CQC report explained · a residential care home
What the CQC found at Meadow House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People felt safe and staff understood safeguarding responsibilities. However, one person's diabetes and choking risks had not been assessed, some kitchen problems remained, and a safeguarding referral had not initially been made after an unsafe hospital discharge.
- Effective?
- Requires improvement
- Staff knew people and supported their health, choices, food and contact with professionals. Records about mental capacity and best-interest decisions needed to be clearer, and important information was not always included in new staff inductions.
- Caring?
- Good
- This question was not inspected during this focused visit. The report says people had positive relationships with the manager, were involved in choices about their home and felt staff knew their wishes and preferences.
- Responsive?
- Good
- This question was not inspected during this focused visit. The report says people's needs were assessed before moving in, menus reflected their preferences and people were supported to take part in activities and access the community.
- Well-led?
- Requires improvement
- Management oversight and staff morale had improved, with new audits and monitoring systems. Some checks did not identify problems found by inspectors, and feedback from surveys was not clearly analysed.
What inspectors found, November 2021
Rated Requires Improvement; inspectors found better management and kind support, but some safety, decision-making and monitoring checks were still not reliable.
This was an unannounced focused inspection on 11 November 2021. Inspectors spoke with four people and five staff. They reviewed care, medicine, recruitment, safety and management records, including three people's care records.
The home had improved since the previous inspection. People said they felt safe, received their medicines as prescribed and were supported by staff who knew them well. Fire safety, recruitment, infection control and accident monitoring had improved.
There were still shortfalls. One person's diabetes and choking risks had not been recorded until inspectors raised this. Some kitchen areas were dirty, equipment was damaged and a fire door was difficult to close. Records about people's decision-making and some management checks also needed improvement.
The overall rating remained Requires Improvement. Safe, Effective and Well-led were all rated Requires Improvement. The home was no longer in breach of the regulations found at the previous inspection, but the improvements had not yet been shown to be fully consistent or lasting.
People felt safe
People told inspectors they felt safe, and staff knew how to report and escalate safeguarding concerns.
“People felt safe living at Meadow House and staff understood their responsibilities to keep people safe.” from the report
Medicines were managed safely
Trained staff administered medicines and records showed people received them as prescribed, including medicines given when needed.
“Medication administration records showed people had received their medicines as prescribed, including those prescribed 'as required'.” from the report
Improved fire safety
Fire information and emergency evacuation plans had been improved, and staff had completed fire safety training.
“The management of fire safety had improved.” from the report
Supportive staff team
People had confidence in staff, who were described as skilled, knowledgeable and familiar with their needs. Staff said the manager had improved morale and teamwork.
“People had confidence in the skills and knowledge of the staff who provided their care and support.” from the report
Some risks were not recorded
seriousRisk assessments were missing for one person who had diabetes and was at risk of choking. The manager completed them after inspectors raised the issue.
“However, risk assessments had not been completed for one person who was diabetic and was known to be at risk of choking.” from the report
Environmental safety problems
seriousSome kitchen areas were dirty, some equipment was damaged and a fire door was difficult to close. The emergency plans were also kept in a locked box that might be hard to access quickly.
“However, we saw some areas in the kitchen were dirty, some equipment in use was damaged and the kitchen door, marked as a fire door, was difficult to close.” from the report
Capacity records needed improvement
needs fixingRecords about people's capacity and best-interest decisions were not always detailed, clear or specific. Inspectors also received conflicting explanations about one person's restriction on their liberty.
“Records to show people's capacity had been assessed and decisions had been made in their best interests required development to ensure they were detailed, clear and decision specific.” from the report
Checks did not find all problems
needs fixingNew audits and daily checks had improved oversight, but they did not identify the kitchen problems found during the inspection. More time was needed for the systems to become effective and consistent.
“However, some checks were not yet fully effective.” from the report
Induction information was incomplete
needs fixingSome important information needed by new staff to provide safe care had not always been shared during induction.
“However, we found some important information to assist new staff to provide safe care had not always been shared during their induction.” from the report
- 01What checks now make sure every person's diabetes, choking and other risks are fully recorded and kept up to date?
