Meadow Home Care is a domiciliary care agency registered to provide personal care to people living in their own home. At the time of this inspection visit they provided 108 people with personal care and employed approximately 60 care staff.

At the last comprehensive inspection in April 2017, we found improvement was required in the key areas of responsive and well led and we rated the service as Requires Improvement. At this inspection we found improvements had been made and the service is now rated as Good.

In May 2017 commissioners stopped referring people funded by the local authority to the service. This was due to concerns about the quality of care identified during a monitoring visit. The provider made the required improvements to the service and in August 2017 the local authority recommenced referrals.

Since our last inspection we have reviewed and refined our assessment framework, which was published in October 2017. For this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The office visit took place on 27 February 2018 and was announced. We told the provider we were coming so they could arrange to be there and arrange for staff to be available to talk with us about the service.

A requirement of the provider’s registration is that they have a registered manager. There was a registered manager 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 2008 and associated Regulations about how the service is run.

At our last inspection in April 2017 the provider had revised the management structure to include the role of senior care worker. Senior care staff had specific responsibility for reviewing people’s care service and their role had been developed to include observations of care staff while working in people’s homes. All the managers and the senior member of staff we spoke with were positive about the impact this had on the service. They said it had reduced the number of minor concerns they received as they were able to identify and resolve issues as they arose.

People who used the service felt safe and procedures were in place to keep people safe and manage identified risks to peoples care. Staff completed training in safeguarding adults and understood their responsibilities to protect people from abuse and harm. The provider conducted pre-employment checks prior to staff starting work, to ensure they were suitable to support people who used the service.

People who required support to take medicines received these from staff that had been trained to administer them safely. Staff used protective clothing, such as disposable gloves and aprons when providing personal care, to reduce the risk of infection being passed from one person to another.

People had an assessment completed at the start of their service to make sure staff could meet their care and support needs. There were enough trained staff to allocate all the visits people required and to meet people's needs safely. When needed, arrangements were in place to support people to have enough to eat and drink and remain in good health.

People's right to make their own decisions about their care were supported by managers and staff who understood the principles of the Mental Capacity Act. Staff respected decisions people made about their care and gained permission before they assisted people with care or support.

At the last inspection some people had experienced inconsistency in the time of their calls and with the care staff that visited them. At this inspection we found this had improved, people told us their calls were made by care staff they knew and who arrived

Meadow Home Care Services Ltd. is a domiciliary care agency which provides personal care to people in their own homes. At the time of our inspection the agency supported approximately 150 people with personal care and employed 53 care staff.

Following our last comprehensive inspection of the service in January 2016 we rated the service ‘Requires Improvement’. This was because the provider was not meeting the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of the legal requirements for good governance of the service, and improvement was required for the service to be consistently effective and well led. During our comprehensive inspection in March 2017 we found improvements had been made, but continued improvements were required to ensure the service was consistently responsive to people’s needs and was effectively managed.

We visited the office of Meadow Home Care Services on 2 March 2017. We told the provider before the visit we were coming so they could arrange for staff to be available to talk with us about the service. The visit was supported by the office manager.

A requirement of the provider’s registration is that they have a registered manager. There was a registered manager 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 told us they felt safe using the service and staff understood how to protect people from abuse and keep people safe. There were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. The character and suitability of staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There were enough staff to deliver the care and support people required. Staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. Not all training had been updated in line with the provider’s time scales, however people told us staff had the right skills to provide the care and support they required.

The managers and staff followed the principles of the Mental Capacity Act (MCA). Staff respected decisions people made about their care and gained people’s consent before they provided personal care.

People had different experiences with the times staff arrived to provide their care. Some people said staff arrived around the time expected; others had experienced late or missed calls. Some people told us the service they received at weekends was not as consistent or reliable as the service they received during the week.

Most people told us staff stayed long enough to provide the care they required and people said they received care from staff they knew. Staff we spoke with visited the same people regularly and knew how people liked their care delivered. Care plans provided guidance for staff about people’s care needs and instructions of what they needed to do on each call.

People told us staff were kind, respected their privacy, and promoted their independence. Staff felt supported by the management team and there was an ‘out of hours’ on call system, which ensured management support and advice was always available for staff.

People knew how to complain if they needed to. People who had raised concerns or issues with the managers said these had been resolved to their satisfaction. Recording of complaints required improvement to ensure all complaints were recorded and investigated in line with the provider’s complaints procedure.

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