About the service: Meadowside and St Francis provides residential and nursing care to people over the age of 65.

People’s experience of using this service:

People were at the heart of the service. They were truly respected, valued as individuals, and were empowered in their care. People were cared and supported in a service which had a strong and visible person-centred culture.

People and staff were complimentary of the management and leadership of the service which continued to help to improve the quality of the service and motivate and inspire staff.

There were positive working relationships with external professionals and a passion for continuous learning and improvement. Staff were well trained to be able to meet people’s needs, and there was an effective system in place to ensure the ongoing review and competency of staff.

People were kept safe and protected from avoidable harm and abuse, and people now had their medicines safely managed. New processes had been put into place to ensure a more robust oversight. People lived in an environment which was fully assessed for cleanliness and safety.

People received personalised care and support, and now had their human rights fully protected. Quality monitoring systems had been further developed. However, we have recommended the provider takes action to continue to strengthen their overall governance systems, because the system had not identified that some records were not always in place, or up to date.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (published 07 April 2018).

Why we inspected: This was a planned inspection. At this inspection we rated the service Good.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

We carried out an unannounced comprehensive inspection on 01, 02 and 07 February 2018.

Meadowside and St Francis is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home is registered to provide care for up to 69 older people. On the days of the inspection, 40 people lived in the home. The provider also operates another nursing home in the same locality.

In June and July 2017, the service was rated Inadequate and was placed into 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.

We told the provider to make improvements to ensure people were kept safe from abuse, that people’s medicines were managed safely and risks associated with their care were known by staff and risks mitigated. We also asked the provider to ensure they followed infection control practices to help reduce the risk of the unnecessary spread of infection, and to make sure there were enough suitably trained staff to meet people’s needs, and that staff were recruited safely. In addition, people’s nutritional needs were not always known and met safely by staff, people’s human rights were also not being protected, and people’s privacy, dignity and independence was not always respected. Action was also required to ensure people’s changing healthcare needs were monitored so responsive action could be taken, that people’s care records were created in line with people’s wishes and preferences, and that they were an accurate reflection of how their care and support needs should be carried out. Improvements were also required to the leadership and culture of the service. People’s confidential information was not always held securely, the provider did not use valuable feedback to help improve the service, staff did not always feel management were approachable, and there were ineffective quality monitoring systems in place to help identify when improvements were required.

Immediately after our inspection, the provider told us they would voluntarily stop new admissions to the service, in order for them to put things right. They also employed a health and social care consultant to help advise them about how they could make improvements, and a robust action plan was submitted to the Commission. We also contacted the local authority safeguarding team who took prompt action to ensure people's health, safety and wellbeing.

During this inspection the service demonstrated to us that improvements had 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. However, whilst action had been taken, some improvements were still needed and ongoing, and where improvements had been made, more time was required to demonstrate they had been embedded in practice and could be sustained.

Since our last inspection the manager had now registered with the Commission and was now the registered manager of 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.

A new management structure had been put into place to help drive improvement and to support staff. This included a new clinical lead, a clinical manager, and a quality manager. The provider spoke proudly of the staff he had employed into these roles, and it was obvious from their interactions with us, that they were a cohesive team, who were passionate and fully committed to improving the service. The service unlike before,

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.

The inspection took place on 29 June 2017, 30 June 2017, 04 July 2017, 05 July 2017 and 14 July 2017 and was unannounced. Meadowside and St Francis is divided into two units; St Francis provides complex nursing care for up to 44 people. Meadowside provides personal care for up to 25 people. The home is registered to provide care for up to 69 older people. On the day of the inspection, 58 people lived in the home. The provider also operates another nursing home in the same locality.

There was a management structure in place. The service had a registered manager. 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 also a separate manager for each unit; with a clinical lead and a matron in post, to oversee the nursing care being provided. A new manager had recently been recruited to share the responsibility of the day to day management of the home. They were in the process of registering with CQC. Following the inspection, the registered manager told us they would be recruiting a new manager to replace them, so they could focus on their role as a director of the two nursing homes owned by the provider.

Prior to our inspection we had received concerns from the local authority safeguarding team. These included concerns about poor standards of care, lack of dignity, respect and compassion shown to people, unsafe recruitment practices, lack of training for staff and staff not meeting people’s complex care, skin care or end of life care needs safely. They also included concerns regarding incomplete monitoring and recording of people’s healthcare needs, staff not following recommendations made by external professionals, unsafe medicine’s management and ineffective monitoring or equipment and stock.

At our last inspection on 14, 15, 19 April and 03 May 2016, we found breaches of regulation. We found care and treatment was not always appropriate to meet people’s needs or reflective of their preferences. Care and treatment was not always provided in a safe way. People’s risks were not always assessed and guidance regarding people’s care was not always followed. Medicines were not always managed in a safe way. The legislative framework of the Mental Capacity Act (MCA) 2005 and associated Deprivatio

The inspection took place on 14,15,19 April and 3 May. The first day of the inspection was unannounced. We last inspected Meadowside and St Francis on 25 June 2014 and found no concerns.

