This inspection took place on 10 October 2018 and was unannounced. A second day of inspection took place on 11 October 2018 and was announced.

Queens Meadow is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Queens Meadow provides personal care for up to 59 people. At the time of our inspection there were 58 people living at the home who received personal care, some of whom were living with a dementia.

We last inspected Queens Meadow in August 2017 and rated the service requires improvement. We found an ongoing breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 which relates to good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions relating to safe, responsive and well-led to at least good. At this inspection we found that significant improvements had been made in the key questions responsive and well-led. Although a number of improvements had been made relating to the key question safe, further improvement was still needed in this area. This was because people’s personal emergency evacuation plans were not always up to date and detailed enough, guidance on ‘when required’ medicines was not detailed enough, and the temperature records of areas where medicines were stored were incomplete. The registered manager and provider took immediate action to address these areas during our visit. Due to the significant improvements made the rating for this service has now improved to good.

A registered manager was in place at the time of our inspection. 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.

During this inspection we found there was a welcoming and homely atmosphere at the service. People were at ease with staff and relatives said staff were kind and caring. Staff respected people's privacy and dignity. There were positive relationships between people, relatives and staff.

People and relatives spoke positively about the care provided. People told us they felt safe.

Staff had received training in safeguarding and knew how to respond to any concerns. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service.

Staff training in key areas was up to date. Staff received regular supervisions and appraisals and told us they felt supported.

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 supported to have enough to eat and drink and attend appointments with healthcare professionals.

Care plans were detailed and person-centred and contained important information about people’s life stories so staff could get to know people well.

People and relatives knew how to make a complaint and were happy approaching staff or the registered manager if they had any concerns.

People were supported to engage in meaningful activities and access the local community.

People, relatives and staff spoke positively about the registered manager being approachable.

Staff said they felt supported and able to raise issues at any time.

The home had good links with the local community and people told us how much they enjoyed this.

We carried out this unannounced comprehensive inspection on 18 August and 14 September 2017. Queens Meadow Care Home provides accommodation and personal care to up to 59 people, some of whom may be living with dementia. At the time of the inspection 56 people were using the service.

In July 2016 we carried out an inspection of this home and found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. We issued requirement notices to the provider in respect of these breaches. They related to people not being protected from the risk of inconsistent care because care records were not sufficiently detailed to provide clear guidance for staff, and people not being protected against risks associated with unsafe infection control and prevention practices. In addition, daily health and safety checks had not always been carried out and the provider’s quality assurance system was not effective in addressing the shortfalls we found at that inspection.

We asked the provider to submit an action plan in response to our findings, setting out how the matters would be addressed. At this inspection we found that overall, improvements had been made. However, we found that not all of the actions set out in the provider’s action plan had been completed and shortfalls continued in respect of the requirements of one regulation.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 some people now had personalised care plans in place which contained their preferences and likes and dislike, but some people’s files still required updating to include more personalised detail. The provider had an improvement plan in place to ensure all people’s care plans were personalised. Staff had received training in care planning to support this work.

We found some actions regarding infection control had been completed. However, further improvements were required to ensure the environment could be cleaned to an acceptable level. The provider had included this work in their action plan. After our visit to the home as part of this inspection, we have written to the provider and gained assurances that environmental work will be completed in planned stages over a three month period.

We have made a recommendation about the management of infection control.

We found remedial work identified at a previous fire risk assessment had not been fully completed. At the time of writing this report we have gained assurances from the Fire Service that they deem the service to be safe, as they have inspected the service in January 2017 and do not plan to revisit ahead of their usual programme of inspection. We have addressed the lack of progress in respect of this remedial work with the provider and obtained assurances from them that this work will be completed by the end of October 2017.

We found some care records pertaining to food and fluid intake were not completed correctly.

We found cleaning records were not always completed consistently. Cleaning schedules did not set out timescales for specific deep cleaning tasks.

The provider had a quality assurance audit planner in place to ensure the quality of the care provided was monitored on a regular basis. During the inspection improvements were noted but not to a level to demonstrate the improvements in the service were sustainable. The quality assurance audits at this inspection had not identified the concerns we found in relation to record keeping. We found audits and action plans associated with the quality assurance process did not always record managerial review.

People said they were comfortable and felt safe living at the home. Staff had been recrui

The last inspection of this home was carried out on 14 January 2014. The service met the regulations we inspected against at that time.

This inspection took place over two days. The first visit on 7 July 2016 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 8 July 2016 which was announced.

Queens Meadow is a purpose-built care home which provides personal care for older people, some of whom are living with dementia. It is registered for 59 places. At the time of this visit there were 54 people living at the home, including two people on short breaks.

The home had a registered manager who had been in this role for several years. 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.

During this inspection we found the service did not always make sure that risks were managed. For example, safety checks had not always been carried out and some areas of bathrooms could not be kept fully clean because they had surfaces that were not sealed.

Care records were not always sufficiently detailed to make sure people received personalised and consistent care.

