Meadow Home Care Services Ltd was rated Requires Improvement overall following a focused inspection in May–August 2022, with breaches of Regulation 17 (Good Governance) and Regulation 19 (Fit and Proper Persons Employed) identified. Key failures included inadequate risk assessments and care plan records, real-time medication monitoring gaps, and safeguarding incidents not reported to the local authority or CQC.
Concerns (8)
criticalRecord keeping: “Risks to people were not always fully assessed and mitigated. For example, falls risk assessments did not always give enough detail for staff to know how to mitigate the risks”
critical
Governance
: “This was a breach of regulation 17(1)(2)(a)(b)(c)(d)(f) — provider did not fully use governance systems and processes to record information needed to keep people and staff safe.”
criticalSafeguarding: “incidents that related to care of people identified during the disciplinary process had not been referred to the local authority safeguarding team or CQC”
criticalLeadership: “This was a breach of Regulation 19 (Fit and Proper Persons Employed) — provider did not have a suitable disciplinary policy in place and decisions were inconsistent.”
moderateMedication management: “medicines audits are not monitored in 'real time' so they were unable to respond quickly to missed medicines unless they are alerted to this by staff at the next call.”
moderateSupervision / appraisal: “Staff supervisions and training had also lapsed but this had been addressed by the time we carried out the site visit on 03 August 2022”
moderateIncident learning: “Audits were in place but we found actions were not always taken, for example the call times audit identified some staff always made use of the 5 minute leeway to leave calls early”
minorCommunication with families: “I have spoken to Meadows home care. I've had problems with them not calling back. I will leave a message, when they do finally get back, they are helpful.”
Strengths
· Established staff team who knew people well, mitigating gaps in written risk assessments
· Staff wore PPE correctly and people/relatives had no concerns about infection control
· Staff were experienced, mandatory training recently renewed, and found managers supportive
· Provider worked collaboratively with GPs, district nurses and other professionals
· Provider responded quickly during and after inspection to update records and address concerns
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
Meadow Home Care Services Ltd improved from Requires Improvement to Good across all five key questions following a previous inspection in April 2017 that identified concerns in responsive and well-led domains. All areas of the service were found to be operating effectively at this inspection, with only minor observations noted around medicines competency recording, trainer qualifications, and centralised collation of feedback.
Concerns (5)
minorMedication management: “competency assessments were not being reviewed as regularly as recommended by the National Institute for Clinical Excellence (NICE) guidance.”
minorMedication management: “There was no additional information available for staff to let them know the amount of tablets in the pack or what the tablets were.”
minorStaff competency: “the registered manager was unable to provide evidence that the NI had an up to date 'train the trainer' qualification to provide this in line with good practice guidelines.”
minorGovernance: “comments made by people during telephone surveys and on the annual postal survey were responded to and recorded on the person's individual file. As this information was not centrally collated the actions taken were not easily available.”
minorRecord keeping: “where these referenced our regulations they referred to the previous Health and Social Care Act not the amended 2014 Act, and associated key lines of enquiry.”
Strengths
· People felt safe with regular, familiar care staff they knew and trusted.
· Improved consistency of call times and continuity of care staff since previous inspection.
· Care plans were personalised, regularly reviewed, and updated when needs changed.
· Staff received regular supervision, spot checks, and observations of practice.
· Effective introduction of senior care worker role improving quality monitoring.
Meadow Home Care Services Ltd received an overall rating of Requires Improvement at its March 2017 inspection, with Good ratings for safe, effective, and caring domains but ongoing failures in responsiveness and governance. Key concerns included late and missed care calls particularly at weekends, inconsistent complaints recording, out-of-date care plans, and gaps in call monitoring for Birmingham-area service users.
Concerns (11)
moderateMissed or late visits: “Sometimes they can be three hours late at a weekend. They come to do my tea but they don't get here until after 8pm sometimes, far too late.”
moderateMissed or late visits: “The company were not aware of the no shows until I contacted them each time.”
moderateGovernance: “Information was not collated to show how many late or missed calls had occurred, or if there were any trends or patterns and if improvements could be made.”
moderateComplaints handling: “The last entry in the book we were shown was 2014...the provider did not have an overview of the concerns and complaints people had raised.”
moderateComplaints handling: “There was no evidence that complaints had been logged and investigated in line with the provider's complaints procedure.”
moderateCare planning: “There is a care plan but it is very out of date. Her needs have changed and what they do now isn't in the care plan.”
moderateCare planning: “Three care plans we looked at had not been reviewed within the last 12 months in line with the provider's procedures.”
moderateMedication management: “On one MAR that had been checked we found errors that had not been identified. There was no staff signatures on some medicines to show these had been given as prescribed.”
moderateIncident learning: “It was not clear there had been any learning or trends identified from complaints received to help prevent them from happening again.”
minorStaff training: “Training that had not been renewed in line with the providers timescales included, food hygiene, first aid and health and safety training.”
minorRecord keeping: “Some people with care plans for the prevention of skin damage did not have risk assessments completed to show they were identified at risk of developing skin damage.”
Strengths
· People felt safe with staff and there were enough staff to provide required support; DBS and safer recruitment processes were in place.
· Staff completed induction based on the Care Certificate and received regular training including safeguarding, moving and handling, and medication administration.
· People were supported by kind, respectful staff who maintained privacy and promoted independence.
· Most people received care from familiar, consistent staff who understood their individual needs and preferences.
· An electronic call monitoring system was in place for Solihull residents, reducing the risk of late or missed calls.
Quality-Statement breakdown (18)
safe: People felt safe and staff understood safeguarding responsibilitiesGood
safe: Risk assessments and care plans identified and managed risks to people's safetyGood
safe: Safer recruitment procedures including DBS checksGood
safe: Sufficient staffing levels to meet people's needsGood
safe: Medicines managed safely and administered as prescribedGood
effective: Staff induction, training and competency assessmentGood
effective: Application of Mental Capacity Act principles and consentGood
effective: Support with nutrition and access to healthcare professionals
Good
caring: Staff treated people with kindness, dignity and respectGood
caring: Consistency of care staff and understanding of individual needsGood
caring: Promotion of independence and person-centred approachGood
responsive: Reliability of care calls — late and missed visits, especially at weekendsRequires improvement
responsive: Care planning and regular review of people's needsRequires improvement
responsive: Complaints recording and managementRequires improvement
well-led: Call monitoring systems and oversight of late/missed callsRequires improvement
well-led: Governance, quality assurance systems and audit processesRequires improvement
well-led: Staff support, supervision and communicationGood
well-led: Leadership culture and registered manager oversightGood