The Meadow is a care home run by Methodist Homes and registered to provide accommodation and personal care support for up to 40 people. At the time of the inspection, 40 people were living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People told us they felt safe living at the service. The service appropriately assessed and mitigated risks involved in supporting people and provided safe care. Staff had a good understanding of risks to people and how to safeguard people against abuse and poor care. There were sufficient staff to meet people’s individual needs, and people and staff were happy with the staffing levels. The service followed safe medicines management, accurate medicines administration records and met infection prevention control and health and safety requirements.

Safe recruitment procedures were being followed to ensure people were supported by staff who were suitably vetted before starting work. Staff received regular support and supervision and relevant training to enable them to do their jobs effectively. People were happy with the food, and their nutrition and hydration needs were met.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People received personalised care from staff who were aware of their likes and dislikes, respected their privacy and treated them with dignity. Staff supported people to remain as independent as they could by encouraging them to carry out any activities they were able to.

People’s cultural, religious and spiritual needs were acknowledged and supported when required. The registered manager updated staff on people’s changing needs and were responsive to those needs and recorded them in their care plans. People’s care plans were person-centred and included information on their life stories, individual needs and preferences.

The service maintained robust and effective systems and processes, and carried out regular monitoring checks and audits to identify gaps and areas of improvement to ensure the quality and safety of the service delivery.

Further information is in the detailed findings below.

When we carried out an unannounced planned comprehensive inspection on 13 August 2014. There were a number of Breaches of legal requirements. The Meadow was found have an overall rating for of Requires Improvement. This was because staff recruitment checks were not always completed, and staff were not adequately trained to equip them to meet people’s needs. People were not fully involved in their care planning and care plans did not reflect people’s support needs. Staff did not always consider people’s capacity to make decisions about their care. The provider subsequently wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We inspected again on 28 October 2015. We found improvements had been made. Staffing levels were assessed to meet the needs of the people using the service and that there were systems in place for the safe recruitment of staff. Staff received relevant training to ensure they could meet the needs of the people they supported. People and their relatives were involved in their care planning. As such care plans reflected people’s support needs. Staff were able to demonstrate they understood the need to consider people’s capacity and how this should be undertaken.

The Meadow is a care home run by Methodist Homes for the Aged. The service is registered to provide accommodation for persons who require personal care. The service can provide for up to 40 people. At the time of inspection there were 31 people using the service. There are two floors, the ground floor provides care and support for up to sixteen older people with dementia and the first floor provides care and support to older people. There is a lift to the first floor and a comfortable balcony area where people can sit and overlook the garden. The dementia unit is within a safe area, which includes a spacious and easily accessible garden.There is no registered manager at The Meadow. 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. However we found a recently appointed manager, who was being well supported by the provider service to manage the improvements to the service. There was also a deputy manager and senior support staff who had responsibility for the daily oversight of the individual units. Changes to facilitate better communication between staff had been made and we found the service was well led.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

The Meadow provides care for up to 40 older people who may also have dementia care needs. There are two separate units where people are accommodated, one on the ground floor and one on the first floor. The ground floor unit provides care and support specifically for people with dementia care needs.

The last inspection of this service took place on 22 May 2013. During that inspection we found that the service was meeting regulations related to respecting and involving people, care and welfare, nutrition, staff recruitment and support, medicines and assessing and monitoring the quality of the service.

This inspection was an unannounced inspection. At the time of our inspection there was a registered manager 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 and associated Regulations about how the service is run.

People were not kept safe at the service. Behaviour that challenged the service was not managed in a way that protected people from harm and staff were not clear about how to manage these risks. People’s needs had not been fully assessed prior to their admission to the service to ensure that staff could meet their needs.

People were not always asked about their likes, dislikes and preferences and care plans were not always updated to reflect changes in people’s needs. Records were not always kept up to date so there was a clear record of people’s wellbeing and any support they needed.

Staff recruitment checks were not robust and therefore did not ensure that all staff employed were suitable to work with vulnerable adults. Staff with the required experience and expertise were not always on shift and staff sometimes worked extra hours which may have meant they had not had enough rest to make sure they could carry out their duties effectively.

We found that the service did not fully consider people’s mental capacity and the impact of any restrictive practices to ensure that people’s rights were respected.

People told us that staff were caring and treated them with respect. Our observations confirmed this.

People told us they enjoyed the activities provided at the service and told us that staff listened to their views. We found that people knew how to make a complaint and felt comfortable raising any concerns. The manager responded to any complaints promptly and addressed any issues raised.

Systems were in place to monitor the service, however, we found that these were not always effective in ensuring that the service met the required regulations.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with nine people using the service, one relative of a person using the service, three care assistants and the manager. We also had a guided tour of the premises and had observed staff interaction with people.

All of the people we spoke with were positive about their experience of living at the home. They told us they felt safe and staff attended to their needs. They spoke highly of the manager. They said the manager was caring and "knew" each person's needs. All of the people we spoke with told us the staff were caring, friendly and ready to help. However, some people using the service felt some night care staff were not ready to respond to their needs.

We observed that the activities provided were stimulating with many of people using the service taking part in group and individual leisure and educational sessions. People spoke highly of the activities co-ordinator.

People using the service told us the food provided at the home was nutritious and met their dietary and cultural needs. We saw people had water for drinking in their bedrooms and there were water dispensers in the communal areas. We noted staff were present to support people who needed help with their meals.

People who use the service told us that they thought this was a very good home and they liked the home. They told us that they valued their freedom and that the home supported to them to live as independently as possible. People said the staff and manager were very good and they were treated with dignity and respect. People told us they had lots of activities they could do both inside and outside of the home. Comments we received included, “Staff are all very nice and they are always helpful.” “There are no restrictions here.” “Everyone treats you with respect.”

We spoke with 13 people living at the home, nine members of staff, five relatives or friends of people using the service, and with a GP visiting the home. We also carried out observations as well as looking at the care files for eight people and at other records for the home.

When we spoke with people who were living at The Meadow, or their relatives, they were positive about their experiences. They told us that they liked living at the home and felt it met their needs. They told us they liked the food and that the staff were nice. The following are examples of some of the comments we received:

“I think people who came here would find it to be very good.”

“It has a warm friendly atmosphere.”

“They treat everyone like a special case.”

We observed care and saw staff treating people in a caring and respectful manner.

We found that people’s privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.