CQC report explained · a nursing home
What the CQC found at Meadowside and St. Francis
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors were assured about the home's infection control, including PPE, testing, isolation, social distancing, visiting and cleaning. They also signposted the provider to resources to develop its approach.
- Effective?
- Good
- This was not assessed or rated in this inspection.
- Caring?
- Outstanding
- This was not assessed or rated in this inspection.
- Responsive?
- Good
- This was not assessed or rated in this inspection.
- Well-led?
- Good
- This was not assessed or rated in this inspection.
What inspectors found, March 2021
Inspected but not rated; inspectors found good infection control during the COVID-19 outbreak, with some resources recommended for further development.
This was an unannounced, targeted inspection on 17 February 2021. It looked only at infection prevention and control because the home had experienced coronavirus outbreaks.
Inspectors found that the home followed guidance on isolation, testing, vaccination, PPE, social distancing and visiting. They were assured that infection risks were being managed in the areas they checked.
The home was clean, infection control was audited, and visiting rooms had been created for families. The report says the service was inspected but not rated, so it does not give a full overall assessment of the home.
Infection control
Inspectors found the home clean, with regular infection control audits and a dedicated team maintaining cleanliness.
“The service was clean and there was a team of staff dedicated to ensuring this was maintained.” from the report
Managing the outbreak
The home followed national guidance during the COVID-19 outbreak and supported people and staff emotionally afterwards.
“The service followed national guidance and self-isolated people and staff for the required amount of time.” from the report
Safe family contact
The home created visiting rooms and had arrangements for family visits at the end of life.
“Visiting rooms had been specially built to ensure families and people could have contact with each other.” from the report
PPE and testing
Staff had training and refresher guidance on PPE. People and staff were tested in line with guidance, and vaccination was offered.
“Staff understood how to use PPE effectively and had refresher training and guidance when needed.” from the report
Further development recommended
minorInspectors signposted the provider to resources to develop its infection prevention and control approach. The report does not give more detail about what needed development.
“We have also signposted the provider to resources to develop their approach.” from the report
- 01What infection prevention and control resources did CQC signpost you to, and what changes have you made since the inspection?
- 02How are visitors currently tested, supported and kept safe from infection?
- 03How often are infection control checks carried out, and what happens when they identify a problem?
- 04How is PPE training kept up to date for staff?
- 05What are the current arrangements for family visits, including visits at the end of life?
This was an unannounced targeted inspection of infection prevention and control only; the service was inspected but not rated and the other areas were not assessed. This explanation was written from the published report of 9 March 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, April 2019
Meadowside and St Francis was rated Good overall; inspectors found Outstanding caring and some records and safety checks still needed strengthening.
This was an unannounced planned inspection on 18 and 19 March 2019. Inspectors spoke with people living in the home, relatives and staff. They also reviewed care records, medicines records, training records, complaints and quality checks.
The home was rated Good overall. Safe, Effective, Responsive and Well-led were rated Good. Caring was rated Outstanding. Inspectors found that people were respected, involved in their care and supported by kind staff.
The home had improved since the previous inspection, which was rated Requires Improvement. Medicines were now managed safely, people's human rights were protected and care plans had improved. However, some health risks and care records were not always recorded, and checks on specialist mattresses were not always completed. The provider was recommended to strengthen its quality monitoring.
Kind and respectful care
People were treated as individuals and staff supported their dignity, choices and independence. Inspectors found a strong person-centred culture.
“People were at the heart of the service, and staff were motivated to deliver exceptional care” from the report
Improved medicines safety
Medicines records and checking systems had improved since the previous inspection. Inspectors found that people received their medicines correctly.
“People's medicines were now managed safely. Medicines recording had improved and showed that people now received their medicines correctly.” from the report
Skilled and supported staff
Staff had training for people's specific needs and ongoing checks of their skills. Inspectors found staff knowledgeable and effective in their roles.
“Ongoing competency checks of staffs practice helped to ensure people received a good standard of care and support.” from the report
Personalised activities and support
People were supported to follow their interests, maintain relationships and take part in activities and community life.
“There was a 'one more time' project which enabled people to choose something they had always wanted to do, or to do again.” from the report
Some health risks were not recorded
needs fixingRisk assessments were not always in place for conditions such as diabetes or epilepsy. Staff knew how to respond, but the records did not always show the required information.
“Risks associated with people's health care were not always recorded, for example if someone was living with diabetes or epilepsy.” from the report
Monitoring did not find all gaps
needs fixingSome specialist pressure-relieving mattress checks were missed, and some care records were not in place or up to date. Inspectors recommended stronger overall quality monitoring.
“However, despite these systems being in place, they had not been fully effective in identifying that specialist pressure relieving mattress checks were not always taking place, and that care records had not always been in place.” from the report
- 01How do you now make sure every person's health risks, including diabetes or epilepsy, are recorded in their care plan?
- 02How often are specialist pressure-relieving mattresses checked, and how do you record that the setting is correct for each person's weight?
- 03What changes have you made to quality monitoring so missing or outdated care records are found quickly?
- 04Has the new manager's application for CQC registration been completed?
- 05How are people and relatives involved in reviewing care plans and giving feedback about the home?
This was an unannounced planned inspection covering all five CQC questions and checking whether improvements had been made since the previous inspection rated Requires Improvement. This explanation was written from the published report of 16 April 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 Meadowside and St. Francis
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- March 2021Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- April 2019Goodup from Requires improvementSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- April 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2017Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- July 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 5 November 2010.
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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