The Meadows is a 35 bedded care home close to local amenities and public transport routes. Bedrooms are located on two floors with communal rooms on the ground floor. The building is modern and has adequate car parking facilities and secure garden areas.

At our last comprehensive inspection on 23 & 24 October 2014 we rated the service as ‘Good’ overall, but the key question ‘is the service Responsive?’ was rated as ‘Requires Improvement’. We carried out a focused inspection on 11 August 2015 to check that the service had improved in this area. Suitable improvements had been made and we changed the rating for the key question ‘is the service Responsive?’ to ‘Good’. This meant the service was rated as ‘Good’ in all of the five key questions and ‘Good’ overall.

The service remained safe. People who used the service were supported by suitable numbers of skilled and experienced staff who had been recruited safely. Staff were aware of the risks to people’s health, safety and welfare and the actions required to keep them safe. Staff had been trained to recognise the signs that abuse or practice may have occurred and understood their responsibilities to report this. Medicines were managed safely and people received the medicines as prescribed.

The service remained effective. People who used the service received care and support from staff who had completed a range of training to equip them with the skills and knowledge to support them effectively. Staff received effective levels of supervision and professional development. Staff were aware of how to gain consent from people and the principles of The Mental Capacity Act 2005 were followed. People ate a healthy and balanced diet of their choosing. When concerns with people’s health and welfare were identified relevant professionals were contacted in a timely way.

The service remained caring. People who used the service were supported by caring staff who knew their needs and understood their preferences. Staff treated people with dignity and respect. People were supported to use advocacy services. Staff understood their responsibility to treat private and sensitive information confidentially.

The service remained responsive. Pre-admission assessments were completed before people moved into the service and the information was used to develop a number of individualised care plans. When people’s needs changed or developed their care plans were updated in a timely way. People were encouraged to take part in activities and maintain relationships with important people in their lives. The registered provider had a complaints policy in place that was displayed within the service; records showed very few complaints had been received.

The service remained well-led. The registered manager was aware of their responsibilities to report notifiable events to the Care Quality Commission. People who used the service, their relatives and staff were asked for their views which were used to develop the service. The registered provider operated a comprehensive quality assurance system to ensure shortfalls in care and support were identified and to drive the continual improvement of the service.

We carried out an unannounced comprehensive inspection of this service on 23 & 24 October 2014. At which a breach of legal requirements was found. This was because the recording in the care files was inconsistent; people’s care needs had not always been fully planned and care plans and risk assessments had not always been updated when people’s needs had changed. This meant there was a risk people who used the service did not receive all the support they needed and in the way they preferred.

After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 11 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Meadows Care Home’ on our website at www.cqc.org.uk’

The Meadows Care Home provides accommodation for up to 36 people who require support with their personal care. The home mainly provides support for older people and people living with dementia. There were 35 people living at the home at the time of our inspection. Local facilities and amenities are within walking distance. The majority of accommodation is on the ground floor, there are six bedrooms on the first floor, and some rooms have en-suite facilities.

The home’s registered manager has worked in this role since October 2013. 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.

At our focused inspection on the 11 August 2015, we found that the registered provider had followed their plan which they had told us would be completed by the 30 April 2015 and legal requirements had been met.

Care plans were more detailed and personalised. They had been regularly reviewed and updated to reflect individuals current care needs. We found risk assessments were completed, reviewed and updated when people’s needs changed. This enabled staff to monitor risk and provided them with accurate and up to date information in order to protect people and support their health, wellbeing and safety. Additional records to monitor food and fluid intake, repositioning support and personal care were now well completed and up to date.

We found people’s health needs were met. We found care was planned and delivered in a person-centred way. We observed staff interacted well with people; knew their likes and dislikes and demonstrated a caring and attentive approach.

The people we spoke with told us they made their own decisions and staff respected them. Their comments indicated they received the support they needed and were happy with how staff delivered their care. One person told us, “We have choice about everything we do here.”

Everyone spoke positively about the care they received. A relative told us, “They care for my mum well.” Improvements had been made with the activity programme although staff and relatives acknowledged that further work was needed.

We found staff were aware of how important it was to follow the infection control policy and this helped to protect people from the risk of infection.

