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Inspection carried out on 15 March 2018

During a routine inspection

This inspection took place on 15 and 16 March and was unannounced. The previous inspection was carried out on 6 December 2016 and there had been three breaches of legal requirements at that time. We rated the service requires improvement in two of the key questions, effective and well led. We found at this inspection significant improvements had been made. The registered manager had submitted an action plan to the Care Quality Commission so that we could monitor the improvements made.

Meadowcare Home provides accommodation for up to 34 people who require nursing or personal care. At the time of our visit there were 30 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

People were protected from the risk of infection. Staff understood the importance of infection control and prevention.

There were enough suitable staff to meet people's needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Appropriate checks were made before staff started to work to make sure they were suitable to work in a care setting.

Medicines were handled appropriately and stored securely. Medicine Administration Records (MAR) were signed to indicate people's prescribed medicine had been given.

Staff received training to ensure they had the skills and knowledge required to effectively support people. Staff felt well supported by the registered manager and received regular supervision and appraisals.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and DoLS.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were monitored and encouraged with their eating and drinking where required and concerns about their health were quickly followed up with referrals to relevant professionals.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People's privacy was respected, and their dignity and independence promoted.

People's needs were reviewed and monitored on a regular basis. Care records were reflective of people's individual care needs and preferences and were reviewed on a regular basis. People knew about the service's complaints procedures and knew how to make a complaint.

People were supported and helped to maintain their health and to access health services when they needed them.

There was system in place for responding to and acting on complaints, comments, feedback and suggestions.

There were effective processes in place to monitor the quality and safety of the service. People's feedback was sought through annual satisfaction surveys.

Inspection carried out on 6 December 2016

During a routine inspection

We carried out a comprehensive inspection of Meadowcare Home on 6 December 2016. At our previous inspection in May 2015, we found the provider had not ensured that medicines were always stored in a safe and suitable environment. Following this inspection, the provider told us what action they had taken to meet the regulation. During this inspection we found that sufficient action had been taken.

Meadowcare Home provides accommodation for nursing and personal care for up to 34 people. The service mainly provides support for older people who are living with dementia. At the time of this inspection in December 2016, there were 32 people living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service had not complied with the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. The service had not consistently ensured any conditions attached to people’s DoLS had been completed. In addition, staff were not fully aware of how the DoLS impacted on their work despite receiving training in the subject. Best interest decisions had not been consistently undertaken in accordance with the Mental Capacity Act 2005. The provider had failed to send DoLS notifications to the Commission as required by law.

People at the service told us they felt safe. People received their medicines on time and medicines were now stored correctly in a safe temperature range. People’s risks were assessed and identified risks were managed. There were sufficient staff on duty and we saw that people’s care needs were attended to promptly. Recruitment procedures were safe and people were cared for in a clean, hygienic environment. Environmental risks were monitored and an analysis of falls and incidents was completed.

People told us they received effective care and relatives we spoke with were complimentary. People had access to healthcare professionals when needed to ensure their needs were met. People’s weights were monitored, and where required they received the required support from staff. The service used a nationally recognised tool to monitor malnutrition and obesity risks and referrals were made when required. Staff received an induction when commencing their employment. Training for staff was provided and staff were supported through a supervision and annual appraisal process.

People and their relatives said they received support from caring staff. We made observations to support this, with staff delivering care in a compassionate and friendly manner demonstrating they knew people well. People could be visited by friends and relatives to avoid social isolation. Staff were responsive to people’s care needs and care records demonstrated a person centred approach to care provision. People had activities to partake in and there were links with the community. The provider had a system to record and respond to complaints.

People and staff told us the service was well-led. People spoke well of the communication they received from the service and staff were happy in their employment. Staff spoke of a good team ethos. There were systems to communicate with people, their relatives and staff. There were systems that monitored the quality of service provided and people’s clinical needs were monitored and reviewed.

Inspection carried out on 19 May 2015

During a routine inspection

We carried out this inspection on 19 May 2015 and this was an unannounced inspection. During a previous inspection of this service on March 2014 there were no breaches of the legal requirements identified.

