The inspection took place on 12 and 15 June 2018 and was unannounced.

Meresworth 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. They are registered to provide accommodation and treatment for up to 51 people, some of whom may be living with dementia. At the time of our inspection 45 people were accommodated at the home.

At our last inspection on 02/02/2016, we rated the service Good. At this inspection, we found that staff did not always follow the correct procedures and this was an area which required improvement.

The home 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.

People told us they felt safe living at the service. There were appropriate risk management arrangements in place to help keep people safe. Although, we found that staff did not always follow these consistently. There was a robust recruitment process in place. Staffing levels overall were sufficient to meet people’s needs. However, at times of peak demand we observed people were not able to be assisted in a timely way.

Staff received a comprehensive induction to the service when their employment commenced and they continued to receive regular training and updates as required. This provided staff with the skills and experience required to support people appropriately.

People`s medicines were overall managed safely by staff who had received training and had their competencies checked. Care plans were comprehensive and provided staff with detailed information. People and their family, where appropriate, were involved in the development and review of people's care plans.

Staff requested peoples consent before they provided support. Where people were unable to consent verbally, staff took time to get their consent through other means such as eye contact or body language. The management and staff worked in line with the Mental Capacity Act (MCA) principles and associated deprivation of liberty safeguards DoLS.

People and their relatives told us staff were kind and caring and we observed staff supported people overall in a way which was kind and caring. We did observe a situation where this was not the case and this was referred to the registered manager for intervention. Staff were observed to have little time to speak with people apart from when supporting them with a task. Staff were aware of people`s likes, dislikes and preferences and overall delivered care and support in accordance to people`s wishes.

People were provided with opportunities to engage in social activities of interest to them. The environment and the grounds were well maintained and provided people with opportunities to utilise the garden which had been developed to incorporate people’s interests. The décor was appropriate for people who were living with dementia with plenty of stimulating objects for people to engage with. Memory boxes and memorabilia were placed in corridors and outside people’s bedrooms to help them recognise their individual bedrooms and the surrounding environment.

The registered manager and management team was open, transparent and inclusive. We observed visible leadership within the service and this was being further developed with the introduction of more robust systems and processes. The registered manager was supported by deputy manager and a regional manager from the providers management team.

The management team provided people with a range of opportunities to provide feedback and comment on the service in order to continually make improvements

This inspection took place on 2 February 2016 and was unannounced. Meresworth provides accommodation and personal care for up to 51 older people, some of whom may be living with a dementia. On the day of the inspection, there were 49 people living in the home.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At the last inspection undertaken on 26 January 2015, the service was found to be meeting the standards tested. At this inspection we found that the provider had continued to meet the standards.

People were protected from the risk of abuse. Staff had a good understanding of how to recognise potential abuse and report concerns. Risks were assessed and kept under regular review and actions put in place to reduce risks where possible.

People and their relatives (where appropriate) had been involved in the development and review of peoples care and support plans. Their care needs were assessed, reviewed and delivered in a personalised way.

People were supported by appropriate numbers of staff which enabled them to meet their individual care needs and also enabled them to spend time supporting people with social activities and events both within the home and the community. Staff were recruited through a robust recruitment procedure and received training relevant to their role and were supported through supervision.

People were supported to eat and drink sufficient amounts to maintain their health and wellbeing. People were supported to access health services when required. Care was person centred and people were treated with dignity and respect.

The leadership in the home was focused and innovative and staff were involved in the implementing new ideas. Staff were valued and were given additional responsibilities which they were responsible for overseeing. There were systems in place to monitor the quality of the service, address any shortfalls and facilitate continual improvements.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was working in accordance with MCA and had submitted DoLS applications which were pending an outcome.

There was a complaints procedure and complaints had been dealt with in accordance with the procedure. Positive comments were also recorded.

The manger and management team were approachable and were open and transparent. Staff told us that the registered manager had a visible presence and people knew who the manager was. The views of people were sought in various ways including ‘residents’ meetings and an annual stakeholder survey.

