The inspection took place on 25 and 26 February 2019. The inspection on 25 February was unannounced but we told the provider we would return the next day to complete the inspection. Meera House Nursing Home 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.

Meera House Nursing Home is a care home with nursing operated by Meera House Nursing Home Limited. It is registered to provide accommodation with personal and nursing care for 59 older people, some of whom have dementia. This location is also registered to provide personal care for people living in their own homes. However, they did not have any people using this service at the time of this inspection. The care home provides care for people of Asian origin and most of the people living there are of the Hindu faith.

There were two registered managers in post at the time of our inspection. One of the registered managers was initially employed to manage the domiciliary care service. As they currently had no service users, this manager co-manages the care home with the second 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.

We brought this inspection forward as we had received information of concern and feedback from local authority monitoring visits. These concerns related to the care of people and the management of the home. At our last inspection on 22 and 23 May 2018 we found a number of deficiencies and the service was rated “Requires Improvement”. At this inspection we noted that although improvements had been made and some deficient areas rectified, there were still some areas where further improvements are needed. Therefore, the service continues to be rated as “Requires Improvement”.

Risk assessments had been prepared for people. These contained guidance for minimising potential risks such as risks associated with falls, medical conditions such as diabetes and pressure sores. However, we noted that there were no risk assessments for people who used bedrails. This was later provided. One person who was at risk of choking did not have a comprehensive risk assessment. This was provided after the inspection. A person who had a history of depression and who was emotionally upset when we met them did not have a depression risk assessment. Comprehensive risk assessments are needed to ensure that care workers are informed of potential risks to people and how risks could be minimised to keep people safe.

The service followed safe recruitment practices and records contained the required documentation. Care workers told us they had received a comprehensive induction and training programme. Staff supervision and appraisals had been provided and these were recorded in the staff records. Meetings had been organised for care workers. We were, however, not confident that the staffing levels were adequate to ensure that people’s needs were attended to. This was because of certain deficiencies identified such as the slow response to call bells and those related to care documentation. The registered manager stated that a new deputy manager had been recruited and additional staff were in the process of being recruited.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The care needs of most people had been attended to. Care plans had been reviewed with people or their representatives. However, documented evidence indicated that some people’ s care needs had not always been attended to, particularly th

The inspection took place on 22 and 23 May 2018. The inspection on 22 May 2018 was unannounced whilst the inspection on 23 May 2018 was announced. Meera House Nursing Home is a care home with nursing operated by Meera House Nursing Home Limited. It is registered to provide accommodation with personal and nursing care for 59 older people with dementia. This location is also registered to provide personal care for people living in their own homes. However, they did not have any people using this service at the time of this inspection. The care home provides care for people of Asian origin and most of the people living there are of the Hindu faith. At our last inspection on 22 August 2016 the service met the regulations inspected and was rated “Good”.

There were two registered managers in post at the time of our inspection. One of the registered managers was initially employed to manage the domiciliary care service. As they currently had no service users, this manager co-manages the care home with the second 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.

We carried out this inspection following a safeguarding incident which was reported to us and the local safeguarding team. We looked at the arrangements for safeguarding people. We noted that the service had a safeguarding policy and a whistle blowing policy to ensure that people were protected from harm and abuse. Care workers we spoke with had been provided with training on safeguarding people. Following the safeguarding incident, the provider had taken action against care workers involved. The incident had also been reported to the police who were carrying out investigations into the matter.

This serious incident involving the abuse of a person who used the service indicated that safeguarding arrangements were not adequate. Following this the service had in place an action plan which included closer monitoring of care workers and further training for them.

Some relatives and care workers informed us that there were occasions when more care workers were needed so that people could receive better care. Although the registered managers informed us that there were sufficient care workers on duty, we noted that the staffing levels had not been reviewed with people, their representative and care workers.

There were suitable arrangements for the administration of medicines. Medicine administration record charts (MAR) and the controlled drugs register had been properly completed.

The premises were kept clean and tidy. The garden was attractive. We however, noted that no garden tables, chairs and umbrellas had been provided. Infection control measures were in place. There was a record of essential maintenance of inspections by specialist contractors. Fire safety arrangements were in pace. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. We however, noted that the hot water temperatures prior to people being provided with a shower had not been recorded. This is needed to prevent scalding. The registered managers stated that this would be carried out. They further explained that the shower heads of the home had been fitted with thermostats to prevent scalding and care workers checked the temperatures were within the safe limit and to the liking of people who used the service. We were informed soon after the inspection that records of shower temperatures had been logged prior to showers being given.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. Our specialist advisor who

We undertook this unannounced inspection on 22 August 2016. Meera House Nursing Home is registered to provide nursing care and accommodation for a maximum of 59 people. At this inspection there were 58 people living in the home. This service is also registered to provide personal care for people living in their own homes. However, they did not have any people using this service at the time of this inspection. This care home provides care for older people of Asian origin of all religious backgrounds. Most of the care workers speak Gujarati, Hindi or Swahili.

At our last inspection on 3 October 2013 the service met all the regulations we looked at.

The care home has 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 of the Health and Social Care Act and associated Regulations about how the service is run.

People using the service informed us that they were satisfied with the care and services provided and these met their cultural and religious needs. They said they had been treated with respect and felt safe living in the home. This was reiterated by relatives we spoke with. There was a safeguarding adults policy and suitable arrangements for safeguarding people.

