This comprehensive inspection took place on 21 June 2018 and was unannounced.

The last comprehensive inspection took place 13 and 14 September 2016. The service was rated requires improvement in the key question is the service well led? We found one breach of regulation relating to the notifications of incidents because the registered person had failed to notify the Care Quality Commission of a safeguarding concern. We asked the provider to make the necessary improvements by November 2016.

On 15 February 2017, we carried out a follow up inspection to check that improvements to meet legal requirements planned by the provider after our September 2016 inspection had been made. We inspected the service against one of the five questions we ask about services: is the service well led? No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. On 15 February 2017, we found the provider was not fully meeting the regulation relating to notifications as they had notified us of seven out of eight incidents.

At this inspection we found the provider had met the regulation regarding notifications but was not fully meeting the regulations for the need for consent, safe care and treatment, good governance and fit and proper persons employed.

The Meadows Residential Care Home 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 Meadows accommodates a maximum of 25 people. At the time of the inspection, 24 people were using the service.

The service is family run. The business owners were part of the management team and were active in overseeing the service. Another family member was the operations manager and there was also 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found individual risk assessments were not always completed for areas such as risks related to falls, skin damage and pressure ulcers, malnutrition and moving and handling. Furthermore, window restrictors were not secure, some windows did not have restrictors and there were no risk assessments regarding this. This meant the risks associated with people’s care and well-being were not always identified so these could be appropriately mitigated.

Safe recruitment procedures were not always followed to ensure staff were suitable to work with people as gaps in employment that had not been explored, references were not always from the last employers and details of their criminal records checks at the time they started working at the service were not on file.

The principles of the Mental Capacity Act (2005) were not always followed as mental capacity assessments were not decision specific and we saw examples of relatives signing consent forms for people when they did not have the legal right to do so. Where people were able to make choices and give consent we saw that the provider and staff supported this.

Care plans mostly had appropriate information about people’s needs and preferences. However, we found information about their sleeping pattern and the times people liked to get up and go to bed, were not accurately recorded or not recorded at all.

The service had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective as not all risks had been assessed and mitigated and health and safety checks had not identified the iss

We carried out an unannounced comprehensive inspection of this service on 13 and 14 September 2016. A breach of a legal requirement was found because an incident was not raised as a safeguarding alert or reported to the Care Quality Commission as abuse or an allegation of abuse as required under the Regulations. This may have placed people at risk of unsafe care. After the comprehensive inspection, the provider submitted an action plan detailing what they would do to meet the legal requirement in relation to the breach.

We undertook this focused inspection on15 February 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Meadows Residential Care Home on our website at www.cqc.org.uk.

The Meadows Residential Care Home provides care and accommodation for up to 24 older people who may also have dementia care needs. At the time of our inspection there were 24 people living at the service.

The owner was also the provider. The provider, his wife and daughter were part of the management team and were active in overseeing the service. The registered manager had been in post since January 2014. 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.

At our focused inspection on 15 February 2017, we found that the provider had not followed all of their plan of action, dated 20 November 2016, and that the legal requirement had not been fully met.

The provider failed to raise a safeguarding alert and notify CQC on one occasion, however they had sent through seven notifications appropriately and as required.

Incidents and accidents were recorded appropriately.

The service had updated its’ notification policy and staff had read it.

The inspection took place on 13 and 14 September 2016. The first day of the inspection was unannounced and we told the deputy manager we would be returning the next day.

The last inspection visit took place on 21 December 2013 at which time all the assessed standards were being met.

The Meadows Residential Care Home provides care and accommodation for up to 24 older people who may also have dementia care needs. At the time of our inspection there were 23 people living at the service.

The owner was also the provider. The provider, his wife and daughter were part of the management team and were active in overseeing the service. The registered manager had been on long-term leave and had returned to the service the week prior to the inspection. During their absence, the deputy manager had managed the service. 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.

We found one breach of the Regulations because the provider had not always followed procedures for raising safeguarding alerts to the local authority and notifications to the Care Quality Commission.

Care workers had attended safeguarding training and knew how to report safeguarding concerns.

