Meadowview Care Home is registered for a maximum of 41 people. There were 41 people in the home at the time of this inspection. The home comprised of a ground floor, dining room, a main lounge, memory lane lounge area, gardens containing numerous ornaments and memorabilia such as a red pillar phone box. It was situated next to a primary school within a residential setting at the heart of a community. The service is not registered to deliver nursing care.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good overall. There were some areas where further improvements were required but no 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.

There was a new maintenance staff member in the home during our inspection who had begun to implement an action plan to improve the maintenance checks and records. They were also improving the fire safety according to the most recent fire inspection by Cheshire Fire Service.

There was an online staff training system in place which we viewed on the home manager’s computer. It highlighted where staff training had expired or was due to be completed. Not all staff were up to date with Safeguarding training but they completed their training during this inspection.

Staff understood what their responsibilities were in relation to safeguarding people from abuse and the different types of abuse. They were able to explain the process of safeguarding people.

We found there was a warm, homely, inclusive, calm atmosphere within the home. The environment was conducive to replicating aspects of a person’s home such as a lounge with a decorative fireplace, a phone with a dial, dolls for people to pick up and carry if they wished.

People were seen walking freely and being included such as one person we observed assisting staff to clean and tidy the tables after lunch. Staff treated people with dignity, compassion and respect. We observed people were being treated as individuals and were being supported in a person-centred way. The service had an equality and diversity policy in place.

Healthcare professionals we spoke with were complimentary about the service being delivered for people. People were being supported to access healthcare professionals when they needed them.

There were enough safely recruited staff seen on duty to meet the care needs of people. Staff and the home manager were seen regularly spending time with people in the moment when they needed reassurance.

We observed activities taking place within the home on both days. The activities coordinator knew people well and was skilled in grading the activities according to people’s individual needs to enable everyone who wished to take part to participate in a positive way.

Staff were overheard asking people what their preferences were, where they would like to sit and if they would prefer to be in their room. This demonstrated people were being supported to maintain choice and control of their lives. Staff supported people in the least restrictive way possible.

Care plans were in the process of being updated at the home. Risks had been identified, recorded and reviewed with improvements seen in the way risks were being recorded in new care plans.

People’s weights were monitored appropriately and people were offered a balanced diet. People were provided with a choice of drinks and food. Dietary requirements information held in the kitchen needed updating. This was actioned immediately during this inspection.

There was strong leadership at the home and systems were in place with quality checks undertaken to always seek continuous improvements.

Prescribed medicines were administered safely and medicines were managed appropriately within the home. There were no covert practices in place. We observed staff spending considerable time

We undertook an inspection of Meadowview Care Home on 9th June 2014.

During our inspection we spoke with the registered manager, three staff, two relatives and fourteen people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Policies and procedures had been developed by the registered provider (Ashberry Healthcare Limited) to provide guidance for staff on how to safeguard the care and welfare of the people using the service.

The registered manager demonstrated awareness of the Mental Capacity Act and the circumstances when it was necessary to apply for authorisation to deprive a person of their liberty and to ensure the correct safeguards were in place.

Likewise, staff spoken with also demonstrated a sound awareness of the different types of abuse and the action that should be taken in response to suspicion or evidence of abuse.

A safeguarding log was in place. Records highlighted that there had been three safeguarding referrals since our last inspection. Two referrals concerned incidents between people using the service and the other concerned the standard of care provided to a service user. The provider worked in partnership with the safeguarding authority to ensure the welfare of the people who used the service was protected.

Discussion with staff and examination of training records confirmed staff continued to have access to a range of induction, mandatory and role specific training. Systems were also in place to monitor the outstanding learning needs of staff and when refresher training was due.

Staff spoken with confirmed they had attended team meetings periodically and received supervision and appraisal sessions.

Is the service effective?

People were observed to be relaxed and at ease, clean and well-presented. Those who were able to discuss arrangements made for their care told us that they were happy and overall very satisfied with the service.

We noted that the home employed activity coordinators and there was a programme of activities available for people using the service to access. On the day of our visit we observed a group of people enjoying a game of musical bingo in the dining room.

Is the service caring?

The atmosphere in the home was relaxed and sociable. We observed staff carrying out their duties and responsibilities with confidence and skill, in good humour and in a relaxed and positive manner. Staff were seen to be attentive to the needs of the people using the service.

Comments received from people using the service included: “I am very happy and very well cared for”; “I like it here. We have a good time and a great laugh”; “I’ve been here a year. I’ve had a wonderful time and I think it’s a marvellous place”; “The staff are great. Always kind and very caring” and “They look after me very well and understand the things I need assistance with. I think that’s very important.”

Likewise, feedback received from relatives included: “We are very pleased. We have no concerns”; “The staff have involved us in the development of a care plan” and communication channels are excellent. The standard of care is exceptional and everyone is very dedicated and friendly.”

Is the service responsive?

We looked at the personal files of three people who lived at Meadowview during our site visit and found copies of assessments from social workers. This helped to provide evidence that the needs of the people living at Meadowview were being kept under regular review.

Files viewed also contained a range of assessment and care planning information that had been developed and produced by the provider. At the time of our inspection the service was in the process of introducing a new care planning system.