Care workers were responsive and knowledgeable regarding the individual choices and preferences of people. People’s care needs and potential risks to them were assessed and recorded. Care workers prepared appropriate care plans which involved people and their relatives. Personal emergency and evacuation plans (PEEPs) were prepared for people and these were seen in the care records. People’s healthcare needs were closely monitored. Care workers worked well with healthcare professionals to ensure that people’s needs were met. This was confirmed by people and relatives we spoke with.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Residents’ meetings and one to one sessions had been held with people to enable them to discuss their care and the services provided. The minutes of meetings were available for inspection. The home had an activities programme which provided social and therapeutic activities and met their religious preferences.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS) when needed.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs, religious and cultural preferences were met. People were satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory. Audit arrangements were in place and people who spoke with us confirmed that they had been given their medicines.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their manager. There were enough care workers to meet people's needs. Teamwork and communication within the home was good. Care workers were aware of the values and aims of the service and this included treating people with respect and dignity within a homely environment and providing a high quality of care.

People and their representatives expressed confidence in the management of the service. The results of the last service user and relatives satisfaction su

People who used the service received appropriate care and support that met their individual needs and they were treated with dignity and respect.

There were processes in place to protect people who used the service from harm and abuse. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

People who used the service were protected from the risk of infection. The service had arrangements in place to manage medicines safely and appropriately.

People were protected from the risks of inadequate nutrition and dehydration.

There were enough qualified, skilled and experienced staff to meet people’s needs. The staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

The home had an effective system to regularly assess and monitor the quality of service that people received and to identify, assess and manage risks to the health, safety and welfare of people who used the service.

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

On the day of the inspection there were fifty four people using the service. The home was warm, clean and had a relaxed and friendly atmosphere.

People who use the service told us that staff were kind and respected their privacy and promoted their independence.

People told us staff understood their needs and provided them with the care and support they needed in the way that they wanted. They told us their religious and cultural needs were met by the home, and staff spoke to them in the language that they understood.

People's comments about their experience of living in Meera House Nursing Home included, “I like it here”, “Everyone looks after us”, “The care staff are very nice”, and “They look after me and respect me as much as my family”.

People told us that they had sufficient and suitable food and drink which met their dietary needs and preferences. People's comments and description of the meals included, “The food is good”, “I can choose what I want to eat”, and “The food is very nice here”.

We observed staff supporting people in a friendly and professional way and saw that people using the service were being offered choice with regard to food and drink, and were asked whether they wanted to participate in activities.

People who use the service told us they felt safe at the home, were involved in their care and could talk with the manager or other staff if they had a worry or concern.

The nursing home had effective systems in place to ensure that people were protected from abuse, and they received the nutrition and health care they needed. Peoples’ records were stored securely.

As part of this review, we spent time talking to all the people using the service to gain their views about what it was like living in Meera House Nursing Home. People told us that; they were happy living in the home, they liked their bedrooms, the food was good, they had their health needs met, the staff were approachable, listened to them, and they had the opportunity to participate in a range of activities of their choice.

People told us that they received the care and support that they wanted and required. They told us they felt safe living in the home and they knew who to talk to if they had any worries or concerns. Comments included; 'I can talk to staff if I have a worry', ' I would speak to my (relative), and staff are ‘never unkind’. A person using the service told us that staff ‘tell us to tell them if we are worried’.

Visitors informed us that they felt their friend/relative were safe living at Meera House Nursing Home, and they told us that they would talk to the manager if they had a concern about the safety of their relative or of others. They told us that they had been asked for feedback about their view of the service provided to their friend/relative.

We saw signs of ‘well being’; people using the service were seen to be relaxed, often smiling and laughing. We were told that most people living in the home spoke Gujarati or Hindi, languages which most staff spoke fluently. Visitors told us that it was good that staff spoke people’s first language. One visitor commented that their relative, who was living in Meera House Nursing Home, ‘does not speak English so it’s important’ that staff speak to him/her in the language he/she understands.

Staff told us they got to know people using the service well. Comments from staff included; ‘I know all their little ways’, and ‘we ask people what they want’.

People told us they could choose what to eat and generally enjoyed the meals provided. Comments included;' 'I like the food’, ‘the food is nice', 'I can choose what I want to eat', the food was ‘not nice at first but we got used to it, it is good now’, and 'there is lots to eat'.

Visitors commented ‘the cook is wonderful’, ‘I can try the food’, ‘I have her recipes’, and ‘the food is good and vegetarian which is important to my (relative)’.

People told us they had contact with a variety of other health and social care professionals. A person spoke of having seen the doctor when they had been unwell.

People confirmed that they were happy with the environment of the home, and liked their bedrooms. They told us that they had brought personal items with them, when they moved in. Comments included; 'my room is cleaned', the home is 'always clean’, 'I like my bedroom', ‘my room is good’, 'I am happy with my room', and ‘I like the garden’. We saw people spend time in the communal lounges, and in their bedrooms.

Visitors told us that they liked the environment of the home. They told us that the atmosphere of the home was pleasant, and spoke positively about the garden. A visitor commented that ‘all the residents were out in the garden the other day’, ‘my (relative) loved it’, and ‘it’s lovely’.

Comments from people included; 'staff help me how I want to be helped’, 'I choose what to eat', 'I choose to do things’, ‘I knitted at home, and I do it here’, 'I have help with a shower', 'staff are good’, the staff were’ nice', 'I am ok here’, ’staff listen to me and do things for me’, and ‘we can talk to staff’. Other comments from people about the service included ‘I am very happy’, and ‘there are no problems’.

Visitors told us that they had been invited to their relative's care plan review meetings, and are kept informed about the well being of their relative/friend. Comments from visitors included; ‘I have meetings about my (relative) every two months’ and ‘my (relative) now participates in activities’.

Visitors spoke positively of staff, comments included; ‘the staff are lovely’, ‘they are very good’, ‘there is good communication between staff’, ‘they listen’, ‘there are relatives meetings every six months’, ‘I visit at different times, so have a good view of the service’.