River Meadows is a nursing home situated in the village of Edgebolton, Shawbury in Shropshire. The home provides accommodation, nursing and personal care, for a total of up to 44 older people and young adults and is situated over two floors.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service. The service was making continual improvements to ensure there were enough staff to meet people’s needs. People were protected from the risk of harm and abuse. Staff were able to demonstrate how they kept people safe and risks were assessed and managed well. Medicines were managed safely. Staff took appropriate action to mitigate the risk of the spread of infection.

The service continued to be effective. People received support from suitably skilled staff that worked well together with other organisations and healthcare professionals in order to deliver effective care and support. People had enough food and drink and were given choices in order for people to have their nutritional needs met. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The service continued to be caring. Staff were kind and promoted people’s independence. People had their dignity and privacy respected.

People continued to receive a responsive service. People were involved in the planning of their care which was individualised and person centred. People were engaged in meaningful activities that were personal to them. People knew how to make a complaint. Complaints were recorded, investigated and responded to in a timely way.

The service continued to be Well-Led. There was an open and honest culture and people said the registered manager was approachable. Systems were in place to monitor the service and identify areas for improvement.

Further information is in the detailed findings below.

This inspection took place on 16 February 2016 and was unannounced.

River Meadows Nursing Home is registered to provide accommodation with nursing and personal care to a maximum of 44 people. There were 40 people living at the home on the day of our inspection.

A registered manager was in post and was present during our inspection. 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.

The home was last inspected on 11 and 12 November 2014 where we gave it an overall rating of requires improvement. At the last inspection we asked the provider to take action to make improvements to staffing levels, to make sure people had the support they needed to eat and drink and to make improvements to their quality assurance systems. We asked the provider to send us an action plan to tell us how they would make these improvements. At this inspection we found that these actions had been completed and the required improvements had been made.

People were able to summon assistance when they needed it. Staff responded to call bells in a timely manner and let people know if there would be a delay in supporting them. Staffing levels were monitored and people were supported by enough staff to meet their needs safely. The provider completed employment and character checks on staff before they started work at the home to check they were suitable to work with people at the home.

Staff understood how to keep people safe. They had received training in recognising when people may be at risk of harm or abuse. Staff knew how to protect people and how to report any concerns they may have about a person’s safety.

People were supported to take their medicines safely and when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent were able to support people with their medicines.

People’s permission was sought by staff before they helped them with any care or support. People's right to make their own decisions about their own care and treatment were supported by staff. Where people were unable to make their own decisions these were made in their best interests and by staff who followed the relevant laws.

People received the support they needed to maintain a healthy balanced diet. People had enough to eat and drink and had access to snacks and drinks throughout the day. Staff supported people to make their own choices about what they wanted to eat and drink. People's routine health needs were met and referrals were made when people needed other health care support.

People were supported by staff who were kind and caring. Staff knew the care needs and preferences of people they supported. Staff made sure people were involved in their own care and made sure they understood information that was given to them. People were treated with dignity and respect and staff understood how important this was in the way they cared for people.

Care and support that staff gave was personal to each person and people were supported to spend their time how they wanted to. People and their relatives knew how to make complaints but told us they had not needed to. They were able to give their opinions of the home and the care they received at meetings and through surveys.

People were supported by staff whose focus was on putting people first. We found the culture of the home was open and people felt involved in what happened at the home. The provider had systems in place which assessed and monitored the quality of care and support staff provided at the home and took action when improvements were needed.

We were shown around the building by the registered manager. All the areas were well decorated and furnished to a high standard. The rooms were light and airy with plenty of space for people to move around. The gardens were accessible with seating areas which the people we spoke to told us they appreciated.

We were told by the registered manager that families were encouraged to furnish people’s bedrooms with their belongings. We saw people had bird feeders outside their windows and tubs of flowers.

We were shown the kitchen by the cook. The kitchen was well equipped and they said they had everything they needed to provide a good standard of catering.

The dining areas were all set out with bright table cloths and flowers. These were intended to reflect the seasons together with the nature display in the fireplace. We were told how the activity organiser worked to provided seasonal displays and activities to help the people remember the seasons. We saw pictures of the people enjoying activities which included pat dogs, aerobic exercises and crafts.

We spoke to one of the housekeepers while they were doing the laundry. They told us how the equipment was well maintained and any problems were addressed promptly.

We spoke to some of the people living at River Meadows. They told us “it’s lovely here and I like all the girls, they are so helpful”. They told us they thought the food was good with plenty of choice. One person said “We can eat in our rooms if we want and it’s lovely to leave the washing up to someone else”.

