We inspected the service on 13 November 2017. Meadowcroft Health Care Limited is a care home. 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. Meadowcroft Health Care Limited provides accommodation and personal care for up to 24 people with varying support needs including nursing and mental health care needs. Accommodation is provided in three buildings. On the day of our inspection 19 people were using the service.

At our last inspection in August 2015, the service was rated 'Good'. At this inspection we found that the service remained 'Good'.

People continued to receive a safe service. People who used the service and their relatives told us they felt safe and well cared for. Staff knew how to support people to remain safe and the registered provider had systems and processes in place to keep people safe from abuse and avoidable harm. Risks associated to people’s needs had been assessed and planned for and people were involved in these decisions. The environment including equipment was checked to ensure they were safe. There were sufficient staff available during the day but night time staffing levels and deployment required further reviewing. Safe staff recruitment checks were carried out before staff commenced employment. People received their prescribed medicines safely. Infection control measures were in place.

People continued to receive an effective service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported by staff that had received an appropriate induction and ongoing support and training. Developments were in place to improve mental health awareness training for staff. People’s nutritional needs were assessed and planned for and people received a choice of meals and drinks. Systems were in place to share information with external services and professionals when required. People received support to maintain their health. The adaptation and design of the home met people’s needs.

People continued to receive good care. People who used the service and relatives, spoke positively about the approach of staff whom they said were kind, caring and compassionate. People were involved as fully as possible in their care and treatment and staff respected their privacy and dignity. Independence was promoted and staff had a good understanding of people’s diverse needs, preferences, routines and personal histories. People were supported to access independent advocacy service when required.

People continued to receive a responsive service. People who used the service received opportunities to contribute to their assessment and reviews of their care and treatment. People’s care plans focussed on their individual needs, creating a person centred approach in the delivery of care and treatment. Further work was required to support people with identifying and achieving their future goals and aspirations. People had access to the registered provider’s complaints procedure and were confident about using this. People’s end of life wishes had been discussed with them.

The service continued to be well-led. An open and inclusive service was being developed; the registered manager had a clear vision and goal of how to continually improve the service. Staff felt listened to and supported to raise concerns and issues with the management team. People who used the service and relatives received opportunities to share their views and experience of the service. Audits were carried out and action plans put in place to address any issues which were identified.

Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have ha

We undertook this inspection to check what improvements the provider had made since our last inspection on 03 June 2013.

We found that the provider had taken action to improve the service.

People were safe and had their health and welfare needs met by staff that were properly trained and supervised and in sufficient numbers to provide a consistent level of care and support.

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant they were not all able or refused to tell us their experiences. We looked at records. We spoke with three people using the service. We visited people in the main lounge. We spoke with the regional manager, manager and five staff. We observed how staff interacted and supported people using the service.

People who used the service told us that care staff involved them in their care, treatment and support programmes. They also told us that they received input and treatment from other health care professionals when required.

People who used the service told us that there had been a lot of staff changes recently and this had impacted on the continuity of the support they were receiving to access activities in the community or smoke outside.

We found that there had been changes to the number of staff available but the manager had a programme of recruitment in place. The staff training and development had not been kept up to date and this did not ensure that the staff had the skills and knowledge they needed to undertake their role effectively.

We used a number of different methods to help us understand the experiences of people who used the service, because they had complex needs which meant they were not fully able to tell us their experiences. There were 17 people using the service. We spoke with three people who used the service, three staff, the manager and operations manager. We looked at the care records for three people.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service were protected from the risk of abuse. However, one person using the service told us that they did not always feel safe when people exhibited challenging behaviour. They said they had a key to their room and were able to lock the door if they wished.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We inspected the service on 19 August 2015. Meadowcroft is registered with the Care Quality Commission to provide accommodation for up to 20 people with varying support needs including nursing and mental health care needs. On the day of our inspection there were 17 people living at the home.

The home 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.

At the last inspection in October 2013 the provider was meeting the essential standards of quality and safety required of them.

Due to the complex needs of the people living at Meadowcroft we were unable to gather people’s views directly about the service they received. Instead we spent time observing practice, including daily routines and staff interactions. We saw staff proving safe and effective care. Staff understood their roles and responsibilities. They were confident that they could recognise and report poor or abusive practice.

Staff were very positive about the support and training they received. They told us that they had received training specific to help them meet and understand the needs of the people they supported. One staff member told us that training gave them a ‘good insight’. Everyone we spoke with demonstrated that they knew people well. They told us that care plans were detailed and helped them to offer consistent support. Staff told us that communication was a strength of the service provided. Staff working at all levels understood the need to work closely with colleagues to ensure that people received consistent support.

Staff gave examples of how people had developed new skills and gained in confidence since living at the home and this had positively impacted their quality of life.

Staff told us that by recognising certain triggers (which they all were aware of) they could redirect people and reduce likelihoods of incidents occurring.

Staff received good handover of information at the start of their shifts. This meant that they could continue activities started on previous shifts but also have a good insight into each person’s needs. One staff member told us that consistency was paying off and good communication was meaning that people were better supported to remain relaxed and calm. They told us that the reduction in the number of incidents of challenging behaviour demonstrates this. Records reflected that this reduction had happened.

People received their medicines safely and medicines were stored and recorded appropriately.

People were provided with sufficient food and drink to maintain their health and wellbeing, and the standard of food provided was good.

People were supported to receive any health care they needed and any advice provided was acted upon. Support plans to manage behaviours that challenged were detailed and enabled staff to offer effective and consistent support.

Staff treated people with respect and kindness and listened to their wishes. We saw that people’s requests for help and support were responded to.

People had opportunities to follow their individual hobbies and interests although motivation was a challenge to staff. Group activities were arranged although, again, participation was hit and miss.

People’s care needs and individual preferences were assessed and kept under review. Care and support plans were very detailed to enable staff to follow guidance enabling a consistent approach.

Information about who people could speak with if they wanted to raise a concern was available. Staff knew the complaints procedure and we saw it had been effectively used in the past.

People living at the home and the staff team had opportunities to be involved in discussions about the running of the home and felt the registered manager provided good leadership. There were systems in place to monitor the quality of the services provided.