The inspection was carried out on 21 August 2018 and was unannounced. This meant the provider and staff did not know we would be visiting. We also returned for a second day on 4 September 2018.

Meadow View is a 'care home.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was previously inspected in October 2017 and was rated requires improvement. We found there were two breaches of the regulations. These referred to risk assessments, management of medicines and the systems in place to monitor the quality of the service. We asked the provider to complete an improvement plan to show what they would do and by when, to improve the key questions of Safe, Responsive and Well-Led.

Meadow View is a care home for older people who require personal and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into three units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

The registered manager in post at our last inspection had recently left. The manager on the days of our inspection was registered at another service and was providing managerial support whilst the registered provider was recruiting a new manager. The recruitment had been successful and the new manager would be starting shortly and beginning the process of registering with CQC. A registered manager is a person who has registered with CQC 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 this inspection, we found improvements in risk assessment and medicines sufficient to meet the previously breached regulation for safe care and treatment. However, we identified omissions and poor practice relating to consent, which the processes for governance had not identified. The registered provider informed us that this would be rectified in the immediate future with the introduction of a revised quality assurance system.

People were protected from harm by staff who were trained to recognise signs of abuse. Where risks to people were identified, staff acted to minimise them. There were enough staff to meet people's needs and staff were recruited safely. People were protected from the risk of infection by robust prevention and control measures. Analysis and reflective practice meant lessons were learned when things went wrong. People told us they felt safe living at Meadow View. Comments included; "Yes, I feel safe here. They (staff) look after me," and “Staff are kind, I'm safe enough.” The atmosphere was relaxed and friendly. Staff supported people to move around and encouraged people to be independent.

Medicines were given to people as prescribed and disposed of safely by properly trained staff. Auditing processes were effective in identifying and addressing any medicines shortfalls. The storage, recording and stock control was robust and in line with guidance.

There was a stable staff team in place who knew people well. New staff were required to complete an induction and initial training. Training was regularly refreshed. Supervisions, annual appraisals and staff meetings enabled staff to raise any issues or suggestions.

Processes to assess people's mental capacity and to ensure decisions were made in people's best interest were not always recorded appropriately.

People's needs were assessed before they moved into the service. These needs were met by staff who had the skills and knowledge to deliver effective support. People were supported to eat and drink enough to have a balanced diet, including those with associated health needs. People were

The inspection was carried out 9 October 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. The service was previously inspected in February 2017 and was rated Inadequate and placed in special measures, with five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last inspections, by selecting the 'all reports' link for 'Meadow View' on our website at www.cqc.org.uk.

At this inspection we found significant improvements. The new registered manager had followed the action plan submitted following our last inspection. Although at this inspection we identified some minor issues and systems still required embedding into practice, the service has been removed form special measures.

The service had a registered manager. 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.

Meadow View is a care home for older people who require personal and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into three units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

The provider had safeguarding procedures and staff were aware of these procedures. Staff had received training in the topic and people were protected from abuse.

We found there were sufficient staff on duty to meet people’s needs but deployment of staff could be improved.

Risks to people had been identified but we found these were not always followed. Systems were in place for safe management of medicines. However, we identified a number of errors that meant systems had not always been followed to ensure people received medications as prescribed.

The service was well maintained and clean.

We found that the recruitment of staff was robust and thorough. Staff supervision took place and staff told us they felt supported by the new registered manager. Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Most staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, we found two people who were admitted urgently for respite care had not been assessed and met the criteria for an urgent DoLS application; this was addressed by the peripatetic manager during the inspection.

A well balanced diet that met people’s nutritional needs was provided.

We found staff approached people in a kindly manner. They were kind, considerate and caring. We saw staff respected people and maintained their dignity.

Care records did not always reflect people current needs. We observed staff did not always follow care plans which could put people at risk.

People who used the service and their relatives we spoke with were aware of how to raise any concerns or complaints and felt listened to.

There were processes in place to monitor the quality and safety of the service. However, these were new and had not yet been reviewed. We found issues that had not been identified by the systems and they were also not fully embedded.

There was a culture of openness and transparency promoted by the registered manager. Staff told us they were well supported.

We found two continued breaches 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 end of this report.

