CQC report explained · a residential care home
What the CQC found at Lower Meadow
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, safe medicines systems, improved risk assessments and appropriate safeguarding arrangements. Infection control was mostly satisfactory, but visitor screening was not followed consistently on the first inspection day.
- Effective?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- The new management team was approachable and had improved oversight. However, some records were inaccurate or incomplete, and some audits did not provide enough assurance that checks had found problems.
What inspectors found, July 2022
Lower Meadow rated Good overall; inspectors found safe care and stronger leadership, but records and quality checks still needed improvement.
Inspectors made an unannounced focused inspection visit on 12 and 15 July 2022. They looked only at Safe and Well-led, after concerns about staffing and the culture in the home. They spoke with people, relatives, staff and healthcare professionals, observed care and checked care, medicines, recruitment and management records.
The home was rated Good for Safe. Inspectors found enough staff to keep people safe, safer medicines systems, improved risk management and appropriate safeguarding. They also found that the home worked within the Mental Capacity Act and responded to accidents and incidents.
Well-led remained Requires Improvement. The new management team was visible, approachable and committed to improvement. However, some records did not accurately show people's needs or care, and some audits did not identify problems. The overall rating improved from Requires Improvement to Good, and the home was no longer in breach of regulations.
Improved safety
Risk management had improved. Call bells were within reach, pressure-relieving equipment was checked and staff acted on health concerns.
“At this inspection people had their call bells to hand if they needed to call for assistance, so were able to get support in a timely way.” from the report
Approachable management
The new management team was visible and staff, people and relatives said they could raise concerns. The managers were working to provide stability and improve care.
“All the staff we spoke with told us they were confident in raising any concerns and would not hesitate to do so knowing they would be listened to.” from the report
Learning from incidents
The home reviewed incidents, shared learning with staff and introduced changes. Inspectors reported a reduction in falls since January 2022.
“Since January 2022, improved risk management and learning from accidents and incidents had resulted in a 50% reduction in falls in the home.” from the report
Inaccurate care records
needs fixingFood intake, fluid output and repositioning records were not always completed accurately. Some electronic care plans also needed further checks to ensure they matched people's needs.
“Records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring to take place.” from the report
Audits did not always find problems
needs fixingSome quality checks were mainly tick-box exercises. For example, checks failed to identify that window restrictor fixings could be easily removed.
“We checked examples of audits and found in some cases they were a tick box exercise instead of providing assurance that what was checked was correct.” from the report
Visitor screening
minorOn the first inspection day, not all inspectors were asked the required health screening questions or asked to show evidence of a negative test. The process was followed on the second day.
“On the first day of our inspection, not all the inspection team were asked any health screening questions or asked to show evidence of a negative test” from the report
- 01How are you checking that food intake, fluid output and repositioning records are complete and accurate?
- 02How do you make sure electronic care plans match each person's current needs?
- 03What changes have you made so audits identify problems rather than becoming tick-box exercises?
- 04How do you check staffing levels at busy times, overnight and during emergencies?
- 05What visitor screening process is now followed during an infection outbreak?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were not inspected and carried over from the previous inspection. This explanation was written from the published report of 27 July 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2021
Lower Meadow was rated Requires Improvement; inspectors found gaps in risk management, medicines records and quality oversight.
This was an unannounced focused inspection on 24 August 2021. Inspectors reviewed Safe and Well-led only. They spoke with people, relatives, staff and a healthcare professional, and checked care records, medicines records and management records.
The home had enough staff on duty during the visit, and it was clean and tidy. Infection control arrangements were effective. However, risk plans and care records were not always updated or complete. Records did not always show that people received planned pressure relief, fluids or other care safely.
There were also gaps in records for prescribed creams and limited guidance for some as-required medicines. Changes in managers had affected communication and oversight. Audits had found some of these problems before, but action had not always been taken.
The overall rating remained Requires Improvement, as it was at the previous inspection. The home was in breach of regulations about safe care and treatment and good governance. The provider was asked for an action plan and will be monitored.
Staff available during the visit
Inspectors found enough staff on duty during the visit to meet people's needs and respond to requests for help.
“At the time of our inspection visit there were enough staff on duty to meet people's needs and respond to their requests for assistance.” from the report
Infection control
The home was clean and inspectors were assured that infection prevention arrangements covered visitors, PPE, testing, admissions and outbreaks.
“We were assured the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Safeguarding arrangements
Staff had safeguarding training and said they were confident about identifying and reporting concerns. Safeguarding incidents were recorded and referred.
“Staff received safeguarding training and told us they were confident identifying and reporting safeguarding concerns to senior staff members or management.” from the report
Some positive experiences
Some relatives said their family members were safe, happy and well cared for, and described positive changes in their lives.
“Some relatives were happy about the quality of care and spoke of positive outcomes for people.” from the report
Risk records and planned care
seriousRisk plans were not always updated after changes in people's health. Records did not show consistently that pressure relief, fluids and other planned care had been provided.
“Records related to people's care did not demonstrate all planned care had been provided safely, in line with people's individual risk management plans.” from the report
Pressure damage risks
seriousThere were gaps in repositioning records, pressure mattresses were not always working correctly and one person's pressure-relieving cushion was not being used as planned.
“One person had developed skin damage and there were no records to confirm the person was being repositioned as described in their risk management plan.” from the report
Medicines and creams
needs fixingMedicine administration records were accurate for the sample checked, but staff needed more detailed guidance for some as-required medicines. Cream application records had gaps.
“Care staff were given limited guidance as to the application of topical creams and gaps in application charts meant the provider could not be assured creams were always being applied as directed.” from the report
Weak quality oversight
seriousAudits and checks were not completed consistently and did not always lead to action. Problems identified earlier were still found during this inspection.
“Where quality assurance processes had identified shortfalls in safety and quality, action had not always been taken to address them.” from the report
Management changes and agency staff
needs fixingTwo manager changes in nine months affected leadership and communication. There were care staff vacancies and agency staff did not always have enough information about people's needs.
“We spoke with one agency worker who could not tell us anything about the two people they were responsible for in the lounge.” from the report
- 01How do you now make sure risk plans are updated promptly when a person's health changes?
- 02How do you check that repositioning, pressure-relieving equipment, fluids and catheter care are provided and recorded as planned?
- 03What guidance do staff have for as-required medicines, especially medicines used for anxiety, and who checks cream application records?
- 04How are agency staff given information about each person's care needs before they start work?
- 05What progress has been made with the action plan and service improvement plan, and are admissions still restricted?
This was a focused inspection of Safe and Well-led only; ratings for Effective, Caring and Responsive were carried over from previous comprehensive inspections. This explanation was written from the published report of 30 September 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Lower Meadow
5 rated inspections over 6 years: the service has held its Good rating throughout.
- July 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- May 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- August 2017Goodstayed GoodWell-led: Good
- September 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- December 2012
Registered with the Care Quality Commission on 10 December 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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At least 100 live-in carers within about an hour of Warwickshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £950 to £1,260 a week. 77 can care for a couple. 11 years' experience on average.
“If you bump into her in the night on her way to the bathroom she will still inquire how you are and if everything is alright.”
“I have never met a person who is so kind and thinks about others before himself to such an extent as Chris Malagala.”
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