- 02What has been done to keep the kitchen clean, replace damaged equipment and ensure the fire door closes properly?
- 03How are capacity assessments and best-interest decisions recorded, and how do you check that any restrictions on liberty have the correct reason and authority?
- 04How do you make sure new staff receive all the information they need during induction before providing care?
- 05How are audits and people's survey feedback used to find and fix problems?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected and their ratings were carried over from the previous comprehensive inspection. This explanation was written from the published report of 25 November 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.
What inspectors found, January 2021
Meadow House was rated Requires Improvement, with an Inadequate well-led rating and serious weaknesses in managing safety and oversight.
This was a focused inspection on 24 November 2020. Inspectors checked whether earlier legal requirements had been met, especially risks around fire, infection control, the premises and management oversight. They spoke with people, staff and managers, and reviewed care, medicines, recruitment and management records.
Inspectors found that risks had not been properly assessed or reviewed. Fire arrangements, infection control, environmental safety and some people's care risks were not managed well enough. Records were incomplete or unclear, and some restrictions had not been properly discussed as best-interest decisions.
People said they felt safe and were positive about staff. Staff knew people well, and there were enough staff on the inspection day. However, the provider's checks had not found important problems, and the home remained in breach of Regulation 12 and Regulation 17.
The overall rating stayed Requires Improvement. Safe also stayed Requires Improvement, while Well-led fell from Requires Improvement to Inadequate. The home had been rated Requires Improvement at the previous inspection in May 2019, so the report says improvement had not been enough.
People felt safe
People told inspectors they felt safe living at the home. Inspectors also saw people looking comfortable around staff.
“People told us they felt safe living at the home.” from the report
Staff knew people
Staff knew people's needs and preferences, despite problems with records. Inspectors found enough staff available on the day of the inspection.
“Staff knew people well and knew how to support their needs.” from the report
Some immediate action
After the inspection, the provider said it had introduced new risk assessments and arranged extra staff to support enhanced cleaning.
“The provider responded to our immediate concerns after the inspection visit.” from the report
Fire safety risks
seriousFire arrangements were incomplete. Evacuation plans had not been reviewed since March 2019, and there was no fire procedure displayed for people and visitors.
“Each person had a personal emergency evacuation plan (PEEP) but these had not been reviewed since March 2019” from the report
Infection control
seriousSome rooms and bathrooms lacked handwashing and drying facilities. Cleaning was inconsistent, and parts of the home were stained and in need of redecoration.
“Some people had not been supported to have access to hand soap, sanitising gel, and hand drying facilities in their rooms or communal bathrooms.” from the report
Weak management checks
seriousThe provider's audits did not identify important safety and record-keeping problems. This was a continued breach of good governance requirements.
“The provider's oversight of the service was not sufficient to drive improvement and ensure compliance with the regulations.” from the report
Unclear care records
needs fixingCare records were not always dated or clear enough to show people's current needs. This could lead to inconsistent or unsafe support.
“Care records were not always dated or clear to identify people's current needs and to support staff in meeting their needs.” from the report
Restrictions and decisions
seriousPeople were subject to some restrictions, including around cigarettes and food, but records did not show that these had been discussed with each person through best-interest meetings.
“It was not evident these restrictions had been discussed with each person as part of any best interest meeting” from the report
- 01Have all personal emergency evacuation plans been reviewed, and can you show us the current fire procedure and contingency plan?
- 02What has changed to provide hand soap, sanitising gel, hand drying facilities and suitable PPE areas throughout the home?
- 03How are individual risks, including smoking, substance misuse and hot surfaces, now assessed, reviewed and recorded?
- 04How does the provider check that care records are current, dated and clear enough for staff to follow safely?
- 05What evidence can you show that the imposed conditions and the two Regulation 12 and Regulation 17 breaches have been fully addressed?
This was a focused inspection of Safe and Well-led only; ratings for Effective, Caring and Responsive from the previous comprehensive inspection were used in calculating the overall rating. This explanation was written from the published report of 28 January 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 Meadow House
5 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- November 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2021Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Inadequate
- May 2019Requires improvementdown from GoodSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2014Inspected but not rated
- May 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- June 2011
Registered with the Care Quality Commission on 3 June 2011.
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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