New care plans viewed had not been signed by the people using the service or their representatives and some information was brief. For example, information on the needs and support requirements of people living with dementia was limited. Other examples were discussed with the manager who informed us that action would be taken to improve records.

Is the service well- led?

The service has a registered manager in place to provider direction and leadership to the staff team. The provider (Ashberry Healthcare Limited) and the registered manager have always worked well with us and keep us up to date on any significant events via statutory notifications.

A range of internal auditing systems have been established to enable the registered manager to maintain an overview of the service. For example, we saw evidence of audits of: care plans; accidents and incidents and medication systems and processes. A new health and safety checklist was also due to be rolled out to improve environmental monitoring. Other auditing systems were also in place for other key areas such as infection control.

The provider had also established systems to involve and obtain feedback from people using the service and / or their representatives. We noted that easy read surveys had not been used to help people understand the information. We have raised this point with the provider to help develop and improve the quality of future consultation processes.

Periodic monitoring of the standard of care provided to people funded via the local authority is also undertaken by Warrington Borough Council's Integrated Commissioning Team. This is an external monitoring process to ensure the service meets its contractual obligations.

During this inspection we visited Meadowview. We spoke with the manager; three care staff; four relatives; a health care professional and eighteen residents.

People living at Meadowview confirmed that they were satisfied with the standard of care and support provided and were of the opinion that staff understood their needs.

Comments received from people included: "It's a great place to live"; "I've never known a day to pass when we haven't had a good laugh"; "The staff do their very best to help each and every one of us"; "The staff are decent people who understand how to help us"; "There are always plenty of staff around to help out when needed and they have always responded quickly when I've needed help"; "There are activities most days. Today we played bingo and sometimes we have entertainment"; "I'm fine and I'm very happy here. I feel lucky to have found Meadowview" and "The food is great. It's well cooked and nutritious and we get a choice for each sitting."

Likewise, feedback received from relatives included: "The manager and staff are always approachable and helpful"; "I Have nothing but positive feedback and praise for this place"; "We feel very fortunate to have found Meadowview and the standard of care provided is excellent"; "I visit every day and I'm always given a warm welcome and a cup of tea"; "The staff who work here are amazing" and "I don't feel my mum could be in a better place than Meadowview."

People using the service at Meadowview confirmed that they were treated with respect and their dignity was maintained. People also told us that they were satisfied with the standard of care provided and were of the opinion that staff understood their needs.

For example, comments received included: “On the whole it’s a nice place to be”; “I like living here. It’s warm and comfortable and I get a choice of three good meals each day”; “I am very well looked after. It’s a smashing home in my opinion” and “It’s like a hotel. For me, moving in here has been a positive experience.”

Systems were in place to offer protection to the people who use the service from abuse and people spoken with confirmed that they felt safe and had no concerns regarding the care provided. No concerns, complaints or allegations were received from the people using the service during our visit to Meadowview.

People spoken with confirmed they had confidence in the staff that provided care and that there were sufficient staff on duty. Comments received included: “The girls [staff] are great. We have good banter together”; “If I need any help or assistance the staff come quickly”; “The standard of care is first class. The carers can’t do enough for you”; “Staff are lovely”; “It’s brilliant and the manager is fabulous” and “I’m being looked after and I’m happy.”

People spoken with reported that they were treated well by staff and confirmed their views on the service were sought. Comments received included; “I couldn’t do better. The staff are respectful and I am looked after well”; “Staff are very nice. I think it’s a wonderful home” and “I’ve not got no complaints. I am happy and I get what I need here.”

People also told us that they were satisfied with the standard of care and treatment provided and were of the opinion that staff understood their needs.

Examples of feedback received included: “The girls [staff] are champions”; “Everyone here is generally happy. The home has a lovely atmosphere and the staff are very nice people” and “The staff are good and nothing is too much trouble. They do their very best to help in any way they can.”

This inspection was unannounced and took place on the 19 and 23 November 2015.

The service was previously inspected in June 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Meadowview Care Home provides both accommodation and personal care for 41 older people, some of whom have dementia care needs. It is located in Penketh, a suburb of Warrington in Cheshire. The service is provided by Ashberry Health Care Limited

The home is a single storey building with 41 single rooms, three lounges, a dining area, conservatory, laundry and hairdressing salon. There is a small sheltered garden at the front of the building and several smaller sitting out areas around the building.

At the time of the inspection there was a registered manager at Meadowview Care Home. 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 manager was present during the two days of our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors.

During this inspection we found a breach of the Care Quality Commission (Registration) Regulations 2009.

We found that the provider had not consistently notified the Commission of incidents or allegations of abuse in relation to people using the service.

During the two days of our inspection we found Meadowview Care Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service and relatives spoken with was generally complimentary about the standard of care provided.

We found that people lived in a safe and homely environment which was properly maintained. Assessments had been undertaken and care plans and risk assessments produced to ensure staff had access to information on how to respond to the diverse needs of people living in Meadowview and to minimise and control risks.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff received training, supervision and support to enable them to understand their role and how to deliver person centred care.

The provider had a complaints procedure and where complaints had been reported, these were responded to appropriately and action had been taken to resolve them promptly.

There was a quality monitoring system in place which involved seeking feedback from stakeholders and people who used the service and their relatives about the service provided periodically. This consisted of surveys and a range of audits.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Medicines were ordered, stored, administered and disposed of safely.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).