The Meadway was rated Requires Improvement overall due to a breach of Regulation 17 (Good Governance), with the provider failing to operate effective audit and monitoring systems to assess and improve service quality. The safe domain remained Good, with effective safeguarding, risk management and recruitment practices, though medicine administration records required improvement.
Concerns (5)
criticalGovernance: “The provider had not operated an effective system to assess, monitor and improve the quality and safety of the service provided.”
moderateRecord keeping: “Spot checks and medicines competencies completed to ensure staff were safe to provide care to people had not been documented.”
moderate
Incident learning
: “There was no evidence the service analysed themes and trends in the accident and incident reports and ensured measures were in place to reduce the likelihood of repeat events.”
minorMedication management: “One MAR did not include information such as specific instructions for giving a medicine, any known drug allergies and the name of the person's GP practice.”
minorSupervision / appraisal: “Not all staff had completed an appraisal within the last year however supervisions had taken place.”
Strengths
· Safeguarding concerns were dealt with appropriately and referred to local authority safeguarding teams
· Individual risk assessments were in place and care plans were informative and written from the person's perspective
· All staff had completed medicines management training and signed MARs appropriately
· Safe recruitment procedures were in place with all necessary evidence in staff files
· Staff described the registered manager as brilliant, supportive, accessible and approachable
Quality-Statement breakdown (11)
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Tonna Care Services Limited received a Good rating across all five key questions at its announced inspection on 21 June 2017, demonstrating safe staffing, robust recruitment, person-centred care planning and effective governance. Minor shortfalls were noted around consistency of staff practice observations and out-of-date regulated activity registrations, both of which the provider committed to address.
Concerns (2)
minorSupervision / appraisal: “One relative told us that they had never experienced the support staff being observed by more senior staff. This was fed back to the provider who undertook to check the observation charts.”
minorRecord keeping: “The regulated activities and service user bands for the service were not up to date and did not accurately reflect the services provided.”
Strengths
· Robust recruitment procedures including regular third-party audits of staff files, achieving 98% compliance score
· Medicines managed safely with all staff trained and competency-assessed before administering medicines
· Highly personalised care and support plans developed with individuals, including easy-read versions
· Strong staff induction combining e-learning and face-to-face training with shadowing of experienced staff
· Open and positive culture with staff feeling valued and management being approachable and transparent