We undertook a comprehensive inspection on 09 and 10 April 2018. The inspection was unannounced.

Meadow Sands 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.

The service is registered to provide accommodation for up to 26 older people. There were 23 people living in the service during our inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had been appointed to post since our last inspection.

When we inspected the service in January 2017 the service was rated requires improvement and was in breach of regulation 12 safe care and treatment and regulation 17 good governance. We undertook a focussed inspection of the service in August 2017 to find out if the provider had made improvements. The registered manager provided us with an action plan that showed that the required improvements had been made.

On this inspection we found that the service had made and sustained the required improvements, and was now rated good.

Systems and processes were in place to keep people safe from the risk of harm and abuse. People had their medicines administered safely by trained and competent staff. The service was clean and staff adhered to safe infection control practices.

People had their care needs assessed and their care was planned in line with up to date guidance and legislation. There were sufficient staff to care for a person's individual needs and staff were trained appropriately. People were provided with a balanced and nutritious diet and staff sought access to a range of healthcare services. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were cared for by kind, caring and compassionate staff. People and staff had a good relationship and the service had a homely atmosphere. People were cared for as unique individuals and their privacy and dignity were respected.

Staff supported people to spend their time as they wished. People had an advanced care plan to protect their wishes at the end of their life to achieve a comfortable and pain free death.

People spoke highly of the care they received and the attitude of staff. Staff enjoyed working at the service and were proud of their achievements. The provider had a robust approach to monitoring the quality of the care people receive. The registered manager had built a good relationship with key organisations and the local community. The registered manager was proactive and innovative and had introduced improvements to the service.

People who live in the service and staff have a voice and are supported to give their feedback on the service.

This was an unannounced inspection carried out on 29 August 2017.

Meadows Sands Care Home can provide accommodation and personal care for 26 older people and people who live with dementia. There were 20 older people residing in the service at the time of our inspection, two of whom lived with dementia.

There was a registered manager but they were not present in the service and were due to finish their employment in the near future. In their absence the service was being overseen by the deputy 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. The service was run by a company that had two directors. In our report we refer to the company as being, ‘the registered person’.

We carried out an unannounced comprehensive inspection of this service on 11 January 2017 when we found that there were two breaches of legal requirements. This was because the registered person had not taken sufficient steps that ensure that all areas of the accommodation were clean, suitable for the purpose for which they were being used and properly maintained. In addition, the registered persons had not sought and acted on feedback from relevant persons about their experience of using the service. Furthermore, they had not established robust quality checks and this shortfall had contributed to the issues noted above not being quickly addressed.

After our inspection of 11 January 2017 the registered person wrote to us to say what improvements they intended to make in order to meet the legal requirements in relation to the breaches. They said that a significant number of improvements had been made to the accommodation and that more were planned. They also said that new arrangements had been introduced to receive feedback about the service and that more detailed quality checks were being completed.

This report only covers our findings in relation to the action taken by the registered person to meet the breaches of legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Accredited Care Limited on our website at www.cqc.org.uk

At the present inspection, we found that the registered person had made a large number of improvements to the accommodation. However, we noted that further developments were still needed. These were necessary to ensure that people were provided with accommodation that was fully properly maintained and suitable for the purpose for which it was being used. In addition, we found that the registered person had introduced new arrangements to receive feedback about the service and that additional quality checks were being undertaken.

We inspected Meadows Sands Care Home on 11 January 2017. This was an unannounced inspection. The service provides care and support for up to 26 people. When we undertook our inspection there were 21 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses, or because they were experiencing difficulties coping with everyday tasks, with some living with the effects of dementia.

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.

The registered person was not meeting two Regulations under the Health and Social Care Act 2008.There was no maintenance plan or audit for the upkeep of the premises and some areas of the accommodation were not well maintained. Some areas had chipped woodwork, there were unpainted areas and unkempt furnishings. People had been consulted about the development of the home through the use of questionnaires, but these had not been analysed to show what actions may be required to improve the service. Other quality checks, such as care plan and medication reviews had been completed to ensure the home was meeting people’s requirements. However, the auditing system was in the early stages of development and analysis of quality checks had improved but required more work to ensure people and staff were aware of what actions had taken place. You can see what action we told the registered person to take in relation to the breaches of the regulations at the end of the full report.

People had a choice of meals, snacks and drinks. Meals could be taken in the dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. However, the menus on display were not in an obvious place and were of small print, so people could not remind themselves of the choices they had made when sitting eating their meals.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 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 there were two people subject to such an authorisation.