People spoken with told us they liked their home. One person told us, “I’m happy here. My room is the best in the house, it’s got a good view and I spend time a lot of time in there.” Improvements had been made to aspects of the facilities. Surveys from people who used the service and their relatives had identified where further improvements were needed.

People spoke positively about the staff that worked with them. Comments included, "Lovely staff” and “The staff here are very good.” However we identified that staff were struggling to meet everyone’s needs at breakfast time. Staffing levels were reviewed during the inspection and improvements made.

People had opportunities to comment on the service through regular meetings and surveys.

People spoken with told us they were treated with respect and their dignity was maintained. They said they could make choices about aspects of their lives. Comments included, “I go to bed late and get up when I like”, “I prefer to sit in my own room but I come to the dining room for meals” and “Yes, they always knock on doors.”

People spoken with said they were looked after well and their needs were met in the home. Comments included, “I get to see my doctor and optician and my family take me to the hairdresser.” Relatives spoken with confirmed they were kept informed of issues and they said health needs were met.

People told us they liked the meals and they had plenty to eat and drink. We observed that staff provided appropriate levels of support when assisting people to eat their meals.

We observed there was appropriate equipment in the home to help people move around safely.

People who used the service told us staff cared for them well, were friendly in their approach and answered call bells promptly. Comments included, “The staff are very nice” and “They pop their head in and check if we are OK”. Relatives were very complimentary about the staff team.

People told us they felt able to complain and mentioned the manager by name as the person would speak to if they had any concerns. Relatives spoken with also confirmed any suggestions or comments would be addressed quickly.

As part of our inspection we spoke to a number of people who use the service. They spoke positively about the staff and care provided and told us that staff treated them with respect. Everyone we spoke with felt involved in their care and in making decisions about their care and treatment.

We received comments such as,"Well looked after" and "Staff are patient" and "Cannot fault the staff".

Everyone told us that the food was good and a varied menu was available. They told us their call bells were answered promptly when they required assistance at any time of the day and night.

As part of our inspection we undertook an observation of care practices in two of the sitting room areas, which took one and half hours.

We undertook this unannounced inspection on the 23 and 24 October 2014. The last inspection was completed on 7 July 2013 and the service was meeting the regulations we assessed.

The Meadows can support up to 36 older people who may have a dementia related condition. The service is an old detached building which has been extended over the years. Local facilities and amenities are within walking distance. At the time of our inspection visit there were 34 people living at the service. The majority of accommodation is on the ground floor, there are six bedrooms on the first floor, and some rooms have en-suite facilities.

The home has a registered manager. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People's health and care needs were assessed. Detailed and personalised care plans had been put in place to support the majority of people’s needs. However, the standard of some recording was inconsistent and we found some people’s needs had not been fully planned. This meant there was a risk they may not receive all the support they needed and in the way they preferred. You can see what action we told the registered provider to take at the back of the full version of the report.

People who used the service and their relatives told us the service was a safe place to live. Staff understood the various types of abuse that could occur and knew who to report any concerns to. There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

The registered provider had robust recruitment processes in place which protected people from unsuitable or unsafe staff. Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs and work in a way that was safe and protected people.

During our inspection we saw there were enough staff to ensure people’s needs were met in a timely manner. The registered manager had recently increased the numbers of staff on duty in the mornings following feedback from people who used the service, relatives and staff. People told us there were enough staff to give them the support they needed.

The registered manager and care staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards, which meant they were working within the law to support people who may lack capacity to make their own decisions.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People spoke highly about the quality of the food and the choices available. Their nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake, or ability to swallow, appropriate referrals had been made for specialist advice and support.

Staff involved people who used the service in choices about their daily living and treated them with compassion, kindness, and respect. Everyone looked well-presented and well-cared for. People had access to a range of activities both within the service and the local community.

Staff had a good understanding of the ethos of the service and told us they enjoyed their work.

The registered manager monitored the quality of the service on a day to day basis, provided leadership and ensured that people who used the service were able to make suggestions and raise concerns. The provision of new updated and in depth policies, procedures and a quality monitoring programme will better assist the registered manager to effectively monitor the quality of the service and drive a culture of continuous improvement.