CQC report explained · a nursing home
What the CQC found at Meadow Rose Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Restraint risks were not adequately assessed, monitored or reviewed, and staff had not received appropriate training. There were also shortcomings in recognising a safeguarding incident and in some recruitment records.
- Effective?
- Requires improvement
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was used when calculating the overall rating.
- Well-led?
- Requires improvement
- Management checks had not identified risks linked to restraint, safeguarding, recruitment records and care planning. The home remained in breach of the good governance regulation, although managers were open to feedback and took action after the inspection.
What inspectors found, October 2020
Rated Requires Improvement; inspectors found unsafe restraint arrangements and weak oversight, although medicines, staffing and infection control were managed safely.
This was a focused inspection on 23 and 24 June 2020. Inspectors looked only at Safe and Well-led because they had received concerns about restraint. They spoke with people, relatives and staff, and checked care, medicine, recruitment and management records.
The home was not always safe. Restraint risks were not properly assessed or reviewed, staff had not received the right training, and records did not clearly show how restraint was used. One safeguarding incident was not recognised or reported promptly. Some recruitment records also lacked full employment histories.
The home was also not well-led. Its checks had failed to identify important risks, and this continued an earlier concern about governance. There were enough staff, medicines and infection control were managed safely, and call bell monitoring had improved. The overall rating remained Requires Improvement, with Safe and Well-led both rated Requires Improvement.
Medicines
Inspectors found that medicines were handled by trained staff, with suitable guidance and regular checks.
“Medicines were stored, administered and disposed of by trained staff and regular audits took place.” from the report
Staffing
Inspectors observed enough staff to meet people's needs. Call bell response times were being monitored and had improved.
“Our observations were there were enough staff to meet people's needs and people were not waiting to receive care.” from the report
Infection control
The home was clean and staff were following updated infection control arrangements during the COVID-19 pandemic.
“Staff were wearing personal protective equipment appropriately such as masks, aprons and gloves.” from the report
Open management
The management team listened to the inspection feedback and acted on concerns raised during and after the visit.
“The management team were open and transparent during the inspection and demonstrated a willingness to listen and address any concerns.” from the report
Unsafe restraint arrangements
seriousRestraint was not supported by adequate risk assessments, staff training or clear care plan guidance. Records did not consistently explain what happened or its effect on the person.
“Risks to people who may require the use of restraint were not adequately assessed by a relevantly trained and competent person.” from the report
Safeguarding response
seriousAn incident involving unsafe care was not recognised or raised as a safeguarding concern until an injury became apparent the next day.
“One person had been supported in an unsafe way that was not in line with their care plan.” from the report
Weak management checks
seriousThe home's systems did not identify several important problems, including restraint risks, safeguarding knowledge and gaps in staff employment histories.
“The provider's failure to ensure that effective systems were in place was a continuing breach of a Regulation 17” from the report
Recruitment records
needs fixingSome staff files still did not contain a full employment history, despite this being identified at the previous inspection.
“At this inspection we found this was still an ongoing concern with a lack of recording in some staff files.” from the report
Person-centred information
needs fixingAlthough people had life history records, some staff could not describe person-centred information about someone they supported. One person also said they did not always choose when to get up.
“However, a relative told us, "They have found out what [person] likes and been very person centred.” from the report
- 01What training have all staff now completed on using restraint safely, and how is their competence checked?
- 02How do you assess and review each person's restraint risks, and where are less restrictive alternatives recorded?
- 03How do you make sure staff recognise and report safeguarding concerns immediately?
- 04Have all staff files now been checked for complete employment histories, and who reviews these checks?
- 05What evidence can you show that call bell response times and other safety risks are being monitored effectively?
This was a focused inspection of Safe and Well-led only; the previous ratings for Effective, Caring and Responsive were carried forward into the overall rating. This explanation was written from the published report of 1 October 2020 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, October 2019
Rated Requires Improvement; inspectors found kind and responsive care, but safety checks, assessments and management oversight were not reliable enough.
