Meadow Grange Nursing Home Limited is a residential home for 60 older people some of whom are living with dementia. The accommodation is provided across two floors.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good. However, we made recommendations for improvement in ensuring that people have maximum choice and control of their lives and staff understand how to assess their capacity to do this.

People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

Staff received training and support to be able to care for people effectively. They ensured that people were supported to maintain good health and nutrition; including in partnership with other organisations when needed. The environment met people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. There were opportunities for them to get involved in activities and pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they received.

People and their relatives were included in developing the service. There were quality systems in place which were effective in continually developing the quality of the care that was provided to them.

Further information is in the detailed findings below.

This inspection was unannounced and took place on the 2 October 2015. .

Meadow Grange Care Home provides personal care for up to 60 older adults, which may include some people living with dementia. There was a registered manager at this service. 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.

At our last inspection in May 2013 the provider’s systems and arrangements did not fully protect people from the risks of unsafe or ineffective care and treatment. This included their arrangements for infection control and prevention; ensuring appropriate consent or authorisation for people’s care and checking the quality and safety of people’s care. These were respective breaches of Regulations 12, 18 and 10 of the Health and Social Care Act (Regulated Activities) Regulations 2010. Following that inspection, the provider told us what action they were going to take. At this inspection we found that the improvements were made.

People felt safe in the home, which was kept clean and well maintained. The provider’s arrangements to prevent and control infection in the home met with recognised guidance for this, which staff understood and followed.

Staff followed the Mental Capacity Act 2005 (MCA) to obtain people’s consent or appropriate authorisation for their care. Staff understood and provided care in people’s best interests when required. Measures to improve record keeping for this were being introduced which helped to mitigate the risk of people receiving in appropriate care.

The provider’s arrangements for staff recruitment and deployment and for managing known risks to people’s safety, helped to make sure that people were protected from harm and abuse. This included risks associated with their health conditions and medicines.

People’s health and nutritional needs were being met in a way that met People were supported to access external health and social care professionals when they needed to and staff followed their instructions for people’s care when required.

Many people spoke highly of the care they received from staff who were provided with the training, support and supervision they needed.

People had good relationships with staff that were kind and caring. Staff treated people with respect and promoted their rights and choices in care. People and their relatives were informed and involved in the care provided and made welcome in the home.

People were appropriately consulted and happy with their care. They were confident to raise any concerns or complaints, which were listened to and addressed by the service.

People were actively encouraged and supported to engage in home and community life; to participate in a range of social, leisure, spiritual and recreational activities and be as independent as they could be. People were positive about their daily living arrangements, which were flexibly planned to suit their needs and choices.

Staff were observant of people’s needs and they responded promptly when people needed them. People’s views about their care and daily living experiences were routinely sought and used to make improvements when required.

The home was well managed and run and people, relatives and staff were confident about this. Systems were in place to inform the quality and safety of people’s care and improvements were made when needed. This helped to make sure that people received safe and effective care. Further improvements were assured in relation to record keeping.

Staff understood their roles and responsibilities and they were encouraged and motivated to make improvements when needed. They were appropriately supported to share their views and concerns and report any changes about people’s care. The provider met their responsibilities to inform us about important events that occurred at the service when they needed to.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

There were 41 people living at Meadow Grange at the time of our visit. We spoke with two people living in the home and the relatives of two people regarding their care. Everyone we spoke with was positive about the care and support they or their relative received. People also commented on how much they liked the environment of the home and the outcome of the ongoing refurbishments. One person said, “Its lovely here, it's always clean and tidy and the staff are friendly."

As some of the people living at Meadow Grange were living with dementia, we also undertook a structured observation over lunchtime in the large dining room at the back of the home. We saw that people were supported to the dining tables and were offered a choice of drinks and food. At the end of the meal, the chef came to speak with people about one of the meals as it was a new item on the menu.

People were being cared for in a clean, hygienic environment however there were not always systems in place to monitor or audit the cleanliness of the home.

We found that people’s care plans, including risk assessments were not always regularly reviewed and did not always contain person centred details about people’s changing needs.

We spoke with six people who used the service who all told us that they were happy with their care. One person told us "I couldn't get better at the Ritz" and another "you're well looked after".

We spoke with relatives of two people who used the service who told us "the care is very good" and "we are happy with the care that mum gets".

We spoke with two staff members who told us the care that they provide is based around what people using the service want not what the service can give.

We found that people's preferences and details about how they liked to spend their day were recorded in their care plans. We looked at records and saw that a quality assurance questoinnaire had been sent out and there had been a relatives meeting held. We had concerns that risks around the home had not assessed and where concerns had been identified there had not been any follow up.