We found that people’s health care needs were assessed and care was planned and delivered in a consistent way through the use of their care plans. People were involved in the planning of their care. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans were put in place to minimise risk in order to keep people safe. Activities were not planned into each day, but people told us how staff helped them to spend their time.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period. However, staff also had a list of other work they were asked to complete each day, which they found difficult and look after people.

People were treated with kindness and respect. Staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

The provider used safe systems when new staf

We carried out an unannounced comprehensive inspection on 8 September 2015. A breach of a legal requirement was found. After the inspection the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach.

At the last inspection on 8 September 2015 we found that the provider was not meeting the standards of care we expect in relation to adhering to the implementation of the Mental Capacity Act 2005.

We undertook a focused inspection on 11 February 2016 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection on the 11 February 2016 we found the provider had made improvements in the area we had identified.

The report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Meadows Sands on our website at www.cqc.org.uk. Meadows Sands provides care for older people who require personal care. It provides accommodation for up to 26 people. At the time of the inspection there were 18 people living at the home.

At the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

On the day of our inspection we found staff interacted well with people and people were cared for safely. Staff knew a lot of information about each person. The care plans showed how people's mental capacity had been assessed and when best interest meetings had been held to discuss each person's needs. Where appropriate applications had been made if a person's liberty was being deprived. Staff had received update training in the Mental Capacity Act 2005 and how to ensure people lived in a safe environment suited to their needs.

We inspected Meadow Sands Care Home 08 August 2015. This was an unannounced inspection. Our last inspection took place on 04 February 2014. The service provides care and support for up to 26 people. When we undertook our inspection there were 21 people living at the home.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing memory loss. The home also provides end of life care.

There was no registered manager in post. The post had been vacant since May 2015. A registered manager is a person who has registered with the Care Quality Commission (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. The current manager had submitted their registered application to CQC and were awaiting an interview.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) 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 or others. At the time of our inspection there was no one subject to such a restriction. Staff had not implemented the MCA guidance correctly and had not recorded how decisions had been reached.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the lack of information on how decisions had been reached for people who could not make decisions for themselves. You can see what action we told the provider to take at the back of the full report.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period by observations and talking with people who used the service and staff. There was no formal recording of how decisions had been reached.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. And meals could be taken in a dining room, sitting room or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse, but had not received any formal training, except on induction. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements. However, there was no analysis of audits or feedback forms so the provider did not know whether suitable actions had been taken by staff.

People told us they liked living at Meadows Sands. One person told us, “The staff are wonderful here.”

We saw staff were responsive to people’s needs and respectful when they spoke with people.

Care was planned to reduce or manage any risk, and care plans were reviewed regularly.

A relative told us they were happy with the service provided. They told us they could raise any concerns if needed and the manager would listen and take action. They said, “I raised something the other day and they sorted it.”

Staff told us they liked working at Meadows Sands and were well supported.

The environment looked clean and tidy overall, however some concerns were raised and the manager said they would address them straightaway and let us know when they had done this.

During our visit we looked at records. These included care plans and minutes of meetings. We spoke with care staff, people who use the service and people who visit the service. We also sat and watched care staff delivering care to people in the home.

People told us they felt their privacy and dignity were respected in Meadows Sands. One person told us, “Care staff always knock my door before they come in.” We also saw people had personalised their own rooms to make them more homely.

People we spoke with told us the home was a nice place to live. They told us the care staff provided the support and care they needed. One person said, “The carers are lovely.”

People liked the food they had and we saw the support needed by some people at mealtimes was given in a quiet way and unhurried. They also enjoyed the activities that were put on for them.

People told us they felt safe in the home and if they didn’t they felt the manager would do something about it. Care staff knew how to protect the people in the home and who to contact if they had concerns.

We saw evidence that care staff received training and support to do their jobs.

People felt they were asked about their opinions in the running of the home by the manager and felt confident taking any concerns directly to her.

When we visited the home we found that the manager had only been in post for approximately five weeks and had not been registered with us yet.

People told us they were happy living at the home. One person said, “It’s very relaxed here, we do what we want to do.”

People told us they enjoyed the food provided. One person said “The food is very good”: and another told us, “It’s (the food) lovely.”

The people we spoke with praised the staff and said things like “They are lovely” and “They are kind lovely people.”

No one raised any concerns or complaints during our visit but said they would feel comfortable speaking to the acting manager or staff if anything arose. One person commented “I quite like it here.”