They told us that they could do what they wanted. They could sit with their friends and chat or stay in their rooms and just watch the people going past. They told us that they liked most of the activities. The dogs that visited and River Meadows cat seemed to give the people pleasure. They said that the staff spent time with them to ask them about their needs.

We saw that the staff supported the people in a friendly and polite manner. We saw that the staff showed respect to the people and ensuring their dignity was maintained

One member of staff we spoke to said “we try to make time to sit with the residents and have a laugh”.

People we spoke with told us that they were getting the care and support they needed. Comments included, “Everything is fine.” “I am being well looked after".

We viewed records that showed people had been involved and consulted in relation to their care and support. People received an assessment prior to being admitted. We saw that staff supported people sensitively and discreetly. We spoke to staff who shared examples of how they promoted people’s privacy and dignity whilst delivering care.

We spoke with visitors who told us that their relative was safe and well looked after. They said staff were kind and attentive. People who used the service said they were able to raise any issues they had with the staff. People told us that they were safe. One visitor said, “Staff do listen and communicate any issues well. We feel assured, as far as possible, that staff can care for our relative as we prefer”.

People were protected because staff were confident to recognise and report abuse.

People told us that the staff asked them if they were alright and if they were happy with everything. They said that they were able to express their wishes and share their views about how they were feeling. People said that if they had any concerns or worries that they would speak with a member of staff or the manager. We saw records that showed the provider had systems in place to monitor and review people’s experiences and deliver improvement.

This inspection took place on 11 and 12 November 2014 and was unannounced. This meant the provider did not know we were coming. At our previous inspection no improvements were identified as needed.

River Meadow provides accommodation, nursing and personal care for older people and young adults. This home is registered to provide a service for 44 people; on the days of our inspection 38 people were living there.

The home had a registered manager in post who was present for our inspection. 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 a 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 people did not always have access to a nurse call alarm to ask for support when needed and people told us that this made them feel unsafe. People told us that staff had not always been available to help them with their personal care needs. We found that there were insufficient staffing levels to ensure people’s care and support needs were met in a timely manner or as frequently as people wished.

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

The management of people’s prescribed medicines needed to be reviewed to ensure that all nurses were aware of how to manage ‘when required’ medicines. ‘When required’ medicines are prescribed to be given only when needed. We found that medicines had not always been stored at the correct temperature which, placed people’s health at risk.

People told us that the staff were skilled and knew how to care for them. Staff told us that they received on-going training to ensure they had the skills and competence to care for people.

Staff knew how to protect people against the risk of abuse and discrimination. The staff we spoke with were aware of how to keep people safe. They were also aware of their responsibility of reporting any concerns of abuse to the relevant agencies.

The staff support available to people at mealtimes did not always ensure that all people received enough help to eat all of their meal in comfort. Some people had to wait for long periods of time after the meal time had commenced before support was provided. People raised concerns about the times when meals were served. We saw that some meals were served within a few hours of the previous meal and then long gaps were experienced between the last meal of the day and the breakfast meal on the following day. Staff who were providing assistance were seen supporting people in a caring and considerate manner and ensured that people had sufficient food to meet their needs. Between meals people did not have ease of access to drinks and staff support was not always available to ensure people had the drinks they wanted.

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

People told us that they had access to a range of healthcare services when needed. The registered manager said that the GP visited the home twice a week.

We found that staff had a good understanding about Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were aware of how this could have an impact on the individual and how this would affect their practice. DoLS are safeguards used to protect people where their liberty to undertake specific activities is restricted. The registered manager had made appropriate applications to the local authority in accordance with DoLS and was following legal requirements.

We saw that staff were caring and kind to people. Staff explained to people what they intended to do before supporting them. Systems were in place to encourage people and their relative to be involved in planning their care.

People told us that staff respected their privacy and dignity. We saw that people were taken to a private area to assist them with their personal care needs. Staff were aware of people’s personal needs and their preferences. However, people were not supported to have a bath or shower when they wanted one.

People and a relative told us that there were very little social activities provided in the home. There was a board displayed in the corridor showing what activities were available during the day. The home had employed an activities coordinator. However, we did not see any activities taking place during our inspection.

Two people told us that they were unaware of the provider’s complaint procedure but would share any concerns with staff who always listened to them and addressed their concerns.

People were given the opportunity to express their views about the service provided to them. People told us that they were able to attend meetings and were routinely asked to complete a quality assurance questionnaire. However, some people told us that changes to the service were not always discussed with them, although this had an impact on the quality of the service provided. For example, the change to meal times and insufficient staffing levels.

Quality audits were carried out but we found that where shortfalls had been identified action was not always taken to improve the service.

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