This inspection took place on 28 February 2017. The home was previously inspected in April 2016, and at the time was meeting all regulations assessed during the inspection, but was overall rated requires improvement. Previously the service had been rated Inadequate. We brought this inspection forward due to concerns.

Meadow View is a care home providing accommodation for older people who require personal care and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into two units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

There was not a registered manager for the service in post at the time of 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, there was a new manager who had commenced in post on 13 February 2017.

The provider had systems in place to protect people from abuse and staff were aware of the procedures to follow. However, we identified these had not always been followed. People had not been protected and we made safeguarding referrals to the local authority following our inspection.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not always followed.

We found there were adequate staff on duty to be able to meet people’s needs. However, the ineffective deployment and direction to staff meant people’s needs were not always met. We also found a high use of agency staff.

We saw that appropriate pre-employment checks had been carried out to ensure staff were of good character and suitable to work with vulnerable adults.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However we found it was not being carried out in practice and conditions were not being met.

A well balanced diet that met people’s nutritional needs was provided. However, we found people were not always supported appropriately to be able to eat and drink. We found best practice guidance was not always followed for people living with dementia in respect of aids for eating and adaptations to the environment.

Staff had undertaken training to give them the skills and knowledge to carry out their roles. However, as we found staff not always following best practice it was not clear if the training had been effective. The new manager had identified additional training was required and had booked more training for staff to attend.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. Some complaints had been raised and appropriate action had not always been taken. The new manager was aware of the need to take any concerns seriously and follow the appropriate procedure so people were listened to.

There were processes in place to monitor the quality and safety of the service. However, we saw these had not always been followed and the processes had not identified issues identified at the inspection.

We saw the process in place to ensure incidents were reported appropriately to the Care Quality Commission had not been followed and incidents had not been notified.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will

We carried out an unannounced comprehensive inspection of this service on May 2015 in which a breach of the legal requirements was found. This was because people who used the service, and others, were not protected against the risks associated with inadequate infection, prevention and control measures.

After the last comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We carried out this comprehensive inspection to check that they had followed their plan and to confirm that they were meeting all of the legal requirements.

This inspection was carried out on 13 and 19 April 2016 and it was unannounced on the first day. This was the third rated inspection for this service, which had previously been rated inadequate, and at the last inspection in May 2015 had been rated requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Meadow View’ on our website at www.cqc.org.uk’

Meadow View is a care home providing accommodation for older people who require personal care and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors. The downstairs unit provided care and support for people living with dementia. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham. At the time of this inspection there were 38 people using the service.

The service did not have a registered manager in post. However, there was a new manager who had commenced employment at the service six weeks prior to this 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.

We found improvements had taken place to the cleanliness of the home so that people who used the service were protected against the risks associated with inadequate infection, prevention and control measures. The home was being decorated throughout at the time of this inspection. The hospitality manager told us that new chairs had also been ordered which would improve the furnishings in lounge areas.

There were robust recruitment procedures in place, staff had received formal supervision. Qualified nursing staff had also received a monthly clinical supervision. Annual appraisals had been carried out before the new manager had taken up her position. These ensured development and training to support staff to fulfil their roles and responsibilities was identified.

Staff told us they felt supported and they could raise any concerns with the manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it

The manager was aware of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. We found some improvements were still required to ensure mental capacity assessments and best interest decision records were more detailed and decision specific.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. The home involved dieticians and tissue viability nurses to support people’s health and wellbeing.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. However, on the first day of this inspection we found the meal time experience could still be improved for people who used the service. On

We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2014 in which breaches of the legal requirements were found. This was because people were not protected against the risks associated with the unsafe use and management of medicines, did not receive care or treatment in accordance with their wishes and there was not always enough staff on duty to meet people’s needs. During that inspection we also issued two warning notices for beaches in relation to regulations 9 (care and welfare) and 10 (assessing and monitoring the quality of the service provision) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had made the improvements in regard to the warning notices issued. We did not look at other breaches at this inspection as the provider was still in the process of implementing their action plan and embedding these improvements into practice.

This report only covers our findings in relation to the two warning notices served in respect of care and welfare and quality monitoring. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Meadow View’ on our website at www.cqc.org.uk.

