any concerns or complaints.

The provider had improved the systems used to monitor and improve the quality of the service. Audits were carried out on a regular basis and action plans developed to ensure changes were ma

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”

We have also taken the decision to leave Meadbank in special measures because since our inspection in August 2018 several serious safeguarding alerts have been raised which are being investigated by the local authority safeguarding team and the Police.

We carried out this unannounced comprehensive inspection on the 8 and 9 August 2018. At our last inspection in January 2018 we found five breaches of regulations and rated the service as 'Inadequate' and the service was placed in 'special measures'. Special measures provide a framework for services rated as inadequate to make the necessary improvements within a determined timescale. If they do not make the necessary improvements, the CQC can take further action against the provider, including cancelling its registration.

The breaches of regulations we found at the inspection in January 2018 were in relation to safe care and treatment, premises and equipment, staffing, receiving and acting on complaints and good governance.

This was because the provider did not have effective systems to assess, review and manage the risks to the health and safety of people and did not do all that was reasonably practicable to mitigate any such risks. They did not ensure that care and treatment was provided in a safe way for people in terms of preventing, detecting and controlling the spread of infections. They did not ensure the proper and safe management of medicines. They did not ensure the premises and equipment used by people was clean, suitable for the purpose for which it was being used, and properly maintained. Staff did not receive appropriate support, training, professional development and supervision as was necessary to enable them to carry out the duties they were employed to perform. They did not have an appropriate system in place to receive, respond to, and act upon complaints. They did not ensure that systems or processes were established and operated effectively to assess, monitor and improve the quality and safety of the services provided. They did not maintain securely an accurate, complete and contemporaneous record in respect of each person, including a record of the care and treatment provided to people or other records of the management of the regulated activity.

Two of the breaches, ‘safe care and treatment and good governance’ were so serious we

We undertook an unannounced inspection of Meadbank Care Home on 16, 17 and 22 January 2018. At our previous inspection in July 2017 the home was rated as Requires Improvement with three breaches of regulations relating to assessing the risks to the health and safety of people and not doing all that was reasonably practicable to mitigate any such risks. We found further that the provider did not always ensure the proper and safe management of medicines and did not always provide care in accordance with the Mental Capacity Act 2005 (MCA) and did not always ensure the nutritional needs of people were met.

As part of this inspection we were responding to the high volume of safeguarding concerns the CQC had received from the London Borough of Wandsworth, Wandsworth Clinical Commissioning Group and the number of complaints we had received from relatives and friends of people who use the service.

Meadbank is a ‘care home’. People in Meadbank receive accommodation, nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered for 176 people and 154 were receiving care on the days of the inspection. The home is based on four floors, each named after a different London bridge (Albert, Chelsea, Lambeth and Westminster). Each floor has a private wing and the private wing is collectively called “London Bridge”. The number of people and staff on each floor varied in response to their needs. Two of the units specialise in providing care to people living with dementia.

The service had a registered manager in place 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. Shortly after our inspection we received information that the registered manager was no longer working at Meadbank.

Following the previous inspection, we asked the provider to complete an action plan, with a timescale, to show what they would do to address the breaches of regulations we found, and improve the areas of Safe, Effective, Caring and Well Led to a standard that was at least “Good”. At the previous inspection in July 2017 we did not look at the area of Responsive.

With regard to the breach of regulation in relation to safe care and treatment, we found that the provider had not followed their action plan to meet the legal requirements of this regulation. We found that the pre-admission assessments were insufficiently detailed to build a detailed care plan for a person and so to mitigate the risk to them of receiving inappropriate care. Where specific risks had been recorded we saw that there was insufficient detail to help mitigate against the risk occurring.

We found the provider had not followed their action plan to meet the legal requirements in regard to the correct management and administration of medicine. A type of needle being used did not protect staff against the risk of an accident. The suction machine was not ready for use if a person was choking. Blister packs of medicine were not stored securely. The extended length of time taken to complete a medicine rounds meant that people may receive their medicine later than prescribed.

At this inspection we identified five fresh breaches of regulation in regard to Staff, Premises, Safe Care and Treatment and Good Governance.

