This inspection site visit took place on 5th June 2018 and was unannounced.

Meads House is registered to provide personal care for up to 16 older people living with dementia. At the time of the inspection there were 13 people living at the service.

Meads House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

We last inspected the service in October 2015. At that inspection the home was rated Good across all domains. At this inspection we found that the service had not sustained this in all areas. The service now has an overall rating of Requires Improvement.

The service had 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.

We found that the environment of the service did not appear to have been adapted to help meet the needs of people living with dementia to promote their independence.

We found the activities recorded and offered to people on a daily basis were not always personalised and inclusive to meet the needs of men and women living at Meads House.

There was a lack of evidence to show how good practice guidance was proactively used to ensure the service continues to deliver the best care for people living with dementia.

We found that people’s general communication needs were met.

Systems were in place to capture feedback from people, staff and relatives such as annual surveys to help identify areas for improvement.

The premises and equipment were cleaned and well maintained and maintenance checks were up to date.

There were contingency plans in place to ensure people’s safety in the event of an emergency.

People told us they felt safe living at the service. Staff understood their responsibilities to raise concerns and report accidents or incidents. People received their medication safely and on time.

We saw people being treated with kindness and compassion at all times and people told us that they were happy with their care and treatment. There were individual risk assessments in place to keep people safe, including falls, moving and handling, nutrition, weight, pressure areas.

Staff received training to ensure they had the appropriate skills and knowledge to support people. We saw training records showing training was mainly up to date. Any outstanding training had been booked to take place imminently. Staff had appropriate knowledge and skills to meet people’s needs.

There were appropriate recruitment processes in place and safety checks were completed to ensure prospective staff were suitable before they were appointed.

People had enough to eat and drink. Alongside regular meals hot and cold drinks and biscuits were available between meals. People were given choice and supported to have their meals where necessary.

People had support with identifying their healthcare needs and could access healthcare professionals such as their GP.

Because people living in the home had dementia, some were verbally unable to tell us of their experiences. We spent time observing people’s interactions with staff and observed body language and facial expressions. There were fourteen people living in the home at the time of our visit. Seven people that spoke with us told us they were very happy. Comments included. “It’s lovely here. They look after me beautifully and my room is always kept lovely and clean.”

Before coming to live in the home people had their individual needs and wishes assessed and recorded. People told us they were treated with dignity and respect.

For each person living in the home there was a detailed, person centred plan of care in place that was regularly reviewed and updated to reflect people’s changing needs.

We spoke with staff and reviewed records that showed us that people were protected from risk of abuse and that their care was planned and delivered in a safe manner.

People were being cared for by an experienced and well trained staff team. Five staff that spoke with us told us they felt well supported by the manager.

There were procedures in place to audit and monitor the quality of the service being provided and to identify and carry out ongoing improvements to the service.

Comments from three family members that spoke with us included. “Invariably I was very anxious about my Mother going into care. The staff are all very kind and have worked hard to allay my fears, they are all patient and attentive and she is very happy.”

We used a number of different methods to help us understand the experiences of people using the service including SOFI.

We found that people using the service and/or their representatives were involved in decisions about their care and treatment. Care plans were personalised, and clearly documented the needs of people. Meads House had a complaints policy and procedure in place. Evidence was seen that comments and complaints were listened to, and resolved in a timely and appropriate manner.

Not all the people living in the home were able to tell us about their experiences of living in the home. However those who could told us they “liked their room” and “the carers are very nice to you”

Meads House is registered to provide permanent and respite care for up to 16 older people. There were 13 people living at the home at the time of the inspection. People required a range of help and support in relation to living with dementia and personal care needs.

The home is based over three floors, with a chair lift in place to allow people access to upstairs rooms.

This was an unannounced inspection which took place on 12 and 13 October 2015.

Meads House had a registered manager. 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 manager was in day to day charge of the home. People and staff spoke highly of the manager and told us that they felt supported by them and knew that there was always someone available to support them when needed. Staff told us that the manager had a good overview of the home and knew everyone well.

We received only positive feedback from people, staff and relatives. Everyone told us that the manager was passionate about ensuring people received the best care possible. This was supported by clear up to date care documentation which was personalised and regularly reviewed.

Medicine administration, documentation and policies were in place. These followed best practice guidelines to ensure people received their medicines safely.

There were robust systems in place to assess the quality of the service. Maintenance for example water, electric and gas had taken place and all equipment and services to the building had been checked and maintained regularly.

There a programme of supervision and appraisals for staff. The manager also received regular support and supervision from the provider.

Staffing levels were reviewed regularly. Staff received training which they felt was effective and supported them in providing safe care for people. Robust recruitment checks were completed before staff began work. Staff and people living at the service were involved indecisions before new staff were recruited.

Care plans and risk assessments had been completed to ensure people received appropriate care. Care plans identified all health care needs and had been reviewed regularly to ensure information was up to date and relevant. People’s mental health and capacity were assessed and reviewed with pertinent information in care files to inform staff of people’s individual needs.

Staff demonstrated a clear understanding on how to recognise and report abuse. Staff treated people with respect and dignity and involved people in decisions about how they spent their time.

People were encouraged to remain as independent as possible and supported to participate in daily activities.

People, relatives or significant people involved in care decisions were asked for their consent before care was provided and had their privacy and dignity respected. People and relatives were invited to attend care reviews to ensure people were involved in decisions.

People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. Menus were reviewed and changes made when requested.

Referrals were made appropriately to outside agencies when required. For example GP appointment, community nurses and speech and language therapists (SALT).

Fire evacuation plans and personal evacuation procedure information was in place in event of an emergency evacuation.

Feedback was gained from people this included questionnaires and regular meetings with minutes available for people to access. The manager had used innovative ways to gain people’s feedback when formal meetings had not been successful due to people’s memory loss and dementia.

Notifications had been completed to inform CQC and other outside organisations when events occurred.