This was an unannounced inspection on 28 and 29 August 2019. Inspectors spoke with people, relatives, staff and health professionals. They observed care and reviewed care plans, medicines records, staff recruitment files and quality records.
People generally said they felt safe, received their medicines and lived in a clean home. Inspectors found kind and respectful staff, personalised care, activities, good support with food and drink, and access to health care.
However, some risks had not been properly assessed. These included risks linked to paraffin creams, behaviour, pressure care and thickening powders. Pre-admission assessments were not always detailed enough, and some staff training and call bell monitoring needed improvement.
The overall rating was Requires Improvement. Caring and Responsive were Good. Safe, Effective and Well-led were Requires Improvement. The home had been rated Good at the previous inspection, published in September 2017.
Kind and respectful care
People described staff as kind and caring. Inspectors saw friendly interactions and found that privacy, dignity and independence were respected.
“During the inspection, we spent time in communal areas observing kind and friendly interactions between staff and people.” from the report
Personalised support
Care plans recorded people's likes, dislikes and important preferences. Staff could explain how they supported people according to this information.
“People's likes, dislikes and what was important to the person were recorded in person- centred care plans.” from the report
Food and drink
People received suitable meals, drinks and help when needed. Staff understood special diets and the correct food textures.
“We saw that people's nutritional needs were catered for and they ate a healthy balanced diet.” from the report
Activities and complaints
The home offered a range of activities and also provided activities for people who preferred to stay in their rooms. Complaints reviewed had been investigated and recorded.
“There were a range of interesting activities on offer including crafts, bingo, baking, Tai-Chi, reminiscence and exercises sessions.” from the report
Incomplete risk assessments
seriousSome important risks were not recorded or explained clearly enough. Inspectors found no risk assessments for people using paraffin-based creams, and one behaviour care plan lacked important detail.
“There were no risk assessments in place for those people who were prescribed paraffin based topical creams.” from the report
Care planning and assessment gaps
needs fixingOne pre-admission assessment did not explore behaviour-related needs sufficiently. Inspectors also found that pressure care records and a nutrition risk calculation needed updating.
“For one person the assessment did not show that identified issues with their behaviour had been sufficiently explored.” from the report
Quality checks missed problems
seriousThe home's audits did not consistently identify risks, recruitment issues, training needs or call bell response concerns. This led to a breach of Regulation 17.
“The auditing of the service had not always been effective.” from the report
Call bell response
needs fixingOne person waited six minutes for help, against the home's three-minute aim. Inspectors also found that the available call bell monitoring system was not being actively used.
“We did observe one incident where a person had to wait six minutes for staff to respond to their call bell, which did not meet the provider's aim of a response time of three minutes.” from the report
Staff knowledge and recruitment records
needs fixingSome feedback raised concerns about staff knowledge of Parkinson's care. The home also needed to ensure that full employment histories were obtained during recruitment.
“One relative told us they thought staff lacked knowledge in the care of people with Parkinson's.” from the report
- 01What risk assessments are now in place for people using paraffin-based creams, and how are staff trained to manage the fire risk?
- 02How do you check that pre-admission assessments fully explore behaviour, health and support needs before someone moves in?
- 03What action has been taken to improve staff knowledge of Parkinson's care and positive behaviour support?
- 04How are call bell response times now monitored, and what happens if someone waits longer than the home's target?
- 05What changes have been made to quality audits since the breach of Regulation 17?
This was an unannounced comprehensive inspection covering all five CQC questions, including both the premises and the care provided. This explanation was written from the published report of 4 October 2019 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 Rose Nursing Home
5 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- October 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- September 2017Goodup from Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- June 2016Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- January 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- December 2013
Registered with the Care Quality Commission on 16 December 2013.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Birmingham
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 £1,230 a week. 79 can care for a couple. 9 years' experience on average.
“God doesn't make people like her anymore!”
“I have never met a person who is so kind and thinks about others before himself to such an extent as Chris Malagala.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.