With regard to Staff we found that there were insufficient staff on duty to meet the needs of people in a timely manner. Although we observed staff interacting with people in a kind and dignified matter, staff were rushed at times and there were periods when staff were not visibly present on the units and not available should a person req

We conducted a comprehensive inspection of Meadbank Nursing Centre on 4 and 5 April 2016. At this inspection a breach of regulations was found in relation to the safe management of medicines. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to this area. We conducted a focussed inspection on 2 September 2016 to check the provider had followed their plan and to confirm that they now met legal requirements in relation to the breach found. We also followed up some information of concern that was received prior to the inspection. We found improvements had been made in line with the provider’s plan and we did not identify any concerns in relation to the information of concern.

We undertook this focused inspection in July 2017 to follow up some information of concern which we received about the care of people using the service and potential neglect. This report only covers our findings in relation to the above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadbank Nursing Centre on our website at www.cqc.org.uk.

Meadbank Nursing Centre is a care home with nursing for up to 176 people, with a particular emphasis on providing palliative care. There are four units at the home each named after a famous bridge in London and each unit was supposed to have its own unit manager. At the time of our inspection, one unit had a recently recruited unit manager and another unit did not have a unit manager in place although the service was recruiting to fill this vacancy. Albert Bridge unit which is based on the ground floor is home to older people with some early onset dementia and Westminster Bridge unit which is on the first floor is a nursing unit. Chelsea Bridge unit which is located on the second floor is home to those with palliative care needs and Lambeth Bridge unit is home to those with advanced dementia needs. There were 157 people using the service when we visited.

The service 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.

Procedures were in place to protect people from abuse. Staff understood how to recognise abuse and knew what to do if they suspected abuse was taking place.

Risk assessments and care plans varied in quality and we found some examples of risk assessments and care plans that did not fully explore and manage risks to people’s care.

At our previous inspection we found improvements had been made in relation to medicines administration. However, at this inspection we identified some concerns in relation to the safe management of medicines. We found medicines were not always stored appropriately. We found one fridge that was not working and therefore the medicines within it were not safe for administration and one controlled drugs cabinet was not in place in line with legal requirements. We found some ‘as required’ medicines were not accompanied with sufficient instructions for nurses to safely administer them and we found two medicines with a reduced expiry date upon opening were not marked with the date of opening for staff to monitor how long they remained safe for use. We also found some expired medical devises were available for use.

There were enough staff employed and scheduled to work to meet people’s needs and keep them safe.

People were not consistently supported to meet their nutrition and hydration needs. Food and fluid charts were used, but these were not consistently filled in. People were otherwise supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs, but staff understanding of people’s h

We conducted an inspection of Meadbank Nursing Centre on 4 and 5 April 2016. At this inspection a breach of regulations was found in relation to safe management of medicines. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this area.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to the breach found. We also received some information of concern prior to our inspection which we followed up during this inspection. This report only covers our findings in relation to the above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meadbank Nursing Centre on our website at www.cqc.org.uk.

Meadbank Nursing Centre is a care home with nursing for up to 176 people, with a particular emphasis on providing palliative care. There are four units at the home each named after a famous bridge in London and each had its own unit manager. Albert Bridge unit which is based on the ground floor is home to older people with some early onset dementia and Westminster Bridge Unit which is on the first floor is a nursing unit. Chelsea Bridge unit which is located on the second floor is home to those with palliative care needs and Lambeth bridge unit is home to those with advanced dementia needs. There were 157 people using the service when we visited.

There service did not have a registered manager at the time of our inspection. A new manager had been hired and was in the process of registering with the CQC. 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.

At our previous inspection we found that there were some issues with regard to the safe administration of medicines. We found that people being prescribed medicines that were labelled ‘do not crush’ were having their medicines crushed prior to administration thereby placing them at risk of unsafe administration. Some PRN or ‘as needed’ medicines protocols were not detailed enough to adequately instruct care staff. We also found that some people with higher than expected blood glucose levels were not being referred for further medical advice or assistance as expected.

At this inspection we found that all people within the home who had their medicines crushed had specific instructions in place from their GP on how to do this and care staff were aware of these. We found people who had medicines administered ‘as needed’ had protocols in place which instructed care staff as to how and when these could be safely administered. We found people whose blood glucose levels were being checked had their levels recorded and there was an indication on the form as to what safe readings were for the person. Nursing staff were clear about what action to take if people’s blood glucose levels were not at a safe level.

