This inspection took place on 30 May 2017 and was unannounced.

The provider is registered to provide accommodation for up to 25 older people living with or without dementia in the home over two floors. There were 19 people using the service at the time of our inspection.

At our last inspection on 9 February 2016, we asked the provider to take action to make improvements in the area of medicines. We received an action plan setting out when the provider would be compliant with the regulations. At this inspection we found that the concerns in the area of medicines had been addressed.

A registered manager was in post and was available throughout the 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.

Staff knew how to keep people safe and understood their duty to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Safe medicines and infection control practices were followed by staff.

Staff received induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005.

People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate and adaptations had been made to the design of the home to support people living with dementia.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved so that more people could access activities outside the home. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising concerns with the management team and that appropriate action would be taken.

The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

This inspection took place on 9 February 2016 and was unannounced.

Accommodation for up to 25 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 22 people using the service at the time of our inspection.

At the previous inspection on 10 and 11 February 2015, we asked the provider to take action to make improvements to the area of good governance. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in this area but more work was required.

There is a registered manager and she was available during the 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.

Safe medicines practices were not always followed. People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Safe infection control practices were followed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received personalised care that was responsive to their needs. People were supported to follow their interests and take part in social activities. Care records contained sufficient information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not fully effective. The provider was not fully meeting their regulatory responsibilities as they had not sent a statutory notification to the CQC when required to do so.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that they would take action.

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

We found that improvements were continuing in respect of record keeping and care planning. We also saw that staff interactions had improved and staff responded to people’s needs and respected their privacy and dignity.

We spoke with four people about their care and the support they received. All of them told us that staff were polite and respectful. One person said, “The staff are very nice.” Another person said, “The staff are nice enough, they are always respectful.”

We spoke with four people using the service about their experiences of the care they received. They all told us they were happy and settled living at the home. One person said, “The staff are very nice and helpful.” Another person said, “The staff are lovely, they help me. I really like it here.”

We found that the recruitment procedures did not fully protect people from the risk of unsuitable staff being employed.

We found the provider did not have a fully effective quality monitoring system in place to ensure that relevant systems and processes were fully managed.

During this inspection we found that continued improvements had taken place in all areas. However there were some areas which still required further development.

We spoke with three people about their care and the support they received. All of them told us staff were polite and respectful to them.

We saw that staff were generally attentive to people's needs. However, the quality of interactions between people who used the service and staff was not always person centred.

Although staff felt they maintained people’s dignity it was apparent that staff did not fully understand the concept of dignity.

Although improvements had continued in respect of care planning we found people’s needs were still not always fully assessed and care and support was not always planned and delivered in line with their individual requirements or in a way that met their needs.

People we spoke with told us they were happy and settled living at the home. One person said, “The staff are very good, you can’t fault them, they help me when needed. Another person said, “The staff are nice and they help me as needed.”

We found the improvements in respect of the environment had been maintained and further work had taken place.

People we spoke with told us they thought the home was clean. One person said, “The staff keep everywhere clean and tidy.”

One person told us that although there were no concerns in respect of the environment that if anything needed to be repaired that this would take place quickly.

Although there had been continued improvements in respect of records and record keeping further improvements were still needed.

Three people using the service spoke positively about the care they received from staff. One person said, “The staff are really good. I am cared for well.” Another person said, “The care here is good.”

We spoke with three people using the service and one relative. They all told us they thought the home was clean. One person said, “They (staff) keep my room clean, I thing the place is clean enough.”

We observed positive interactions between staff and people using the service. There was a relaxed atmosphere and we saw that people using the service looked comfortable talking to staff. We spoke with three staff and they told us they thought there were enough staff to meet the needs of the people using the service.

We found there had been many improvements to the service since we last visited.

We visited the location to carry out a planned review. We also looked at the compliance actions that had been set at the previous inspection to see if these had been addressed and improvements had been made.

