The Mead 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. The home accommodates up to 60 people in one adapted building some of whom live with dementia. There are two floors; each floor was divided in to two separate units. Each unit can accommodate up to 15 people. Three of the units are for people who live with dementia and one residential unit.

At the last inspection the service was rated good. At this inspection we found that the service remained good.

People we spoke with felt safe living at The Mead. There were enough staff to meet people’s needs. Safe recruitment practices were followed to ensure staff were of good character and suitable to work in this type of service. Risks to people were reviewed and managed appropriately. Medicines were managed safely by staff who received the appropriate training. There were suitable arrangements for the safe storage and management of people’s medicines.

Staff received induction, training, and development to carry out their role effectively. People were offered daily choices and their views about the care they received were sought. The service met the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People`s nutritional and hydration needs were managed effectively. People had access to health care professionals and were supported to attend appointments.

Staff developed good relationships with people and promoted people’s dignity, respect and encouraged their independence. People had regular meetings and daily opportunities to participate in activities. People and their relatives where appropriate were involved in their care.

People felt supported and received personalised care that met their individual needs. People had appropriate support and encouragement to access meaningful activities and follow their individual interests and one to one activities were also provided. Care plans had clear guidance for staff to ensure people’s support needs were met.

The registered manager promoted an open, transparent and inclusive culture within the service. People and staff were encouraged to have their say to improve the way the service operated. There were quality assurance systems in place and shortfalls identified were resolved to improve the service.

Further information is in the detailed findings below.

The inspection took place on 28 October 2015 and was unannounced. At our last inspection on 04 July 2014 the service was found to be meeting the required standards. The Mead provides accommodation and personal care for up to 60 people. At the time of our inspection 54 people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that where people lacked capacity to make their own decisions, consent had been obtained in line with the MCA 2005. The manager had submitted DoLS applications to the local authority for people who needed these safeguards.

People felt safe in the home. Staff were knowledgeable about how to protect people from the risk of abuse and other areas where they may have been assessed as being at risk. Falls, accidents and incidents were monitored to ensure the appropriate action had been taken to minimise the risk of reoccurrence. There were regular quality assurance checks carried out to assess and improve the quality of the service.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. People were helped by trained staff to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

People told us they had enough to do and activities were provided for them. People’s feedback was sought through meetings and surveys. Actions were developed as a result of this feedback and any complaints received were acted on promptly.

People who lived at the home and relatives were positive about the skills, experience and abilities of staff. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

People received care that met their needs and care plans were developed with their involvement. Staff were aware of people’s needs and had formed positive relationships. Dignity, privacy and respect were promoted and staff had a good understanding on how to ensure people received care in a personalised way.

Staff was positive about the leadership in the home. There were systems in place to monitor the quality of the service and address any issues found. The service had involved external agencies to support them to maintain the improvement going forward.

During this inspection we set out to answer our five key questions; is the service caring,

responsive, safe, effective and well led? The inspection was carried out by one inspector over one day.

Below is a summary of our findings.

Is the service safe?

Not assessed during this inspection

Is the service effective?

Not assessed during this inspection

Is the service caring?

We observed staff interact with people in a respectful way, for example. During dinner time we observed that people were offered clothes protectors and that their choice was respected. People were frequently offered drinks through the day. One person we spoke with said, "Staff are very good and speak to me nicely, they knock on my door before they come in." One relative we spoke with said, we are involved in our [Relative’s] care. The home is lovely; they [Staff] look after my [Relative] nicely."

Is the service responsive?

Not assessed during this inspection

Is the service well-led?

Not assessed during this inspection

We inspected The Mead on the 3rd September 2013 and found that they were not meeting standards required for protecting people against the risks of receiving unsafe or inappropriate care and treatment because accurate records were not maintained. We asked the provider for a plan of action and revisited on the 26th February 2014.

We spoke with the Manager and deputy manager; we spoke with people who used the service and staff. We reviewed food and fluid charts, turning charts, and staff training records. The manager told us that they had spoken to all staff personally and that they were updated with correct procedures for completing care plans and fluid charts. One person who used the service said "I like the staff, they were very caring”. We reviewed the care plans and saw that these were reviewed regularly and dated.

During our visit to the service at 7am on 3 September 2013, we observed that nearly all the people who lived at the Mead were still in bed. A few people were in the process of getting up and were offered a cup of tea. We noted that some people who were still in bed did not have water jugs or a glass in their rooms and we spoke to staff about this, to establish how they ensured that people had access to fluids and were assisted to keep hydrated. We spoke to several people who told us that they liked living at The Mead, and they were well cared for. We observed that people were treated with dignity and respect. Activities were provided seven days a week and people could choose what they participated in. People looked clean and well groomed, and appeared relaxed in their surroundings. Staff records confirmed that staff had attended regular training relevant to their roles, and they were well supported through supervision and team meetings. We noted that regular quality monitoring had been completed. Several people told us they were not keen on the food, "but that you could usually choose an alternative". We observed staff assisting people with eating and drinking.

We noted from a review of various records that records were not always maintained and did not always reflect the current position. We spoke to the manager about the impact this had on people's wellbeing and the risks associate with poor record keeping. We were assured that this would be addressed immediately.

During our visit to the service we spoke with twelve people who lived at The Mead and two of their relatives. People told us that they liked living at The Mead. We observed that people were treated with dignity and respect. Staff offered people choices and assistance throughout the day. One person told us ‘the staff are wonderful' and 'have a sense of humour from morning till night. My room is like a showroom. We have china cups here’. Another person said they were ‘quite content’ and told us they liked to bake and take part in exercises. One person told us that, although their relative spends time in their room by choice, all the staff speak to her and she gets to hold the dogs and babies when they were brought in.

We observed that there was a sociable atmosphere and a variety of activities were available to keep people occupied during the week and at weekends. A visitor, describing the service, told that us ‘they have a celebration at the drop of a hat. It is so lovely and the food is unbelievable’. One person told us if you ‘don’t like the food they investigate to see what’s gone wrong’.

People told us that they enjoyed their meals and we observed that staff were available to support people who needed assistance. We noted that people’s nutritional needs and fluid intake were being monitored where risks had been identified.