There were enough staff employed and scheduled to work to meet people’s needs and keep them safe.

Care staff were trained in how to safely move and reposition people with mobility problems. Care plans included instructions for care staff about how to safely move and reposition people and care staff were aware of people’s requirements. We observed a person being moved safely in accordance with the details in their care plan.

We conducted an inspection of Meadbank Nursing Centre on 4 and 5 April 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second day.

We undertook an inspection of this service in November 2014. During that inspection we identified concerns in relation to infection control, people’s social and emotional needs being addressed appropriately, the recording of fluid intake and some issues with a lack of signage in the building to help people with dementia orientate themselves. The provider sent us an action plan after this inspection setting out how they were going to address these issues. We conducted this inspection to check that improvements were being sustained in accordance with the provider’s action plan. We found all areas had been addressed appropriately.

Meadbank Nursing Centre is a care home with nursing for up to 176 people, with a particular emphasis on providing palliative care. There are four units at the home each named after a famous bridge in London and each had its own unit manager. Albert Bridge unit which is based on the ground floor is home to older people with some early onset dementia and Westminster Bridge Unit which is on the first floor is a nursing unit. Chelsea Bridge unit which is located on the second floor is home to those with palliative care needs and Lambeth bridge unit is home to those with advanced dementia needs.

There was a registered manager at the service. 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.

We found that there were some issues with regard to the safe administration of medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities. However, we found that people being prescribed medicines that were labelled ‘do not crush’ were having their medicines crushed prior to administration thereby placing them at risk of unsafe administration. Some PRN or ‘as needed’ medicines protocols were not detailed enough to adequately instruct care staff. We also found that some people with higher than expected blood glucose levels were not being referred for further medical advice or assistance as expected.

The provider had good systems in place for the prevention and control of infection. We found all previous issues with regard to the external storage of waste had been addressed. The provider maintained a clean home environment and staff members were aware of their responsibilities with regard to infection control.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. Mental capacity assessments were completed as needed and we saw these on people’s files. Where people were at risk of having their liberty deprived, applications were sent to the local authority for Deprivation of Liberty authorisations.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

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During the inspection people using the service and their relatives told us they thought their care and support needs were well met by the home. They also said enough activities were provided for them and it was their choice whether they participated or not. "Mum likes to use the visiting hairdresser who brings their dog in". "Overall brilliant, never any problems". "I come in everyday and it's lovely, mum's been here for three years".

They were also aware of the complaints procedure.

They did not tell us about the support staff received, medication administered or the quality assurance system in place. They did say that their views were asked for, they had filled in satisfaction surveys and generally staff were very good. In some instances individual staff were singled out with comments such as "Superb" and "Excellent".

We found that the home provided good care and support for people living at Meadbank, medication was appropriately administered and accurate records kept when this took place.

There was suitable support, training and supervision of staff to enable them to fulfil their roles competently and effectively.

There were effective quality assurance and complaints procedures in place to monitor the quality of care provided and satisfaction levels of people using the service and their relatives.

Our inspection of the 8th November 2012 found that some people were at risk of receiving unsafe care, treatment, support and attention because there was insufficient staff to meet people's needs. Some people's dignity was not always being respected and people were not always being involved in decisions about their care needs. Some people were at risk of receiving unsafe care and treatment, because some aspects of care were putting people at risk due to poor hygiene controls. The home did not have sufficient or adequate maintenance staff to routinely address work repair requests. We returned to inspect the home and found that improvements had been made.

We spoke with people living at the home, their relatives and staff who worked at the home. The relatives we spoke with all told us that they felt staff treated their family member well and showed respect and empathy towards people. One person commented "staff are kind they help me when I call and make time for me". During meal times we observed many staff available to deliver meals to people's rooms and provide assistance to those who required more support. Staff sat with people both in their rooms and in the dining facilities to provide help and assistance where needed.

Someone told us "there are domestic staff on hand to help keep the home clean". Another person said "there's a nice maintenance chap, he sorts it all out". We saw domestic staff working on all floors and laundry staff fulfilling their roles.