Meadow View is a care home providing accommodation for older people who require personal care and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into three units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

There was a new manager at the time of our comprehensive inspection in November 2014 and they have now registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

People’s needs had been assessed and care plans developed. Care plans had been reviewed since our last inspection. From our observations, talking to staff and people who used the service we found these were followed and people’s needs were being met. Although the new practices still needed to be monitored closely to ensure they were fully embedded into practice.

The registered manager had introduced new monitoring systems to ensure the quality of the service provision was monitored. We saw audits had been regularly completed including infection control, medicine management, accidents and incidents and care plans. The regional manager had also completed monitoring of the service. We found action plans in place to ensure any issues identified were addressed and resolved.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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.

We found inadequate monitoring systems were in place to record people’s food and fluid intake, when they had been identified as at risk of poor nutritional intake. This did not ensure the risks to people were managed.

Is the service effective?

People’s health and care needs were reviewed, and they were involved in the reviews.

Is the service caring?

Due to the complex needs of the some of the people who used the service we were unable to gain some people’s views. Therefore we used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and visitors, and checking records.

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

We spent time in the dining room observing during lunch. We saw the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were given choices and their preferences were respected. However there was a long wait for the meal to arrive. One person told us, “It varies every day it should be 12.15 but it comes anytime between 12 and 13.15hrs.”

Relatives we spoke with told us they were happy with the home, and that they had been involved in planning their relative’s care. They praised the activities available for their relatives to participate in.

We observed staff giving appropriate sensitive support when required. We observed that staff made the effort to communicate with people living with dementia while at their level physically for example kneeling down beside their chair to talk to them, or sitting next to their bed, rather than standing over them.

Is the service responsive?

The provider had employed a peripatetic manager to oversee the service until a permanent manager could be recruited. The peripatetic manager is applying to register with CQC. The provider has made a number of improvements over the last few weeks since our visit in March 2014. The choice of meals and variety of food had completely changed. The menus had been drawn up with the involvement of the people who used the service. The cook told us that they were still work in progress as she was trying different meals to determine what people preferred. One person told us, “The meals changed overnight following our last visit and they have improved tremendously.”

The environmental works identified at our visit in january 2014 were in progress at this visit. The provider told us they were on target to meet the dates of the action plan submitted to CQC.

Is the service well-led?

The provider has provided a manager and a new deputy to oversee the service. The deputy is supernumerary so is able to look at improvements required and review and update all plans of care.

Since our last visit the acting manager appointed in October 2013 had left. Two nurses and a senior care worker had also left and another nurse had handed in her resignation.

The provider had a registered manager from another service overseeing the home for three days a week and the operations manager was also visiting regularly.

People's needs were assessed and care and treatment was planned in line with their individual assessed needs. However care was not always delivered in line with their individual needs.

We observed activities ongoing during our visit. People were engaging in the activity and enjoying it. We observed people laughing and joking together during activities.

We observed lunch. We found the experience for people who used the service was extremely poor and people’s nutritional needs were not met.

There was little choice and the presentation of food was unappetising. People were sat for over an hour and a half waiting for lunch to be served.

One person said “I think you have forgotten to put me any meat on my plate.” But the cook did not acknowledge the persons comment.

Relatives told us, “The lunch is the best meal, you ought to see the dreadful sandwiches they dish up at tea time.” Another relative said, “The food is like slop and never any choices.”

People we spoke with said most care staff were very good they worked very hard and were always busy. One person said, “They try their hardest but they are always very busy.”

At our visit we identified that the registered manager had moved to another service. An acting manager had been appointed in November 2013. The acting manager told us they were in the process of registering with the Care Quality Commission.

People we spoke with told us they were well looked after. They told us the staff were good and looked after them. One relative told us, “The staff are amazing they look after my relative and everyone extremely well, they understand the needs of the residents.”

People also told us that staff treated them with respect, listened to them, and gave them choices.

We found people were not always cared for in a clean, well maintained environment. Infection control procedures were not always followed. The new acting manager had identified the need for improvement.

We found there was an effective recruitment and selection process in place. Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed. Staff we spoke with told us the training was good.

There was an effective system to regularly assess and monitor the quality of service that people received. However some of the infection control quality monitoring had not identified shortfalls that required action.

