About the service: Meadowbrook is a ‘care home’ registered to accommodate up to 69 people. At the time of this inspection the service was providing personal and nursing care to 44 older people.

People's experience of using this service:

•Overall people were satisfied with the quality of the service provided and people, visitors and staff all spoke of improvements that had taken place over recent months.

•The quality of the food remained an area where people expressed mixed views and the registered manager was working with the catering company to address issues.

•Staffing levels were under review. Overall people were confident that there were enough staff to meet their needs however some issues in relation to the allocation of staff were shared. The registered manager was actively reviewing staffing levels and liaising with people, relatives and staff to share progress.

•Risks to people were monitored and procedures were in place to help keep people safe.

•People received their medicines as and when they needed them.

•People were protected from the risks associated with the control and spread of infection.

•Staff understood the importance of ensuring people's rights were understood and protected.

•People's health care needs were monitored and understood by staff.

•People told us staff understood their needs and were kind, caring and compassionate.

•People had opportunities for social stimulation and more would be welcomed.

•People were confident that complaints would be addressed.

•Quality checks and audits enabled the provider to ensure improvements were being made within the service.

Rating at last inspection: The service was rated Requires Improvement at the last inspection in December 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 4 and 15 December 2017 and was unannounced on the first day and announced on the second day.

Meadowbrook Care Home is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Meadowbrook Care Home accommodates up to 69 people across three separate units, each of which have separate adapted facilities. The Garrett Anderson Unit specialises in providing care to people living with dementia. The Agnes Hunt Unit specialises in providing care to people living with neurological conditions. The Mary Powell Unit specialises in providing care to people with general nursing needs. At the time of our inspection, there were 48 people living at the home, two of whom were staying there on a temporary basis.

There was a registered manager in post who was present during 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.

At our last inspection in April 2017, we found five breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These breaches related to the provider's failure to provide dignified care; to deploy enough suitably trained staff; to ensure people’s rights were protected; to ensure that people received safe care and treatment and to ensure effective governance to drive improvements in the service. We gave the service an overall rating of ‘Inadequate’ and placed them in special measures. This meant significant improvements were required or further enforcement action could be taken. We asked the provider to complete an action plan to tell us what they would do and by when to improve the service and meet the regulatory requirements.

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.

The provider had developed and implemented an action plan to address the shortfalls in the service within set timescales and had worked hard to achieve improvement. Whilst we acknowledged the efforts made by the registered manager and provider, we found that systems put in place to address the shortfalls were not consistently embedded across the home and there were still areas that required improvement.

Staff were not always effectively deployed to meet people’s needs in a person-centred manner.

People and their relatives had raised concerns about the choice and quality of meals. The registered manager and provider were in continued talks with the catering staff to make the required improvements.

People were protected from abuse and discrimination by staff who knew how to identify and how to report signs of abuse and poor practice. Where concerns were raised, these were investigated and action taken to prevent reoccurrence.

Risks associated with people’s needs were assessed and measures were put in place to minimise them. The provider ensured the environment and equipment were maintained to ensure safe and effective care.

People were supported to take their medicines by staff who were trained and assessed as competent to administer them. Medicines were stored safely and accurate records maintained.

People were supported to access healthcare services as and when necessary to promote good health.

People’s

The inspection was carried out on 4 and 5 April 2017 and was unannounced.

The home was last inspected on the 14 September 2016 where we gave it an overall rating of requires improvement. We had identified the provider was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to a lack of person centred care. We asked the provider to make improvements and send us an action plan. At this inspection we found that improvements had not been made and that further concerns were identified.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

Meadowbrook Care Home is registered to provide accommodation with nursing care for up to a maximum of 79 people. There were 50 people living at the home during our inspection. People were cared for in three units. These included the Garrett Anderson unit which provides supports to people living with dementia. The Mary Powell Unit which provides support to people with physical health needs and the Agnes Hunt unit which supports people living with neurological needs.

There was a registered manager in post who was absent during 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.

There were not enough suitably trained staff deployed to meet people’s needs in a timely and person centred manner. There were staff vacancies and a high turnover of staff. There was a reliance on agency staff to cover the gaps in shifts. This added additional pressure to permanent staff as they had to show agency staff what to do as well as doing their own jobs. Staff felt stressed and morale was low.

Risks to people’s health and well-being had been assessed and guidance developed to advise staff on the equipment and support required to minimise risk. However, these were not always reviewed or followed by staff. The provider did not ensure that people’s environment was kept clean and hazard free.

People and their home environment were not always treated with respect and their dignity was compromised. People’s information was not always kept confidential.

People were not always provided with pe

The inspection was carried out on 14 September 2016 and was unannounced.