We spoke with sixteen people living at BUPA Meadbank Nursing Centre and seventeen relatives because some of the people living at the home had complex needs which meant that they were not able to tell us about all of their experiences. We used a number of methods to help us understand the experiences of people using the service including observations and reviewing records. We spoke with twenty-two staff and contract staff working at and for BUPA Meadbank.

Relatives we spoke with told us that they were pleased with the overall care that people received. They told us that they can visit whenever they wish to and that staff were pleasant and welcoming. Relatives explained that staff kept them informed and involved and provided good care to people living at the home. One relative said “the staff have been marvellous; I cannot fault them I’ve been very happy with the support they have given”. One relative of someone living at the home spoke about how people can attend faith services of their beliefs.

Two relatives also told us that although the care was usually very good, the staff were very busy and that often people’s personal belongings including clothing can go missing temporarily. One person told us that despite clothes having people’s names written in them they had found clothes belonging to other people being worn and that clothes had temporarily been mislaid between the laundry and the unit. Another relative told us that they were very pleased with the care provided although there were times when the home was often short of staff and this had an impact on the care people received.

Another person told us that cleaning could be improved and that they have often found used tissues, food and fluid spillages on the floor and used syringes and pads left in people’s rooms on one of the units. However, we spoke with several relatives who told us that they found the home very clean, while three relatives told us that they had requested maintenance repair works to people’s rooms which had not been completed.

Comments we received from people who live at Meadbank included:

'I couldn't be happier' and 'I have no complaints'.

One person said about the staff – 'they couldn't be kinder' and another said that staff

asked how she wanted to be cared for.

Another person said to us that 'the food is good and you can choose what you want – they come around and ask you.'

A relative told us that: 'staff are kind and caring, I feel confident that they keep me

informed in any changes that arise in my mother's condition.'

Staff told us that they enjoy their work at Meadbank and that they had opportunities to

do a range of training courses that assisted them in their work

The inspection took place over three days, on the 6, 10 and 12 November 2014. On the first day of the inspection we arrived unannounced.

Meadbank Nursing Centre is a large nursing home, providing care for up to 176 people. Most of those using the service are older people, including some who are living with dementia. The top floor specialises in caring for those with dementia, although all the units support some people with this condition. A few people receive a service for a short period (respite care), but most receive long term care.

The home met all the regulations we checked at our last inspection visit in September 2013.

Although the home is purpose built, it has been added to over the years. Each area has been divided into units or suites overseen by a unit manager who is a registered nurse. The suites are named after different London bridges and the home is located near to the river Thames.

The Registered Manager was due to leave the company a few days after our inspection. He had been covering a more senior role just prior to his departure, so day-to-day management of the home was in the hands of the deputy manager and the clinical nurse manager, both of whom had worked within the home for many years. We saw that there was an advert out to recruit a new registered manager. 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.

There was evidence of good care throughout the home, but there were inconsistencies too.

The home was clean, with the exception of one lounge early in the morning, but the poor state of the external bin stores amounted to the breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

Some parts of the building were overdue for refurbishment, but there were plans in place to address this. Signage and other means of helping people to find their way around were underdeveloped.

People’s personal care needs, such as assistance with bathing and skin care, were well attended to, but there was less emphasis on meeting people’s social and emotional needs. This was particularly important for those living with mental ill-health or dementia. We made a recommendation about this.

The management team was well informed about the Mental Capacity Act 2005 and applications for Deprivation of Liberty Safeguards had been made if people could not make their own decisions and restrictions had to be put in place to keep them safe.

Assessments, care plans and risk assessments were up-to-date and staff were well informed about people’s individual needs and preferences. Meals were nutritious and well presented. People told us that the staff were kind.

We found that the home benefitted from good local leadership and there were robust systems in place to monitor and evaluate the care provided. The home had achieved recognition for the quality of its end of life care from the Gold Standard Framework.

Staff members were supervised regularly and received appraisals. The provider followed safer recruitment practices and ensured all appropriate checks were carried out prior to employment. As well as mandatory training and refreshers in areas of health and safety, staff members attended training in dementia care and had the opportunity to enhance or consolidate their professional qualifications. People told us that staff were kind and caring; there was only one exception to this which we reported to the managers so they could investigate.