Meadows Edge Care Home 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 home is registered to provide accommodation for up to 45 older people and people living with dementia. There were 37 people living in the home at the time of our inspection.

We inspected the home on 25 October 2018. The inspection was unannounced.

There was a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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 our last inspection we found shortfalls in the auditing of service quality. As a result, the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Reflecting this and other concerns, the overall rating of the home was Requires Improvement.

At this inspection we were pleased to find the breach of regulations had been addressed. Some shortfalls in the management of people’s medicines aside, service quality in all other areas had also improved and the overall rating is now Good.

Staff worked alongside local health and social care services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control although action was required to ensure the management of people’s medicines was consistently safe.

Staff worked together in a mutually supportive way and communicated effectively, internally and externally. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. There were sufficient staff to meet people’s care and support needs without rushing. Staff provided end of life care in a sensitive and person-centred way.

Staff were kind and attentive in their approach. People told us they enjoyed the food and drink provided. There was a programme of regular activities and events to provide people with physical and mental stimulation.

In her short time in post the registered manager had won the trust and respect of her team. Throughout our inspection she demonstrated an admirably open and responsive approach which set the cultural tone in the home. A range of audits was in place to monitor the quality and safety of service provision. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. Systems were in place to promote organisational learning from significant incidents and events. The number of formal complaints was reducing and any informal concerns were handled effectively. There was an ongoing programme of improvement to the physical environment and facilities in the home.

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. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted a DoLS authorisation for 11 people living in the home and was waiting for a further 5 applications to be assessed by the local authority. Staff understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Senior staff documented decisions that had been made as being in people’s best interests.

We carried out this unannounced inspection on 3 July 2017.

Meadows Edge Care Home can provide accommodation, nursing and personal care for 45 older people and people who live with dementia. There were 39 people living in the service at the time of our inspection of whom 23 needed nursing care.

The service employed both nurses and care workers. In our report when we speak about both of these groups we refer to them as being, ‘care staff’.

The service was run by a company who was the registered provider. There was an acting manager who had taken up their post four weeks before our inspection visit and who had applied to us to become the registered manager. In our report we refer to this person as being, ‘the 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. In this report when we speak about the company we refer to them as being, ‘the registered person’.

At our inspection on 14 July 2016 we found that improvements needed to be made to ensure that people who lived in the service fully benefited from it being safe, effective and well led. The improvements needed to make the service safe included putting right defects in the accommodation and addressing a security issue. In relation to developing the service’s effectiveness we found that people who lived with dementia needed more support to find their way around their home. We also concluded that parts of the catering arrangements were strengthened so that meals were appetising and hot. In addition, we found that the service was not always well led as robust action had not been taken to address the concerns we had noted.

At this inspection we found that only some of these shortfalls had been addressed and we also identified some additional concerns. We found one breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because records did not show that suitable arrangements had not been made to fully involve people in the development of the service. In addition, the records we were shown did not assure us that robust quality checks had not always been completed. You can see what action we have told the registered person to take at the end of the full version of this report.

Our other findings at this inspection are as follows. People had not been fully helped to avoid preventable accidents and parts of the accommodation were not clean. Medicines were not consistently being managed in the right way. However, there were enough care staff on duty and background checks had been completed before new care staff were employed. Care staff knew how to respond to any concerns that might arise so that people were kept safe from abuse.

Although some care staff had not received all of the training the registered person considered to be necessary they knew how to care for people in the right way. Most people enjoyed their meals but some people did not promptly receive the help they needed to eat their meals. Suitable steps had not always been taken to fully promote positive outcomes for people who lived with dementia. However, nurses ensured that people received all of the healthcare they needed.

People were helped to make decisions for themselves whenever possible. When people lacked mental capacity the registered person and the manager had ensured that decisions were taken in people’s best interests. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in ord

This was an unannounced inspection carried out on 14 July 2016.

Meadows Edge Care Home can provide accommodation, nursing and personal care for 40 older people and people who live with dementia. There were 39 people living in the service at the time of our inspection.

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 2008 and associated Regulations about how the service is run.

