About the service: Meadow House is a residential care home providing personal care to seven people with mental health needs at the time of the inspection.

People’s experience of using this service:

¿ The service checks and maintenance had failed to ensure the service and equipment was safe for people living at Meadow House.

¿ People’s safety had not been promoted and risks in relation to fire safety had not been sufficiently mitigated.

¿ Systems of governance and oversight were not sufficiently robust to have identified the issues we found.

¿ Staff were safely recruited and received the training and support they needed to undertake their role.

¿ People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

¿ There was a wide range of opportunities for people to engage in activities and follow hobbies and interests.

¿ People were very positive about the staff and told us that their privacy and dignity was promoted.

¿ The service had good community links such as local churches and schools.

¿ Preferences and choices were considered and reflected within records and work was ongoing to improve the new electronic system.

We identified three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to safe care and treatment, good governance and failure to display rating. Details of action we have asked the provider to take can be found at the end of this report.

We found the service met the characteristics of a “Requires Improvement” overall rating

More information is available in the full report.

Rating at last inspection:

Good (Published June 2017)

Why we inspected:

We received information from the fire service regarding an escalation of concerns about the service. We completed this inspection based on these concerns.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with other agencies.

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

Meadow House provides accommodation with personal care for up to eight people. There were eight people living at the home at the time of the inspection. At the last inspection, the service was rated Good. At this inspection the service remained Good.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received support from staff who knew how to keep them safe. Staff knew how to protect a person from the risk of harm and how to report any concerns they saw. People were assisted by staff who ensured they were available for people when needed. Staff had time to support people in every aspect of their daily lives. Staff gave people their medicines when needed and recorded when they had received them.

People’s care was provided by staff that had been trained to understand their needs and were supported in their role. People’s decisions about their care and treatment had been recorded and staff showed they listened and responded to people’s choice in how they received care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People made choices regarding their meals and planning the menu options and alternative diets had been considered. People were supported to access health and social care professionals with regular appointments when needed and were supported by staff to attend these appointments.

People were comfortable around the staff that supported them. People were happy to chat and relax with staff. Staff knew people’s individual care needs and respected people’s dignity and independence.

People chose how they spent their days in their home, the garden or out and about. People had the opportunity to raise comments or concerns and these were addressed. There were processes in place for handling and resolving complaints and guidance for people living in the home was available in alternative formats. Staff were also encouraged to raise concerns on behalf of people and they had done so where necessary.

The registered manager was available, approachable and known by people. The provider ensured regular checks were completed to monitor the quality of the care delivered. The management team had kept their knowledge current and they led by example.

This inspection took place on 15 April 2015 and was unannounced.

Meadow House is a care home providing personal care and accommodation for a maximum of eight people. It supports the care and welfare of younger and older adults with a mental health diagnosis and provides mental health rehabilitation services. The home is located in Coventry. Eight people were living at the home when we visited.

The home has a 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.

People who lived at Meadow House felt safe, and were supported by a staff group who had been trained to work effectively with people who had mental health conditions.

Staff understood safeguarding policies and procedures, and followed people’s individual risk assessments to ensure they minimised any identified risks to people’s health and social care. Checks were carried out prior to staff starting work at Meadow House to ensure their suitability to work with people in the home.

The manager understood the requirements of the Mental Capacity Act and Deprivation of Liberty safeguards and the home complied with these requirements. Medicines were administered safely to people, who had good access to health care professionals when required.

There were sufficient staff to meet people’s needs both in the home, and to support people with their hobbies and interests outside of the home. People received care and support which was tailored to their individual needs. People enjoyed the food provided at the home and were involved in menu planning and cooking.

Staff were motivated to work with people who lived at Meadow House, and were caring and understanding. They treated people who lived in the home with dignity and respect.

The management team were open and accessible to both people and staff. Management were trusted, and staff felt they could talk to them if they had any concerns.

Meadow House supports the care and welfare of younger and older adults with a mental health diagnosis and provides mental health rehabilitation services. The service offers both short-term rehabilitation and “slow-stream rehabilitation.” The aims of the service are to enable people to build their independent living skills whilst living in a safe and secure environment. All of the people living at the service at the time of our inspection had long term mental health needs and many of them had been at the service for some time. The service had discharged two people in 2013. Recovery models of care were being used at the service and adapted to meet people’s mental health needs. The majority of people living at the service had been admitted for “slow stream rehabilitation” and may live at the service for some years. The service is located in Coventry. At the time of our inspection there were seven people living at the service.

