We inspected the service on 18 June 2018. The inspection was unannounced.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Meadow View accommodates up to 20 people with a learning disability in three bungalows on the same site. On the day of our inspection, 20 people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the last inspection on 7 June 2016, the service was rated ‘Good’ overall and requires improvement within safe. This was because consideration had not been given to how certain products had been stored which may present a risk to some people, and some of the beds may not have been suitable. At this inspection, improvements had been made in these areas and we found the evidence continued to support the rating of Good. 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.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. People were protected against the risk of abuse, as checks were made to confirm staff were of good character and suitable to work in a care environment. There were sufficient staff available to support people. Medicines were managed safely and people were supported to take their medicine as prescribed.

Care continued to be effective as staff had knowledge about people’s care and support needs to enable this to be provided in a safe way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The provider understood their responsibility to ensure people could make decisions about their care or be supported by others to make decisions in their best interests. Staff received training to enable them to continue to meet people’s needs and preferences. People were supported with their dietary needs and received care to maintain good health.

People were supported by staff who were caring and kind and who knew their needs, preferences and what was important to them. Staff respected people’s privacy and dignity, encouraged people with making choices, and promoted independence. Relatives and health and care professionals were involved with how care and support needed to be provided.

People had opportunities to develop and maintain their hobbies and interests, both at home and in the local community. There were processes in place for people to raise any complaints and express their views and opinions about the service provided. There were systems in place to monitor the quality of the service and enable the provider to drive improvement. Relatives and staff were positive about the management team. The provider had an on going action plan that showed how the service was continually improving.

Ash Lodge (Meadowview) is a residential and nursing home which provides care and support for up to twenty people with a learning disability. The home provides support in three bungalows which are connected by internal corridors.

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 and associated Regulations about how the service is run.

People and their relatives were happy with the care and support provided and all felt their needs were being met. People were treated with kindness and respect and told us they felt safe using the service. Relatives we spoke with confirmed this. People were involved in the planning and delivery of their care and had opportunities to be involved in choices about their everyday living arrangements. Care plans were updated regularly so, as people’s needs changed, they were still being cared for in an appropriate way.

We saw people were well supported by a staff team who understood their individual needs. We observed that staff were friendly, kind and treated people with respect. Staff we spoke with had a good understanding of people’s needs.

Staff received a thorough induction and felt they had received appropriate training. There were sufficient staff on duty to prevent avoidable harm to people and provide the care needs they required on a day to day basis. However, people told us they felt there were insufficient staff on duty to take people on trips outside the home as often as they would wish.

Safeguarding procedures to ensure any allegations of abuse were reported and referred to the appropriate authority. The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008 had been met. Medicines were safely stored and administered and people received their medicines as prescribed.

The home had a warm and friendly atmosphere and there were effective systems in place to assess and monitor the quality of the service provided to people. This included gathering the views of people who used the service, their relatives and staff.

Our inspection team was made up of a lead inspector. The summary is based on our observations during the inspection, speaking with relatives, the staff supporting them and from looking at the records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Staff had received training in safeguarding and understood how to safeguard the people they supported. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risk to people and helped the service to continually improve. People were cared for in a service that was safe, clean and hygienic.

Risk assessments were in place in individual care plans in relation to activities of daily living. Staff personnel records contained all the information required which meant that the provider could demonstrate that the staff employed to work in the home were suitable and had the skills and experience needed to support the people living there. Medicines were stored and administered safely and the risk of error was reduced because staff were trained and followed agreed protocols.

Is the service effective?

We were unable to speak with people who used the service because they had complex needs. This meant that most people were not able to tell us their experiences but we observed during the inspection that people appeared to be happy with the care they received. Relatives we spoke with told us that they thought that people were well looked after by the staff and they believed that their needs were met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. One relative told us, "I know she's looked after". Staff had received training to meet the needs of the people living in the home.