At our inspection on 2 July 2015 there were two breaches of legal requirements. We found that medicines were not always safely managed and quality checks had not been robustly completed. After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 29 February 2016. This delayed timescale was due to an administrative error by CQC.

At the present inspection we found that the improvements necessary to meet the two legal requirements had been made. However, we also concluded that further improvements were needed to the way some quality checks were completed. This was necessary to ensure that people received the facilities and services they needed

Parts of the accommodation were not clean and hygienic and people had not always been helped to avoid the risk of accidents. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse and medicines were managed safely. There were enough staff on duty to care for people and background checks had been completed before new staff were appointed.

Some areas of the accommodation were not designed and adapted to meet people's individual needs. Although people had been assisted to eat and drink enough parts of the catering arrangements did not support people to enjoy their meals. Staff had received training and guidance and they knew how to care for people in the right way including helping them to receive any healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (MCA) and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. The registered manager had taken the necessary steps to ensure that people’s legal rights were protected.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and there was provision for confidential information to be kept private.

People had been consulted about the care they wanted to receive and they had been given all of the practical assistance they needed. People who lived with dementia and who could become distressed received the individual support and reassurance they needed. People were given opportunities to pursue their hobbies and interests and there was a system for resolving complaints.

Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

The inspection took place on 02 June 2015 and was unannounced.

Meadows Edge is registered to provide accommodation and personal care for up to 40 older people or people living with a dementia. There were 38 people living at the service on the day of our inspection.

The service has had no registered manager for 12 months. 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 our last inspection in May 2014 we asked the registered provider to take action to make improvements to the care and welfare of people, medicines management, supporting staff, safe storage of records and how they ensured the quality of the service was being maintained. The provider did not send us an action plan to tell us how these improvements would be made. On this inspection we found that the registered provider had not made all of the required improvements.

At this inspection we found that the provider was not meeting our legal requirements for, medicines and governance. You can see what action we told the registered provider to take at the back of the full version of the report.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves or others. One person living at the service had their freedom lawfully restricted under a DoLS authorisation.

Staff understood safeguarding issues and knew how to recognise and report any concerns in order to keep people safe from harm. However, people’s safety was not always maintained, because staff did not always follow safe medicine administration and storage procedures and people were at risk of not receiving their medicine. Also, the provider did not always ensure that the service was consistently clean and that safe infection control procedures were adhered to. Furthermore, people were at risk of using equipment that was not clean or not fit for purpose.

People were cared for by staff who were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities. People had their healthcare needs identified and were able to access healthcare professionals such as their GP or psychiatrist. Staff knew how to access specialist professional help when needed.

People and their relatives told us that staff were kind and caring and we saw some examples of good care practice. However, we found that people were not always treated with dignity and respect. People were not always enabled to follow their hobbies and pastimes and people were not supported to maintain their independence.

The registered provider did not have systems in place to monitor the effectiveness of the care and treatment people received.

The home can accommodate up to 40 older people or people living with dementia. The home has a large open plan lounge and dining room with a conservatory off the lounge. There is also a small quite lounge. Several rooms have ensuite facilities. The home is well provided with toilets. However there is only one functional bath and there are no showers that were suitable for people to use.

We saw the home had achieved the Gold Standard Framework for end of life care. This is a framework that guides staff on how to give a person at the end of their life a pain free and peaceful death.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI). SOFI helps us to understand people’s perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their visitors and the staff supporting them. We also looked at three care records.

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

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We asked care staff if the home was a safe place for people to live. They told us it was a safe place to live. One member of care staff said, “The home is safe, we have alarms on the stairs, on the fire doors and buzzers and sensor mats.”

We found some people may be put at an infection control risk as hoist slings and wheelchairs were shared and not cleaned between use.

We found some discrepancies with the safe management of medications, such as the safe administration, storage and disposal of controlled drugs and topical applications such as skin creams.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift.

We found staff attended training courses to meet the individual needs of people such as people living with dementia or people who are at the end of their life.

Is the service caring?

