Mid Meadows is care home owned by the provider Black Swan International. It provides accommodation and personal care and support for up to 21 people who may have a physical disability and or not associated learning difficulties. Nursing care is not provided at Mid Meadows. There were 20 people living in the service when we carried out an unannounced inspection on 14 December 2016.

A registered manager was 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.

Ensuring people received safe quality care and were fully protected was integral to the running of Mid Meadows. The management team including the provider’s nominated individual were clear about the importance of keeping people safe and their expectations relating to how the service should be provided and led by example. Staff understood their role and responsibilities and the importance of keeping people safe. This encouraged creative, innovative and practical thinking in relation to people’s safety and managing risk.

Robust procedures and processes to ensure the safety of the people who used the service had been fully embedded. These included risk assessments which identified how the risks to people were minimised but also ensured their rights and choices were respected. The management team shared and discussed examples with the staff of accidents and incidents that had occurred within the care industry to learn from these experiences and drive the service forward.

Staff had received safeguarding training and understood what actions to take to protect people from abuse. They were able to confidently describe the different types of abuse that may occur and how it should be reported.

People were complimentary about the care and support provided. They and or their representatives, where appropriate, were involved in making decisions about their care and support arrangements. As a result people received personalised care and support which was effectively planned and delivered to meet their specific needs, take account of their wishes and keep them safe.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff understood the need to obtain consent when providing care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were encouraged and supported to attend appointments with other health care professionals to maintain their health and well-being. Where people required assistance with their dietary needs there were systems in place to provide this support safely.

Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences. The atmosphere in the service was friendly and welcoming.

Consideration had been given to maintaining relationships that were important to people. They were supported with regular opportunities to participate in activities within and outside the service and to sustain links in their local community.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People’s feedback was valued and acted on.

There was visible and effective leadership within the service underpinned by a clear and transparent manageme

Some of the people who lived at Mid Meadows had complex needs but most were able to speak with us. We spoke with people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the home and with staff. We also spoke with staff members. We looked at four people's care records. Other records viewed included staff rotas, training and supervision records, health and safety checks, staff and resident meeting minutes, medication records and records which related to the quality assurance of the service.

We considered our inspection findings to answer 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?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made and how to submit one.

We saw appropriate processes were in place with regard to medication and it’s administration, so that people could be confident they were protected from the unsafe use and management of medicines.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. We saw the service had processes in place which ensured that staff had the skills and knowledge to support people safely.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "I really like it here, they know me very well and staff are kind and helpful." People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People could therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We used a number of different methods to help us understand the experiences of people who used the service. Some of the people using the service had complex needs which meant they were not able to tell us about their experiences. Where people were unable to provide a response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Mid Meadows to be positive.

We saw that people had individual ways of communicating and were able to make members of staff aware of their needs and preferences.

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service.

Mid Meadows was effectively run by a competent manager; there were robust systems and processes in place to ensure people received a good service that took into account their needs and preferences.

People who use the service were given appropriate information and support regarding their care or treatment.

We observed that staff members were polite and attentive towards people using the service, in particular those people with no verbal communication. We saw that staff made good eye contact with people that were unable to communicate and used touch, such as holding people’s hands or stroking their upper arm to reassure them when they reached out to staff.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. Where people were unable to provide a verbal response or tell us verbally their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Mid Meadows to be positive.

One person who used the service told us they could remember being consulted

about and involved in developing their care plan. They also told us that they were able to make choices about some aspects of their care. For example, we spoke with two people about how they are supported to choose what to eat each day and activity choice. They told us that staff offer them a choice of meals each day and that they can also choose where they have these, for example in the comfort of their own room or dining area. They are also able to make a decision as to whether or not they participate in social activities. One person told us "I can go out when I like and have a sleep during the day as I am up quite late at night and I like it that way"

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they were satisfied with the level of care and support they received

at Mid Meadows. One person with whom we spoke told us "I really like it here, I don't know anything else now."

People told us that they feel well looked after by the staff at Mid Meadows. One person said "The staff are very kind and look after us well".

People told us they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People spoken with indicated that they were happy with their rooms and found them comfortable.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People told us that they felt comfortable talking to the staff about any issues that they had and that the manager was also always available for them to talk to.