The provider’s quality monitoring processes were not fully effective in making sure people received a safe or quality service. This was because shortfalls had been identified but action had not always been taken to address them.

You can see what action we told the provider to take at the back of the full version of the report.

The people and relatives we spoke with felt the home provided a safe and comfortable place for people to live. One person commented, “I’d rather be in my own home, but I know I’m safer here.” A relative commented, “I can leave without worrying about her because I know they look after her.”

Staff were clear about how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. The provider made sure only suitable staff were employed, although there were no regular renewals of checks for long-term staff.

There were enough staff to support people with their needs. One relative said, “There always seems to be enough staff.” Another visitor commented, “There are always staff around when we visit.” People were assisted with their medicines in the right way.

People and relatives felt staff were well trained and experienced. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

Health and social care professionals said the staff cared for people in a competent, effective way and responded appropriately to any changes in people’s well-being. People were supported to eat and drink enough and they had choices about their meals.

People felt the staff were “caring” and “friendly”. For example one person said, “The lasses are lovely.” Another person told us, “It’s a nice home and the girls are smashing.”

Relatives said the home was “caring” and “supportive”. One relative commented, “My [family member] says she’s well looked after and they are lovely to her. They need medals for the job they do.” Another relative told us, “We really like it and my [family member] is happy here. They’ve been settled since the day they moved in and staff are really good with my [family member]. They are as happy here as they have ever been.”

Staff were knowledgeable about people’s history as well as their likes and dislikes. A relative told us, “It’s a very stable staff team so they know people’s needs, and people are familiar with staffs’ faces and voices which is really important for people with dementia.” A care professional said, “The staff in the home tend to know the resident

During the inspection we sat in one of the communal lounges and saw there was a friendly and relaxed atmosphere between the people living at Queens Meadow Care Home and the staff. We observed staff interacting well with people and supporting them which had a positive impact on their wellbeing. We spoke with two people who used the service and they expressed satisfaction with the care and service that they received. One person told us, “They look after us really well, the girls are lovely.” Another person told us, “I like living here.”

We found that records within the service were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.

We looked around the home and saw there were several areas where people could choose to spend their time. These areas were well decorated and maintained. People we spoke with all said the home was well maintained. Comments included, “It’s all just been done out” and “I’ve got a nice room, they clean it everyday.”

We spent time observing how staff supported people who lived at the home. People we spoke with said they were happy with the staff. They told us “I couldn’t do without them”, “Staff are alright”, and “Everyone’s pleasant.”

People were generally very happy with the care provided. Comments included “The staff are lovely, they know people really well", “I enjoy it here” and “The girls are very caring.”

We also saw evidence that staff employed had been through recruitment checks prior to commencing employment. This demonstrated people’s health and welfare needs were being met by staff who were fit to do their job.

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would say straight away if I wasn’t happy about something", another said “If we have any problems we can tell them.”

We saw some care plans and daily notes did not contain up to date information. This meant people were not being protected against the risks of inappropriate care as records were not always accurate and fit for purpose.

The visit took place because we were following up issues we had raised during the last

inspection in June 2011. Since this inspection new owners have taken over the home and although the company has changed they kept the same trading name on their registration certificate. The majority of the people we spoke with told us about the change of owner and how they had made some marked improvements to the home.

Generally when talking with people we concentrated on the specific areas that had been raised at the last inspection. We spoke with twelve of the people who used the service and four relatives. People told us that ''The girls are great'', ''They can't do enough for you here, in fact our wish is their command'' and ''I have always found this a good place to live''.

People told us that the activity co-ordinator was extremely good at her job and that she organised a great deal of entertainment. At the time of the inspection two local MIND co-ordinators were in running a carpet bowls session. One person said ''I didn't expect to be here but there is so much going on and the girls are friendly enough that is much more of a pleasant experience than I was anticipating''. Other people told us that they could go out when they wanted and one person said he was still able to do the garden, which was their main passion in life.

We spoke with 3 people who live at Queens Meadow who said they were happy living there. One person said “I like it here they look after you and you get so much food “

Other people said they were offered a choice at mealtimes of what they would like to eat and drink and were happy that their rooms were kept clean.

We spoke with members of one person’s family who said “there has been some problems recently but it does look like it is starting to improve from the care and staff side of things”

All of the people we spoke with said there was a lack of social activities at the home including opportunities to go out.

During the inspection we spoke with two people who used the service and four relatives. We also spoke with the manager, the regional manager, a senior carer, a supervisor and two care staff. One person we spoke with told us, “I’ve lived here eight and a half years and it’s wonderful.” They also said, “There is always someone around to help but I like to do things myself.”

We used a number of different methods to help us understand the experiences of people who used the service, because some people had complex needs which meant they were not able to tell us their experiences.

We found that people had their needs assessed and that care plans were in place. People we spoke with told us they liked living at the home. The people we spoke with were satisfied with the service they received.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

We found that systems were in place to ensure medicines were administered safely.

The quality of the service was monitored and reviewed on a regular basis.