We found people using the service were receiving safe and effective care which met their individual needs. We found the provider had systems in place to protect people from abuse. The premises people lived in were well maintained and suitable to meet the needs of people using the service. However, we felt that were improvements needed in relation to staff training in the management of challenging behaviour.

People’s heath and well-being was being monitored on an on-going basis and people were involved in the planning and delivery of their care. Staff were adequately trained and supported to deliver safe and appropriate care to people and there were systems in place to support staff .

People were cared for by kind and compassionate staff who understood their individual needs and who treated them with respect and maintained their dignity. People using the service were able to express their views about how the service was being run on a regular basis.

The service had policies and procedures in place in relation to ensuring people’s rights were protected in line with the Mental Capacity Act 2005. The appropriate referrals had been made to professionals in relation to someone who was deemed to lack capacity and ensured that their best interests were being represented. The service had applied the Deprivation of Liberty safeguards as appropriate and nobody was the subject of a Deprivation of Liberty safeguard at the time of our inspection.

There was effective leadership at the service which encouraged an open and inclusive culture. Staff said they were well supported and felt able to express their views about how the service was being run. There were systems in place to ensure that the service learnt from any incidents and we found sufficient numbers of suitably trained staff working at the service. There was a registered manager in post.

Our visit to Meadow House was part of our annual inspection programme. We were also following up on concerns raised at our previous inspection.

We spoke with four of the six people who lived at Meadow House. They were all happy with the support they received. One person, who had been critical of the service when we last visited, told us that there had been big improvements. People said:

"I feel safe here."

"It's not a bad place to be in, they're pretty good to you here."

We talked to the contracts officers at Coventry Primary Care Trust and Coventry City Council. They told us they had seen improvements at the service and were now satisfied with support being provided to people living at Meadow House.

We looked at the staffing arrangements at the service. We saw there were sufficient staff on duty to meet the needs of people who lived at Meadow House.

We spoke with staff and looked at care records. We were satisfied people living at Meadow House received appropriate care and support to help them with their mental health needs.

We looked at the premises. The premises were safe and the furniture, fixtures and fittings were sufficient to meet the needs of people living at Meadow House. The décor and carpets in some areas of the home looked a bit tired and worn.

We checked the cleanliness of the home. We were satisfied that the home was clean and staff knew their roles. Record keeping for infection control needed to be improved.

We looked at the management of medicines and were satisfied that medication given to people in the home was given safely and recorded correctly.

We had been made aware of concerns about the availability and choice of food for people living at Meadow House. We were satisfied that action required by Coventry City Council to improve this had been acted upon. We were told by staff and people who use the service that there had been big improvements. The four people we spoke with all said they had plenty to eat and liked the food. We had concerns that external agencies had to require systems be put in place to ensure the availability and choice of food for people.

We looked at management systems to see whether they supported people living at Meadow House in having safe and effective care. We had concerns about management arrangements. A member of staff had been promoted to the role of deputy manager. The deputy manager was undertaking both care and management duties. Details of the agreed delegation of management duties and the identification of time to complete them was not available at the time of our visit. The registered manager was not working in the home at the time of our visit.

We had concerns about the management of staff rotas and planning for staff sickness and annual leave. We also had concerns about the complaints policy and whistleblowing policy. They did not give clear information about the processes or time frame of responses people should expect.

We spoke with three people who lived at Meadow House to gather information about their experience of the service. People told us they were satisfied with the care they were receiving. Staff told us that they explained options available to people so that they could make choices and consent to care. Staff told us: “We tell them what the options are, if they refuse that’s fine.“

We saw that care plans were person centred although we could not be certain that some people understood the content of their care plan. Care records confirmed that health professionals were regularly involved in people’s care.

People we spoke with were complimentary of the staff. They told us: “They are alright, I get on with them all. If I was not happy I would talk to a member of staff.” “Very good.” People told us they felt safe within the home and knew who to speak to if they had any concerns.

People told us they liked the food although we could not be sure that people’s choices and preferences were always provided. People told us: “Really nice, I like the food.” “It’s alright”.

We found that some medicine records were not sufficiently clear to demonstrate people were receiving their medicines as prescribed.

We saw records confirming that staff had completed training linked to the needs of people in the home. They had also completed the required mandatory training to help them care for people safely.