The service provides care for older people and people with a physical disability and can provide care for up to 69 people. Meadowside and St Francis is registered to provide nursing and residential care. When we inspected, 66 people lived at the service.

A registered manager was employed to manage the service locally. 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 aspects of medicine management were not always safe. We found it was not always clear whether people had been given all their medicines at the right time.

People’s risk assessments and care plans did not always accurately reflect their needs or the care they required. Some care plans were detailed, but staff did not always follow the guidance in the care plans, for example regarding diabetes management. This placed people at risk. We found care records were not always updated promptly as people’s needs changed. This meant there was the risk of people not receiving care according to their care plan. In addition, people’s end of life care was not consistently planned and delivered to reflect their needs and preferences. People did not always have personalised end of life care plans.

The legal requirements of the Mental Capacity Act (2005) were not always followed. Assessments had not been requested by the service to ensure people were not being deprived of their liberty unlawfully. Staff were due to receive training on the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DoLS) to improve their understanding of these laws which protect people’s human rights. Staff however asked people for their consent as they provided care and treatment.

Audits were undertaken but these had not identified the areas we found required improvement during this inspection. People’s views on the service were sought by the provider.

We found people who had more complex needs would benefit from a more individualised approach to keeping them stimulated. Group activities were enjoyed by many and included visiting animals, garden fetes, seasonal events such as horse racing and musical entertainment.

Staff were recruited safely.

People and relatives knew how to raise complaints and the service had a process for managing complaints. We found complaints were investigated and responded to.

People told us they enjoyed the food and people had their dietary needs met. Meals were a social event and people enjoyed the company of others whilst eating in the conservatory and dining room.

Staffing levels were flexible and based upon people’s needs and occupancy at the home. People and staff told us there were enough staff on duty and if there was sickness every effort was made to replace staff.

The service was clean and we saw staff followed infection control guidance.

People told us they felt safe. The service was well maintained and decorated. The staff team worked hard to create a home from home environment.

The leadership within the home was keen to provide a quality service. The registered manager was approachable and visible within the home.

We found a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We visited on 6 November following concerns we had received about staffing levels and record keeping at Meadowside and St Francis. As part of our inspection we spoke with 12 people living at Meadowside and St Francis, 6 members of staff including the registered manager, four relatives and examined six care records.

People told us “I’m very well looked after”; "It's very good here, how they put up with us all I don't know"; "Yes, they respect my privacy and dignity and respond quickly"; "I have nothing to complain about" and "The staff are kind, we are happy with the service."

We found that people were happy with the care they received and the staff were knowledgeable about people. Assessments had occurred relating to people's needs and care plans reflected the care and treatment required.

We found that Meadowside and St. Francis had recently recruited to two new trained staff. There were sufficient staff on duty which was based on dependency and skill mix.

We found that information was not always recorded about the care and treatment people received. Staff told us that they followed the care plans but there was not the written, documented evidence to substantiate this.

We met with people who lived at Meadowside and St Francis, talked with staff, the registered manager and owner and looked at care records and staff files as part of our visit.

People told us that they felt respected and involved in the running of the service and that staff respected their privacy and dignity. We found the staff were knowledgable about the people they cared for and people's care plans and healthcare assessments were accurate and regularly reviewed.

We found people's nutritional needs were assessed, reviewed and met with sufficient, nutritious food. We found the environment and equipment was clean and there were processes in place to manage the risk of infection.

We found that although staff attended training in relevant courses, there were significant gaps in some essential training areas. Additionally we found there was not a regular system in place to ensure all staff were regularly supervised and received appraisals. Staff however told us they felt supported.

We found there were adequate mechanisms in place to ensure the quality of the service. People's views through resident meetings and questionnaires. Staff felt they were able to talk about issues in staff meetings. There was a process to regularly review people's care and monitor complaints.

We inspected Meadowside and St. Francis to follow up on an area of non compliance identified at the previous inspection.

We visited Meadowside and St. Francis on the 13 December 2012. Due to outbreak of the winter sickness and diarrhoea illness we were only able to speak with one person using the service. We also spoke with six members of staff, the acting head of care, two Registered Nurses and the provider.

All the staff we spoke with confirmed the provider had increased the staffing levels and now had sufficient staff on duty.

The one person we spoke with said, “It’s much better now as they have floaters (two staff that move from floor to floor where needed) over the three floors and it helps”.

We observed staff working as a team to provide comfort and reassurance to people who were unwell.

We saw staff spoke with people in an attentive, respectful, and caring way. We saw people’s privacy and dignity being respected at all times.

We met 16 people who used the service, met relatives, talked with staff and visiting professionals and checked the provider's records. We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

All people we spoke with stated that the home was short of staff and people living in the home had to wait for long periods for assistance.