Meadowcare Home provides personal and nursing care for a maximum of 34 people. At the time of the inspection there were 34 people living in the home. The home has four floors with access via a passenger lift or the stairs. The home provides care to people living with dementia.

A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People received their medicines on time, however medicines were not always stored appropriately. Medicines that required storage at room temperature were being stored in an environment that exceeded the medicine manufacturers guidance and national guidance. The home was clean however we identified areas where cross infection risks to people could be reduced.

People felt safe within the service and people’s relatives commented positively about the staff at the service. Staff understood safeguarding procedures and reporting processes. Safeguarding and whistleblowing policies were being updated to reflect new legislation.

People’s needs were met and there were sufficient staff on duty. People or their relatives felt there were sufficient staff available and staff felt they could meet people’s needs.

There were systems that ensured new staff members were recruited safely. Correct pre-employment checks were completed with the Disclosure and Barring Service for staff. Checks to ensure nursing staff were correctly registered were completed.

People and their relatives gave positive feedback about the staff at the home and the standard of care that was provided. Staff were provided with regular training to meet the needs of people living at the service and received regular support through supervision.

The service were had completed applications where a need had been identified in regard to the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities to ensure compliance with the DoLS framework and staff understood how the Mental Capacity Act 2005 impacted on their work.

People were provided with sufficient food and people received the support they required when eating. Advice from a person’s GP or other healthcare professional was sought when a need was identified.

We observed caring interactions between people and staff during our inspection. Staff knew how to interact with the people they were caring for and understood their communication needs. People and their relatives were involved in decisions about the care and support they received.

The provider had a complaints procedure and people felt confident they could complain should the need arise. Activities were arranged for people and people were observed taking part in activities during the inspection.

The registered manager was well respected and staff thought the service was well led. A notification had not been sent to the Commission as required.

People and their relatives commented positively about the management of the home. There were systems to communicate with staff and the systems to monitor the quality and safety of care provided to people at the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 6 March 2014

During an inspection looking at part of the service

We undertook an inspection on 1 and 4 November 2013. The provider was not meeting two of the �Essential Standards of Quality and Safety�. The provider submitted a report that stated what action they were going to take to achieve compliance with the essential standards. We conducted a follow-up inspection on 6 March 2014. The purpose of the inspection was to check that the necessary improvements had been made to ensure compliance with the essential standards.

Meadowcare mainly supported people with dementia care. Not all people were able to verbally tell us about the care and support they received. We observed how staff interacted and supported people. This enabled us to make a judgement on how people�s needs were being met.

Since our previous inspection we found that the care planning system and documentation had been amended. The plans were person-centred and specific to the individual�s needs. We found that the home had implemented a thorough pre-assessment and planning programme. This ensured that people�s welfare was protected and their needs were understood from the outset.

We spoke with four relatives. They all confirmed that they were involved in discussions relating to the care planning of their relative. One relative told us �I have been impressed with the care plan as x has only been here for a week. I feel they have been thorough�. Representatives of people who used the service could express their views and were involved appropriately in making decisions about their relative�s care, treatment and support.

Inspection carried out on 10 January 2014

During an inspection looking at part of the service

During our inspection conducted on 1 and 4 November 2013 we found that the provider had a lack of effective systems to regularly assess and monitor the quality of the services provided and to identify, assess and manage risks, so that the people using the service were not protected against the risks of inappropriate or unsafe care.

We revisited Meadowcare Home on 10 January 2014. We found that the appropriate corrective action had been taken. This meant that the people who used the service were now adequately protected against the risks of inappropriate or unsafe care.

Inspection carried out on 1, 4 November 2013

During an inspection looking at part of the service

We undertook an inspection on 22 and 24 May 2013. The provider was not meeting five of the 'Essential Standards of Quality and Safety'. The provider was required to provide a report that stated what action they were going to take to achieve compliance with the essential standards. The purpose of the inspection was to check that the necessary improvements had been made to ensure compliance with the essential standards.