The service was previously found to be non- compliant in four regulation areas. We completed this follow up inspection to check that the provider had made all the required improvements. We found that the provider had improved in all the required outcome areas, and was now meeting the four standards that we reviewed as part of this inspection.

We observed people’s dignity, privacy and choices were respected. Since our last inspection visit staffing levels had been reviewed and increased. The quality monitoring process had been made more robust and monthly quality monitoring audits and actions are revisited to make sure they have been addressed. We were shown evidence that the complaints process had been strengthened and additional opportunities for people to feedback have been introduced.

Most people we spoke with told us they were mainly happy living at Meresworth home. One person who used the service said “It’s quite nice here, carers are alright. I get on well with all of them.” Another person who used the service told us “it’s alright, not as good as it has been. They have changed staff and administration. There is a shortage of staff I think.”

We found that the provider did not have sufficient staff on duty at all times to meet the needs of the people who used the service. We found that peoples care records were regularly reviewed and contained detailed support plans and risk assessments. However, we found that people were not always treated with dignity and respect. We noted that the provider had systems in place to ensure medication was managed appropriately. We found that complaints were not always suitably investigated and responded to. The provider had processes in place to monitor the quality of service they provided to people but issues which arose from these processes were not always addressed.

The people who used the service told us that they were very happy living at Meresworth. They said that the staff were lovely and were “jolly good fun”. We were told that the staff were respectful to the people and that the people felt respected as adults. The people told us about their house meetings with the manager of the home and how they were consulted on the social life of the home and how the home was run.

Relatives told us that people were much happier in Meresworth than their previous home and that they had thrived since coming to Meresworth.

We looked at five outcomes and found that the home was meeting these standards. An assessment of need had been carried out prior to the person being admitted to the home. A care plan had been drawn up to meet the person’s needs and wishes and risk assessments had been carried out and updated regularly to ensure the person’s safety and welfare. The people were kept safe and staff were aware of what they needed to do should they have concerns about a person’s welfare and safety. Staff were trained appropriately and there were sufficient numbers of staff on duty to meet the people’s identified needs.

Audits were in place that ensured all aspects of the home had been reviewed on a regular basis. People’s falls or near falls had been monitored and fall prevention measures had been put in place. This ensured people had optimum independence while they remained as safe as possible.

People we spoke with during our visit, on 18 August 2011, described the service provided at Meresworth as being ‘very good’, ‘very friendly’ and ‘congenial’.

People told us they like the meals they are served and enjoy the garden. We heard about the various activities that people can take part in.

Three relatives told us that the staff were ‘very good’ and ‘cheerful’. They said there were always plenty of staff around when they visited.

One person was concerned, that on occasions, it was difficult to attract the attention of staff when they were in the lounge because they did not have access to the call bell.

This inspection took place on 26 January 2015 and was unannounced. Meresworth provides accommodation and personal care for up to 51 older people, some of whom may be living with dementia. On the day of the inspection, there were 49 people living in the home.

The service has a registered 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.

People were protected from avoidable harm or abuse. Risks to individuals’ had been assessed and managed appropriately. The service followed safe recruitment procedures and there were sufficient numbers of suitable staff to keep people safe and meet their needs. There were safe systems for the management of people’s medicines and they received their medicines regularly and on time.

People were supported by staff who were skilled and knowledgeable in their roles. Staff were aware of how to support people who lacked the mental capacity to make decisions for themselves and had received training in Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. People’s nutritional needs were met and they were supported to have enough to eat and drink. They were seen by their doctors or other health care professionals when required.

The experiences of people who lived at the care home were positive. They were treated with respect and their privacy and dignity was promoted. People were involved in the decisions about their care and support they received.

People had their care needs assessed, reviewed and delivered in a way that mattered to them. They were supported to pursue their social interests and hobbies and to participate in activities provided at the home. There was an effective complaints procedure.

There was an open culture and people were encouraged to air their views about the quality of service provision. There were systems in place to seek the views of people, their relatives and other stakeholders. Regular checks and audits relating to the quality of service delivery were carried out.