We saw that staff and people using the service knew each other well and chatted in a relaxed way. People using the service told us, “Well looked after but sometimes have to wait”, “All staff are lovely, helpful but not enough of them”.

All of the people we spoke with were happy with the care they were receiving. We saw that people were spoken to by staff in an attentive, respectful, and caring way. We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences.

We pathway tracked four people who use the service. Pathway tracking means we looked in detail at the care four people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

People said that they would feel able to complain if they needed to.

We carried out an unannounced inspection on 16 August 2012. On the day of our visit there were 67 people living at Meadowside and St Francis. We visited both units during our inspection. We spoke with 10 people living at the home, seven relatives, eight staff members, the registered manager and looked at 10 people’s care files.

Comments included: “I had quite a lot of information before I came here and I was quite pleasantly surprised with the good care I have and the home itself. I would recommend this place to friends”, “my daughters looked at lots of homes and came up with a final choice of two. I chose this one as it is so light here and it seemed a better and nicer building”, “X has seemed to get better over the last 12 months since they came here”, “X always appears rested, relaxed and happy” and “staff are very caring.”

People told us what it was like to live at the home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

Some of the people who used the service at Meadowside and St Francis had a dementia and therefore were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

We visited the home with an expert by experience. The Care Quality Commission considers an expert as a person who has experience of using a similar service. This helps us to gain a clear picture of the experience of people using services.

There are two separate units that make up the care home. St Francis is the nursing care unit and Meadowside is the residential care unit. On the day of our visit we spoke to seven of the 42 people living in St Francis. We spoke with eight of the 21 people living in Meadowside. We spoke with four relatives and eleven members of staff.

People and their relatives were complimentary about the care and support they received. People told us that their privacy was respected when personal care was given and their preferences were taken into account.

People we spoke with said they could get up and go to bed when they wanted to. They also told us they were offered choice whilst living at the home.

People appreciated that care staff helped them to do as much as possible for themselves. One person said, “I like to transfer myself from the wheelchair to the bed and at first it was difficult to stop the carers from helping me but now they stand by and watch and are ready to steady me if necessary”.

Everyone we spoke with was satisfied with the care and support. One person said “They (the staff) are gentle and kind and seem to know what they are doing”. A relative said “I have no qualms about this place. It’s been the best decision to move him here. The staff are excellent and keep us informed of what’s going on.

People said staff were at hand when they were needed and said the response to call bells was good. Some people told us there was sometimes a short delay at peak times of the day.

People appreciated the activities and said they could join in or opt out. We saw that even the most frail people were included in this programme. People also appreciated the effort staff made to support them in accessing the community and personal interests.

Everyone we spoke with said they felt safe at the home and knew how to make a complaint. People said they are able to express their views and found staff approachable.

People felt staff “knew what they were doing” and felt safe in the hands of staff. We saw there was a programme of mandatory training although organisation of this evidence was not always clear.

Two adult social care inspectors carried out this inspection on two separate days. The focus of the inspection was to answer five key questions (Is the service safe, effective, caring, responsive and well-led?) and to follow up on two compliance actions which had been issued following our previous inspection in November 2013.

As part of this inspection we spoke with the Head of Care, the Matron, ten members of staff, 19 people who used the service, two relatives and two visiting healthcare professionals. We reviewed records relating to the management of the home. These included seven care plans, the home’s training matrix, several audits and the service’s complaints file.

Below is a summary of what we found. The summary describes what people, staff, relatives and visitors told us, what we observed and the records we looked at.

Concerns had been identified during our previous inspection in November 2013. These related to staff not being supported with appropriate training, there being a lack of staff supervision and records not being kept up to date.

During this inspection, in June and July 2014, we found that processes had been put in place to ensure the concerns identified had been addressed and rectified.

Is the service safe?

People’s needs had been assessed and regularly reviewed. There were plans in place to ensure people’s care was delivered in a way that ensured their safety and welfare. Care needs and risks were identified and appropriate steps were taken to respond to these.

Is the service effective?

People told us they were satisfied with the care they received. We saw from care records that people’s care needs had been appropriately assessed and care plans reflected these needs. Where people’s needs had changed, care plans had been updated to reflect these changes.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed understanding and gave encouragement when supporting people. Staff communicated clearly and at an appropriate pace with the people they were supporting. People’s preferences had been obtained by the home and were included in people’s care plans. During our inspection we overheard a person saying to a member of staff “I feel secure, I feel at peace here, I feel happy here.”

Is the service responsive?

The home responded to people’s changing needs and sought advice and guidance from relevant healthcare professionals. Appropriate actions had been taken to respond to accidents and incidents. The service took steps to obtain views from people who used the service and staff and responded to these.

Is the service well-led?

Quality assurance processes were in place in the home. We saw evidence of people being asked for feedback and this being responded to and acted on. We saw that several audits and internal inspections had been carried out and that issues identified had been acted upon. Staff told us they were asked for their feedback and felt their opinions had been listened to and used to improve the home.