We observed staff speak with people in a kind and caring way and give them time to answer questions. We saw no one was rushed and staff helped people to do things in their own time.

We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent.

We asked people if they felt well cared for. One person told us, I’m well looked after, I get help to do things. They all know what condition you are in and what to do.” Another person told us, “I am well enough looked after. Staff look after me.”

One visitor told us, “The care is very good, he is looked after really well, staff are really good to XX.”

Staff told us there was not enough staff to meet people’s needs. One member of staff told us, “The demands of the job are high…I am not satisfied I can give full care.”

Is the service responsive?

We saw recorded in the care files that when a person’s condition changed or deteriorated care staff called in the appropriate health professionals such as the person’s GP or district nurse. We spoke with a relative whose comments supported this. They told us, “Staff ring me straight away and tell me when XX is unwell. They tell me what they have done; rang the doctor and called an ambulance.”

We saw when care workers raised concerns about people's health and social care needs the provider contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

During our inspection the manager was on leave and the deputy manager was working permanent night duty. This meant there were no senior staff members on duty during the day. We spoke with newly appointed member of staff who told us they had not received an induction and did not work under supervision. We observed this staff member working on their own.

We spoke with staff who told us the manager was approachable. One staff member said, “Her door is always open.”

We spoke with a relative who told us, “I can go to XX at any time, if I need to talk to her I can just pop in.”

When we visited Meadows Edge Care Home 36 people were living there. We spoke with 11 people as well as one of the owners, the manager and members of nursing and care staff, two relatives and a visiting social worker.

We looked at records and observed how staff supported the people living in the home.

Staff spoke about making sure people gave them their consent to help them get up in the mornings or have their personal hygiene needs met. However, one member of staff told us some people were got up without their consent being obtained.

People told us they were happy living in the home. One person said, ”I’m well satisfied with the care and the girls are very good.”

We found the home’s medicine policy was not being adhered to in relation to the administration of controlled drugs.

There were enough skilled and qualified staff to meet the needs of people in the home. Nursing staff were overseeing the care needs of people requiring personal care as well as those needing nursing care. This could impact on the amount of time nurses had to meet the needs of people who required nursing care.

On this visit the manager and deputy manager observed lunchtime with the inspector. Lunch was served in the open plan lounge/dining room. All care staff on duty were available to assist people at lunchtime.

People were offered a choice of fruit squashes with their meal. One person asked for a cup of tea and this was made for them.

We saw staff sat to assist people who required support to eat their meals. People were not rushed and lunchtime was a positive experience.

We spoke with three members of staff; two support workers and a registered nurse. They told us mealtimes and nutrition had improved since our last visit.

As part of our inspection we spoke with several people who use the service, visiting relatives and a selection of staff members.

During our visit to Meadows Edge Care Home on 18 September 2012 people told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. One person told us, “My bedroom is very nice and it’s clean.” Another person said, “I have a nice clean room and the staff are lovely.”

They told us they were happy living there and were well looked after. They told us they felt safe and care staff understood their needs. One person told us, “I feel very safe.” Another person said, “This is the best home I’ve been in.”

Some of the people living in the home were unable to talk with us about their experience of living in the home. We have used a Short Observational Framework for Inspection (SOFI 2). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

There were 31 people living in the home on the day of our visit and 20 people had a diagnosis of dementia.

On the day we visited there were 32 people living at Meadows Edge. 15 people were receiving nursing care, two were receiving respite care and the remaining 15 were receiving personal care. Twenty two people at Meadows Edge had dementia.

Some of the people that we spoke with were unable to answer direct questions about their experience of the home and whether they felt involved and respected. As a result we spent time in communal areas to help us gain a view on the experiences of people.

One person told us the food was good and that they were, “Happy with the food,” while another told us, “The food is ok but we are not offered a choice.”

People told us the staff were kind, one person said, ”The staff are all good.” While another person described the home as a lovely place and said, “The nurses are good.”

During our visit we saw that people were not always able to make choices about the care they received. We also saw the home environment was not as clean as it should have been. Since the visit the matron contacted us and told us they had taken steps to address the cleanliness of the home.