The home was last inspected on the 7 and 9 December 2015 where we gave it an overall rating of requires improvement. We had identified the provider was in breach of Regulations 9 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to not enough staff suitably deployed to meet people’s needs and a lack of person centred care. We asked the provider to make improvements and send us an action plan. We found that improvements had not been made and that the provider remained in breach of the Regulations.

Meadowbrook Care Home is registered to provide accommodation with nursing care for up to a maximum of 79 people. There were 66 people living at the home on the day of our inspection. People were cared for in three units. These included the Garrett Anderson unit which provides supports to people living with dementia. The Mary Powell Unit which provides support to people with physical health needs and the Agnes Hunt unit which supports people living with neurological needs.

There was a manager in post who was present during our inspection. The manager was in the process of applying to become registered manager for 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.

Although people felt safe there were not always enough staff to meet their health and social needs in a timely manner. There was a high turnover of staff and numerous staff vacancies. Staff felt fatigue and morale was low. Agency staff were used to cover staff vacancies but they were not always familiar with people’s needs. This placed additional pressure on permanent staff who were overwhelmed with their workload.

People were not always provided with support that was tailored to their individual needs and preferences. Support provided was task focused and placed people’s independence at risk. There was a lack of stimulating things to do to maintain people’s emotional wellbeing and people were bored.

The provider had a clear complaints procedure however, this was not consistently followed. The provider had a range of routine checks in place to monitor the quality and safety of the service but these had been ineffective in identifying shortfalls in the service. The provider had committed resources to make the required improvements and to change the culture of the service.

There was a lack of formal supervision to allow staff to discuss their training and development needs. Staff lacked knowledge and understanding of people’s complex illnesses as they had not received specific training on how best to support them.

People were protected from harm or abuse by staff who knew how to recognise and report concerns. The provider had safe recruitment procedures which ensured that prospective new staff were suitable to work with people living at the home.

People received support to take their medicines as prescribed. Only staff who had received training on the safe administration of medicines did so. Staff monitored people’s health and arranged health care appointments when required. The provider employed their own physiotherapist to support people’s physical wellbeing.

People were provided with a choice of meals and drinks. People enjoyed the food and were offered drinks at regular intervals. People were supported to eat their food in a patient and dignified manner.

People were supported by staff who were friendly and caring. Staff had formed positive working relationships with people. Staff talked with and about people with respect.

People knew the manager and both they and staff felt they were approachable. The manager was keen to develop the service

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

This was an unannounced inspection. This meant the home did not have advance notice that we were carrying out the inspection. Meadowbrook Care Home provides a service for up to 79 people who have care and nursing care needs including those living with a dementia type illness. There were 69 people living at the home when we visited. The home had a registered manager.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found there were not sufficient staff on duty in the home. Staff were task focused and had no time to spend with people to socially stimulate them. Relatives told us the home was always short staffed and people had to wait for their call bells to be answered for long periods of time. We saw that people were left unsupervised in the main large lounge for long periods.  

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Staff we spoke with were knowledgeable about who to, and how to, report any suspected or potential abuse. Some staff did not have knowledge about the Mental Capacity Act 2005 and its application. This meant that staff might not understand when a mental capacity and best interest assessment should be completed. This action would ensure decisions were being made within an agreed legal framework. The provider had a recruitment process in place that checked people’s suitability to work with adults.

The provider did not have systems in place to minimise the risk of infection. This meant that the service did not protect people from the risk of infection because guidance had not been followed and people were not cared for in a clean, hygienic environment.  

The registered manager told us staff had not have regular support meetings and annual reviews this meant that potentially people could be cared for or supported by staff that are not competent.

People told us they had access to community health and social care professionals who were involved with people’s care. We spoke with a health professional who visited the home on a regular basis and told us the home always seemed to be a happy place.

People told us they could choose how to spend their days and choose what they wanted to do and where they wanted to be. We looked at a sample of care plans and saw people’s preferences were recorded. This meant that people had choice and care was personal to the individual.

The registered manager had been covering at another home for seven months. CQC were not informed of this absence. They told us that improvements needed to be made in some areas at the home and spoke to us about where improvements were necessary. Morale was low at the home. Staff did not feel supported and this was apparent through discussions with them.  The registered manager held regular staff meetings, resident and relative meetings.  This meant that people were actively involved in developing the service. However some people told us they did not feel their concerns were listened to or acted on. This meant that potentially people did not receive care and support from staff that felt valued and listened to.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and of the Care Quality Commission (Registration) Regulations 2009.

 You can see what action we told the provider to take at the back of the full version of this report.

People we spoke with were satisfied with the service they received. They told us that the atmosphere was, "Very friendly and caring". One person said, "It's a good place to live and I feel safe with the staff that help me".

People told us that they attended reviews to ensure that the care they received continued to reflect their needs. People were supported to meet their individual needs in ways that promoted their health and wellbeing. This meant that the care was responsive to people’s needs.