Due to the complex needs of some people living at Meadow Lodge they were unable to talk with us. We therefore observed their care to help us understand the experience of people who could not talk with us.

We also spoke the manager and her assistant, two senior staff, two care staff and four people using the service.

One person said their family had received all the information they needed so they could make any decisions about their care. Whereas another person said, “I don’t really get enough information but I’m not really sure what information I would like.”

All four people said they could make their own choices and decisions about what they did and how they spent their time.

One person said because of their experiences with a member of staff they did not feel staff listened to them all the time when they were expressing concern about their health and wellbeing. Whereas another person said, “I am very happy here, the staff are very nice and caring, they come and make sure I am ok if I am unwell.”

Three people felt that staff knew their likes and dislikes as they supported them in a way they preferred.

One person said, “It is a nice beautiful home, it is kept clean and tidy.” Another person said, “The environment is alright, my room is alright, I don’t know if they clean it everyday.” However, other evidence did not support this and we observed that parts of the environment and equipment in use were not kept clean and hygienic and there were no clear systems in place in respect of infection control and the spread of infection.

Three out of four people felt there were enough staff to meet their needs and they did not have to wait long for assistance. Whereas one person said, “There are not always enough staff and sometimes I have to wait. Sometimes I feel I am left in bed for too long.”

Two people said they thought staff listened to them whereas two people did not feel there were effective ways they could provide feedback about the service.

Residents were positive about how they were treated by staff and told us that they were shown respect. One person told us, “I’m looked after very well.” They said they were happy with the flexibility of their daily timetables and felt that all their needs were met, with one adding, “They’re very kind here.” However, the residents we spoke with had no recall of being involved in their personal plans of care.

Residents gave us a mixed response as to whether there were sufficient activities offered to them but one person gave us a positive account of activities over the recent Christmas period. The people we spoke with said they felt safe living at Meadow Lodge. One person told us, “Staff treat me well.”

Residents said there were normally sufficient staff available at all times and told us that staff were competent at their job. Comments by the people we spoke with, about the quality of the service, were generally positive. They said they felt listened to and that issues raised were acted upon.

Meadow Lodge provides accommodation and personal care for up to 25 older people. 23 people were living at the home at the time of the inspection. This was an unannounced inspection, carried out over two days on 10 and 11 February 2015.

We last inspected Meadow Lodge on 22 October 2013. At that time it was not meeting two essential standards. We asked the provider to take action to make improvements in the areas of the requirements relating to workers and assessing and monitoring the quality of service provision. We received an action plan dated 27 November 2013 in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found they had taken some action. However, we found that some improvements were still required and the provider was not meeting the essential standard in relation to assessing and monitoring the quality of the service provided.

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 2008 and associated Regulations about how the service is run.

People living in the home told us they felt safe. Staff had a good understanding of what constituted abuse and told us they would report concerns.

Staff provided support in a safe way. Risk assessments were completed regarding people’s care. However, some information in care records was unclear regarding the risks and managing these.

There were enough staff to meet people’s needs. Staff recruitment and selection processes were in place. However, these were not robust as some staff had started work before the outcomes of all relevant checks were known.

People received their medicines in a safe way.

Staff received induction, supervision and training and knew about people’s needs.

People were asked for their consent. Staff offered choices to people and respected people’s decisions.

People received enough to eat and drink. However, appropriate arrangements were not always in place to monitor people’s weight.

Referrals were made to health care professionals for additional support when needed.

Staff were caring and kind and treated people with dignity and respect. Staff provided support in a person-centred way. However, some care records did not contain enough information about people’s needs and preferences.

Staff supported people to take part in activities that reflected people’s interests.

People felt that the registered manager was approachable. Staff felt comfortable raising concerns to the registered manager.

The provider had not notified the Care Quality Commission of all incidents that they were required to do so by law. There were some systems in place to monitor the safety and quality of the service provided and to address risks. However, improvements were required to improve the effectiveness of these. This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 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.