Meadowcare supports people with dementia care. Not all people were able to verbally tell us about the care and support they received. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We viewed four care plans. The planning documentation was not person centred and specific to the individual regarding their care needs. We spoke with four relatives of the people who used the service. The family members we spoke with told us that they were not involved in regular formal discussions regarding their relatives care.

We viewed the staff training matrix and found that staff had attended or are booked onto training appropriate to their roles.

We found that the provider had introduced a support structure for staff supervisions and annual appraisals. The majority of the staff told us that they felt that staffing levels were now adequate.

We found that the provider did not have robust systems in place to regularly assess and monitor the quality of the services provided.

Inspection carried out on 23, 24 May 2013

During a routine inspection

Meadowcare supports people with dementia care. Not all people were able to verbally tell us about the care and support they received. Therefore we observed how staff interacted and supported people, to enable us to make a judgement on how their needs were being met.

We viewed four care plans. The planning documentation used generic wording and was not person centred and specific to the individual regarding their needs and preferences. Staff we spoke with were knowledgeable about the people they supported. Two out of the four family members we spoke with told us that they were not involved in formal discussions regarding their relatives care plan.

We viewed the staff training matrix and found some areas of staff training required updating. A training plan had been implemented to address this issue.

We found that there was not an adequate support structure in place for staff supervisions and annual appraisals. The majority of the staff told us that they felt that staffing levels were inadequate in unforeseen circumstances, such as covering for sick absences. The acting manager advised that the service did not use agency staff and where possible absences were covered by existing staff.

We found that the provider did not have robust systems in place to regularly assess and monitor the quality of the services provided.

Inspection carried out on 11 December 2012

During an inspection looking at part of the service

Meadowcare Home provides accommodation and nursing for up to 34 people. It specialises in providing care to individuals with dementia.

This inspection was to review the compliance action we placed following our inspection of 3rd May 2012. At that inspection we found there was a lack of person centred information to promote a greater level of person centred care. There was a lack of consistency in the recording of individual care needs and actions taken to meet those needs to ensure the welfare and safety of the person. We have not visited the service as part of this inspection but asked the provider to give us information as to how they have addressed the compliance action.

We found that the provider had taken the necessary action and had improved their arrangements in relation to needs assessment. The assessments are now person centred and they have put in place a system to record where people's care needs had changed. We found that the proper steps had been taken to ensure the each person is protected against the risks of receiving care or treatment that is inappropriate or unsafe.

Inspection carried out on 3 May 2012

During a routine inspection

We were only able to speak with a small number of people who live at Meadowcare because of the difficulties in communication associated with dementia. We did speak to a number of relatives and have used their comments to help us in making a judgement about the quality of the care provided to individuals.

Over the two days of our visit we observed staff interacting and supporting individuals. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We have referred to this observation throughout this report and have used some of our findings from this observation to make comments about the quality of care.

We looked at some compliments that had been received by the home. Comments included:

"It was clear that staff were caring and understanding. It is a relief our relative was looked after by such kind staff."

"I always felt comfortable and welcomed when I visited."

Our relative was very much cared for in a lovely, friendly and professional home."

"All welcoming and kind"

Comments made to us by relatives included: " he could not be in better hands", "I have lots of trust in the staff","staff are really good, friendly and welcoming".

One relative told us that it was a: "very good home, they keep me informed, it is excellent".

Inspection carried out on 20 July 2011

During an inspection in response to concerns

We spoke to a number of people who lived at the home but they had limited capacity to provide meaningful feedback about the service. However we spoke to a number of relatives who told us that they were very happy with the care provided at Meadowcare Home. They told us that staff were �friendly, supportive and encouraging�. They said that the staff took the time to get to know all of the people in their care, and what their needs were. They said that they carried out their duties "efficiently but with warmth and genuine care.� People told us that they appreciated that the home kept them informed about their relatives� progress and always told them if they were unwell or if, for instance, they had a fall. They said that if they were concerned about any aspect of the care they felt able to talk to the staff who were �approachable and responsive�.

Reports under our old system of regulation (including those from before CQC was created)