People's health and care needs were assessed and where possible relatives were involved in writing their plans of care. Specialist dietary, moving and handling and equipment needs had been identified in care plans where required. People's needs were taken into consideration in the layout and design of the service enabling staff to support people in wheelchairs to move around freely. There were different areas throughout the building where people could spend time including a recently refurbished sensory room with soft cushions, music and lighting.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and communicated continuously with people using the service in a way which was appropriate and individual for each person. One staff member we spoke with, told us about a person living in the service, "I know her as a whole person, her mental health and emotional needs are just as important". We saw that people were supported to do things at their own pace and meals were served at different times so that people were not rushed to eat their food. One visitor we spoke with told us, "The staff are always nice to me".

Is the service responsive?

People regularly completed a range of activities inside and outside the service. The home supported people to attend local activities within the community and people were supported to go out on a variety of outings. The service employed an activities manager who worked with staff and people who lived in the service to better understand their preferences and the range of activities that they enjoyed. People's needs were regularly reviewed and services put in place to improve their quality of life at Ash Lodge.

Is the service well-led?

The service worked well with other agencies and services to ensure that people received their care in a joined up way. The service had a quality assurance system which included planned audits. Records seen by us showed that identified shortfalls were addressed promptly and as a result the service was constantly improving. Staff were well supported through training, supervision and there were regular staff meetings where staff were supported to share ideas and their views.

On the two days of this inspection there were 13 people using this service. We used a number of different methods to help us understand people's experiences because they had complex needs. This meant that most of them were not able to tell us their experiences. We spoke with two people's relatives and we observed people’s activities, and how staff interacted with them, in one of the two bungalows. We spoke with the acting manager and with three members of staff. We also read the care plans of two people, to find out more information.

The relatives we spoke with said that people’s privacy and dignity was respected. One relative said, “Only female staff are involved in [the person’s] personal care…doors are kept shut.” People were supported to maintain and improve their independence. One relative told us, “Staff try to let [the person] eat themselves but help when [the person] struggles.” Staff respected people’s personal preferences.

Relatives told us that people had a choice of food and drink and their personal tastes were catered for. We noted, from reading records and our observations, that people’s nutritional needs were being met.

Relatives thought that staff were well trained to meet people’s needs and records confirmed that most staff were up to date with relevant training.

Relatives were asked for their views, and comments that they made were acted on. Systems were in place to review and manage the risks potentially affecting people.

Although Ash Lodge is registered for thirteen people, only twelve people were living in the home at the time of our inspection

A number of people who use the services were out at day care facilities.

Most people living in the home were unable to share their experiences with us. One person was able to express their satisfaction with the care and support they receive.

We spoke to the parents of one person. They told us that they are very thankful for the standard of care their relative received and that they felt that the home provided a true ‘home’ environment. They also told us that the staff were ‘exceptional’ stating that when their relative was recently hospitalised, as they were elderly, staff had ‘ stayed at the hospital to support their relative when they could not be there'.

We observed members of staff talking to people who use the services and informing them of what care or treatment they needed and how it was to be undertaken.

People who use the services were consulted about their general environment, such as the type of music being played. Staff continually monitored the temperament of people who use the services and watched for signs of disagreement or increased agitation which may display their dislike of what is happening in their immediate environment.

In view of the proposed changes to the provider’s registration two new managers have been appointed to manage the locations to be known as Ash Lodge and Rowan Lodge. The manager’s were submitting applications for registration as registered manager.

Most people living in the home were unable to share their experiences with us. People able to express their views said they were happy with the care and support they received, and felt their needs were being met. People are given information to help them make choices and decisions about their lives, as staff explain things in a way they can understand.

One person told us ''I like living here as staff look after us well’'. Another person said ‘’They enjoyed a beer and going out’’.

People felt that staff respected their privacy, dignity and independence. They also felt listened to and able to express their views and raise any concerns with staff if they were unhappy.

Relatives we spoke with praised the care and support their family member received. They felt that staff are caring and have a good understanding and respond to individuals needs. Two relatives told us ‘’There has been a lot of improvements to the care and service; people are given choices and there are more activities to occupy their day’’.