The home was clean and hygienic. An odour issue within flooring in some bedrooms was known to the provider and plans were in place to address this.

Staff were knowledgeable about people's individual needs. Staff told us they had attended a range of training courses to equip them with the knowledge and skills to carry out their duties effectively. The staff had the opportunity to regularly meet with their line manager to review their performance and address any induction, training and development needs.

The provider had a suitable system in place to monitor the quality of the service it was providing. This meant the service was well led.

We spoke with ten people and five relatives who were visiting the home. We also spoke with a visiting healthcare professional, seven staff and the manager.

People were satisfied with the care they received from staff. People spoke positively about the staff that looked after them. Comments made by relatives included that they had "Total faith in the staff" and "The staff are brilliant". Visitors to the home were made welcome at any time.

People were treated with respect and courtesy by staff.

People who were able to were involved and consulted with the way that care and support was given and reviewed. People were supported to retain their independence as much as possible.

Care plans contained guidance for staff on people's needs and how these should be met. This was done in a way that reflected people's individuality and preferences.

Measures were not in place to protect people from the risk of healthcare associated infections.

People were protected from the risk of abuse because staff were trained to recognise and report any concerns.

Checks were made before staff started working at the home to make sure they were suitable.

There were systems in place to monitor and review people's complaints.

We carried out this review to check on the care and welfare of people who used this service.

We did not review every outcome for this provider. We were proportionate in our approach and focused on outcomes four and 16. We met with 12 people who used the service, 10 staff and the manager. People we spoke with shared very positive experiences of the service that they received. We observed people who used the service and staff interaction in the lounge of the care unit for people with dementia care needs.

People told us that they were involved in the assessment of their needs and development of their care record. They said the service had equipped them with strategies to help them understand and manage their problems. One person said, “I feel safe living here, I enjoy the activities available and I can choose whether to participate in them or not. Staff ask me questions about my care and understand how I like them to care for me”.

People told us that the staff were available to speak with whenever they needed them, day or night. Comments included, “The staff are good to me, as soon as I came through the door they understood and really cared about me”. “They’ve helped me move forward. It’s a good home and I like it here”.

People who used the service told us that they were happy with the meals provided and said the service was able to meet their dietary needs. They told us they liked the dining room facilities and that staff had worked hard to make these more homely in appearance. One person said, “There is a very good choice of food and alternative meals are always made available”. People told us their rooms were comfortable and that staff respected their privacy and dignity.

We spoke with staff that had different roles. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe. They spoke about the service empowering people and providing them with specific goals for their care and support. One person said, “I do enjoy my job, I like giving people the power and freedom of choice”. Another staff member said, “We work in partnership with our service users and support them in their journey”.

The inspection took place on 7 and 9 December 2015 and was unannounced.

Meadowbrook Care Home is registered to provide accommodation with nursing care for up to a maximum of 79 people. There were 66 people living at the home on the days of our inspection. People were cared for in three units. These included the Mary Powell unit which provided support for people with physical health needs. The Garrett Anderson unit which provided support to people living with dementia. The remaining unit was the Agnes Hunt unit which provided support to people living with neurological needs.

There was a registered manager in place who was present during the 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.

The home was last inspected on 30 April 2014 where we gave it an overall rating of “Requires Improvement”. We asked the provider to make improvements to their infection control procedures. This was because they had not protected people from the risk of infection because guidance had not been followed. At this inspection we found improvements had been made.

At our last inspection we asked the provider to review their staffing levels as there were not sufficient numbers of staff to ensure people received the care and support they required. At this inspection we found that improvements had not been made.

Although people felt safe they did not feel there were always enough staff to care for their physical and social needs. People often had to wait for support and this sometimes compromised their dignity. There had been a high turnover of staff and staff morale was low. There was a lack of consistent supervision to allow staff to have discussion about their training and support needs.

People did not always receive their medicine at the required time. The morning medicine round sometimes only just finished before the lunch time medicine was due. Staff felt there was risk of medicine errors because they were expected to support people with their breakfast whilst undertaking the medicine round.

People and staff felt that communication was poor and were not confident in the management ability. They felt able to raise concerns and complaints but were not confident that these would be acted upon.

People’s preferences were not always known or acted upon. People had limited opportunities to pursue their interests and hobbies. People living with dementia did not receive adequate stimulation to promote their emotional well-being.

Staff knew how to keep people safe from harm and abuse and who to report any concerns to.

People’s health and nutrition were regularly monitored and people had access to health care professionals as and when required.

People thought staff were kind and caring and supported them to keep in touch with people who were important to them.

People told us that staff asked their consent before supporting them and respected their wishes when they declined support. Where people were unable to make decisions for themselves we saw that decisions had been made in their best interest.

People were offered choice in day to day matters and staff promoted their independence by encouraging them to do as much as they could for themselves.

You can see what action we told the provider to take at the back of the full version of the report.