This was an unannounced inspection visit which took place on 19 and 20 July 2017. At the last inspection on 15 and 17 March 2016 we found the provider was not meeting fundamental standards and we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked them to make improvements to their quality assurance processes and the reporting of incidents to CQC. Following the last inspection the service was rated as requires improvement. You can read the report from our previous inspections, by selecting the 'all reports' link for Meadow Rose Nursing Home on our website at www.cqc.org.uk. At this inspection, we found the required improvements had been made and the provider was no longer in breach of the regulations.

Meadow Rose Nursing Home is registered to provide accommodation with nursing and personal care for a maximum of 47 people including people living with dementia and physical disabilities. At the time of our inspection 46 people were living at the home. Accommodation is provided over three floors. There are lounges, rest spaces and dining areas. Every bedroom is equipped with en-suite facilities.

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 and associated Regulations about how the service is run.

People were cared for and supported by staff that had received training to equip them with the required skills to meet people’s needs. Staff received supervision, providing them with appropriate support to carry out their roles. We saw staff treated people as individuals, offering them choices whenever they engaged with people. Staff sought people's consent for care and treatment and ensured people were supported to make as many decisions as possible. Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. However, mental capacity assessments were not always up to date and consistently completed to clearly show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interest; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People spoke positively about the choice of food available. Staff supported people who were living with dementia to eat and drink to maintain their health and wellbeing in a caring and sensitive way. People were supported to access health care professionals to ensure that their health care needs would be met, although instructions left by healthcare professionals was not consistently followed.

People who lived at the home were kept safe. Staff were trained to identify signs of abuse and supported by the provider’s processes to keep people safe. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm. People were supported by sufficient numbers of suitable staff that had been recruited safely. People received their medicines as prescribed.

People and relatives told us that staff were kind, caring and friendly and treated people with dignity and respect. The atmosphere around the home was welcoming. People were relaxed and staff supported people in a dignified way. People and relatives told us they were well supported by staff and the management team and encouraged to maintain relationships that were important to people. People’s health care needs were assessed and regularly reviewed. Relatives told us the management team were good at keeping them informed about their family member’s ca

This inspection took place on 15 and 17 March 2016 and was unannounced. The inspection was undertaken by two inspectors. We previously inspected the service on 12 August 2014 and the service had an overall rating as good. We brought this inspection forward due to a number of concerns that had been raised by a visiting care professional and the number of safeguarding incidents reported to the local authority by relatives.

Meadow Rose Nursing Home opened in December 2013 and has accommodation for up to 49 older people who require nursing care. There were 47 people living there at the time of our inspection.

We found that the management of the service was not robust and this affected the quality of the service people received. This was a breach of regulations.

The provider was not fulfilling their legal responsibility to keep us informed of all incidents that occurred in the home. This was a breach of regulations.

There was no 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.

Whilst people felt they were safe we found that procedures were not always followed to keep people safe from harm. Senior staff were not always aware of what action to take to ensure people were safe from harm. We found that the systems and processes were not operated effectively to ensure that when safety issues relating to people’s care were identified appropriate acknowledgment and actions were taken to keep people safe.

We found that the service did not learn from incidents, so incidents affecting the safety of people were sometimes repeated.

People could not be confident that their complaints and concerns would be listened to and the appropriate actions taken to resolve them.

We found that the majority of people that lived at the home were living with dementia care needs and the environment was not suitable to support their needs. People’s privacy and dignity was not always respected by staff.

We found there were sufficient staff available to meet the needs of people, and resources were available to increase staffing numbers as necessary.

People received their medicines as prescribed and systems were in place to ensure medicines were safely administered.

People had a choice of food and drink and were supported to maintain a healthy diet. People had access to health care professionals to ensure their health care needs were met. People’s rights to consent to care and treatment was respected by staff.

People felt staff were caring towards them and their independence was respected. A range of activities were available for people to participate in if they wished and visitors were welcomed at the service.

The action we told the provider to take can be seen at the back of the full version of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service. This was an unannounced inspection.

Meadow Rose Nursing Home opened in December 2013 and has accommodation for up to 49 older people who require nursing care. There were 26 people living at the home when we visited. We found that the home had a registered manager. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that the home followed safe recruitment practices and had appropriate policies and procedures in place to keep people safe from harm.  For example the home’s safeguarding procedures were robust and there were arrangements in place to deal with foreseeable emergencies. People were safe and their health and welfare needs were met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We saw that the provider had appropriate policies and procedures in relation to the MCA and DoLS which ensured that the home protected people’s rights to express how they wanted their care to be delivered and receive care which met their needs.

People’s health needs were met and care and support was provided by well trained staff. We saw that staff received effective support, supervision, appraisal and training which meant they had the knowledge, skills and support they needed to deliver safe and effective care.

People were appropriately supported and had sufficient food and drink to maintain a healthy diet.  We found that people living at the home had been assessed for the risks associated with poor diet and dehydration and care plans had been created for those who were identified as being at risk. Care and catering staff told us that they were aware of people’s nutritional needs including those who needed thickened fluids or fortified foods.

People living at the home and their relatives told us that the staff were kind, considerate and caring. It was apparent to us from our observations that staff were attentive, polite and sought consent before providing care and support.

Staff had a good knowledge and understanding of people’s medical and health needs but did not always know their preferences and personal histories. Care records contained important information regarding health and welfare needs, but did not always contain detailed and relevant information regarding people’s individual social needs, interests and background.

People who lived at the home told us that their call alarms were not always responded to promptly and sometimes they had to wait for assistance. Although staffing arrangements had been assessed and appeared sufficient to meet people’s needs, it was apparent that there were some difficulties that needed to be addressed to ensure that people received the care and support when they needed it. The manager of the home assured us that this concern would be dealt with as a priority.

A check of care records showed that one person had lost weight in a relatively short period of time. Although this person had been weighed regularly, there was no evidence that the weight loss had been identified and acted upon by the manager or staff at the home. There was no action plan on file to indicate that the weight loss had been responded to and referrals made to appropriate health professionals. We found that this person’s needs had not been appropriately reviewed, assessed and met.

During our observations at the home, we saw that one person was sat in a chair for a long period and was not supported by a pressure cushion. We checked this person’s care records and saw that they had been assessed as being at risk of developing pressure sores and should have been supported by a pressure cushion when sat in a chair. We found that this person was not receiving appropriate care and support when they needed it.

People told us that they were encouraged to make their views known about the care, treatment and support they received at the home. This was achieved by holding group meetings, sending out survey questionnaire forms and seeking ‘one to one’ feedback (via key workers) on a variety of topics that were important to people who lived at the home. This meant that people had regular opportunities to provide feedback about the quality of care and support they received at this home.

A check of records showed that the provider had an effective system to assess and monitor the quality of service that people received at the home on a regular basis and a system to manage and report accidents and incidents. Findings from these systems were analysed and used to make improvements.