People told us they were happy living at Meadow View. The service had recently had a major redecoration throughout and people told us they liked the new decor and one person told us, "I really like my bedroom it is lovely."

Staff told us they felt proud to work at the home now it had been redecorated as it had been in a poor state. We observed the service was well maintained and the manager had employed a gardener to also improve the grounds.

People we spoke with said staff worked very hard and were pleasant. We were also told that staff respected people’s choices and supported them to be independent as possible.

People we spoke with told us they did not get out as much as they liked. They said the garden was very overgrown and in a mess so was not a pleasant place to sit out

Some of the comments we received were;

“Staff are nice they look after me.”

“My room is very nice, always kept clean.”

“I am well looked after.”

“Any complaints or concerns I have raised have been promptly dealt with.”

People who lived at Meadow View said that staff members worked very hard. They told us that there have had been different managers in charge of the home in the last few years and as they got to know each manager they were moved on.

One person said, “It must be very unsettling for the staff who work here.”

They said the environment looked tired and that they had been informed that the “home may be getting a face lift soon”.

Two people commented about the lack of variety of meals served at the home.

People using the service said they chose to live at Meadow View since they used to live locally. They also explained that the home was within easy reach for their family members and friends to visit.

Relatives said there had been several changes of manager at the home. They said that these changes had made them and the staff working at the home unsettled. They told us this had contributed to some of the staff leaving. They also said most days there was insufficient staff to care for people living at the home. However, they insisted that the staff worked very hard and they would like more care staff on duty each day.

Five people living at the home and three relatives said activities were organised by the activities co-ordinator. They said the people would benefit by going out on short trips. They suggested the local garden centre, the park or a trip around the village on a mini bus. One relative said not all the people living at the home were able to benefit from the activities. Another said the activities co-ordinator should work weekends and evening to be more useful. They told us that people were bored watching TV. They also said the care staff did not have time to take part in individual’s recreational activities.

We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2014 in which breaches of the legal requirements were found. This was because people were not protected against the risks associated with the unsafe use and management of medicines did not receive care or treatment in accordance with their wishes and there was not always enough staff on duty to meet people’s needs. During that inspection we also issued two warning notices for beaches in relation to regulations 9 (care and welfare) and 10 (assessing and monitoring the quality of the service provision) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook a focused inspection on 26 March 2015 to check that they had made the improvements in regard to the warning notices issued. We did not look at other breaches at that inspection as the provider was still in the process of implementing their action plan and embedding these improvements into practice. At the focused inspection we found that action had been taken to improve the responsiveness and the management of the service.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Meadow View’ on our website at www.cqc.org.uk’

Meadow View is a care home providing accommodation for older people who require personal care and nursing care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 48 people over two floors, which is divided into three units. The floors are accessed by a passenger lift. The service is situated in Kilnhurst near Rotherham.

There was a new manager at the time of our comprehensive inspection in November 2014 and they have now registered. 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.

We carried out this comprehensive inspection on the 12 and 14 May 2015, we found that the provider had followed their plan which they had told us would be completed by the 30 March 2015. We found that improvements had been implemented and legal requirements in relation to the breaches we had identified at our inspection in November 2014 had been met.

People were kept safe at the home. We found that staff we spoke with had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make some or all decisions about their care.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms, so appropriate referrals to health professionals could be made. The home involved dieticians and tissue viability nurses to support people’s health and wellbeing. However we found there was not always enough stimulation or activities to meet people’s social needs.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. However, the meal time experience could still be improved for people who used the service.

We found staff approached people in a kind and caring way which encouraged people to express how and when they needed support. People we spoke with told us that they were encouraged to make decisions about their care and how staff were to support them to meet their needs.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. We found new systems had been introduced and regular checks were being carried out.

There were robust recruitment procedures in place, staff had received formal supervision. Qualified nursing staff had also received a monthly clinical supervision. Annual appraisals had been scheduled. These ensured development and training to support staff to fulfil their roles and responsibilities was identified. We found generally there were enough staff to meet people’s needs.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it

The provider had introduced new systems to monitor the quality of the service provided. We saw these were more effective. Since our focused inspection in March 2015 we found these systems had been further embedded into practice and were sustainable.