Risks to people’s safety and wellbeing had been assessed to keep people safe and staff knew how to record incidents and accidents. The provider followed safe recruitment procedures and there were enough staff deployed to meet people’s needs.

There were a number of regular maintenance and service checks carried out to ensure the environment was safe. Medicines were administered and stored safely.

The deputy manager had made appropriate DoLS applications, however consent to care and treatment was not always sought in line with Mental Capacity Act (MCA) 2005 legislation. We recommended that consent is sought for care and treatment and where a person lacks mental capacity, the provider acts in accordance with the requirements of the Mental Capacity Act 2005.

People’s nutritional needs were met and they were able to have food and drinks when they wanted to. People had access to health care services and the service worked with other community based agencies.

People who used the service told us staff were kind and their dignity and privacy was respected.

Comprehensive care plans recorded people’s needs and goals and were reviewed monthly.

Activities were not meaningful for everyone who used the service. We recommended that the provider consult appropriate guidance and review activity provision.

All stakeholders indicated they could speak to one of the management team and felt they would be listened to.

The service had systems to monitor the quality of service delivered and ensure the needs of the people who used the service were being met.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with the provider, the manager, three other members of staff, two relatives and four people who were using the service. People and/or their relatives were asked for their views about the service and these were listened to. We found that relatives had been asked to read and comment on care planning arrangements and the relatives we spoke with told us they were kept informed about their family member's changing needs.

A care plan had been developed detailing each person's individual needs and the action staff should take to meet these. Since our last inspection a new care plan format had been developed that provided more detailed information about people's needs. The home had also employed an activity co-ordinator since our last inspection and people told us that there was now more for them to do. People told us they liked living at the service and commented, "I am very happy here" and "I'm very well looked after."

Staff had received safeguarding training and were able to demonstrate that they would respond appropriately to any safeguarding concerns that they had. The relatives we spoke with said they felt their family member was safe at the service and one person we spoke with said, "I feel very safe here."

People were protected from unsafe or unsuitable equipment because the provider had taken steps to ensure that equipment was well maintained and checked at regular intervals to ensure it was in good working order.

Staff received sufficient support which included an induction to the service, regular supervision, an annual appraisal and training to ensure they were able to meet people's needs effectively.

There were effective quality monitoring systems in place.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed care, spoke with the provider and looked at the records in the home.

At the last inspection on the 3 November 2012 we found that people were not being involved in making decisions about their care or about changes being made to their bedrooms. As a result the provider told us that he was going to introduce a 'consultation strategy' to ensure that people and/or their representatives were involved in individual care planning and consulted about any changes that were to take place.

At this inspection we found that some consultation had taken place with the people who used the service and their representatives. The provider had introduced new ways of recording information to ensure that people's wishes and preferences were considered but these had not yet been implemented, this will be verified at the next inspection.

At the last inspection we also found that there were issues with the maintenance of the home. All of the concerns identified had been addressed and the provider showed us a new system of checks that he was introducing to ensure that maintenance issues were addressed promptly.

We also saw up to date certificates relating to health and safety within the home that had not been available at the last inspection.

We spoke with five people who lived at the home, the manager and one other member of staff. People were involved in their care and told us that staff treated them respectfully. However, people's wishes were not always taken into account when making decisions about their own personal space. For example, items of furniture and soft furnishings had been removed from people's rooms without consulting them or their relatives.

When we asked people about their experiences of being cared for by staff one person told us "it is very homely here" and another said "everyone is friendly". These contained details of people's needs and the action staff should take to meet them and had been reviewed regularly.

We found a number of maintenance issues at the home. There had been some redecoration but this was unfinished in places and there were risks to people's safety identified. For example, some communal areas were not adequately lit for people moving around the home independently. Equipment such as hoists used to lift people had been checked at regular intervals to ensure they were safe.

The staffing levels were adequate to meet people's needs. However, we saw that people were not engaged in activities as staff were busy supporting people with their meals and personal care. There was an appropriate system in place for people to complain if they were unhappy about the service.

People said that the staff were caring, respected their wishes and listened to them. They said that they or their representatives had visited the home prior to admission in order to see if it was somewhere they would like to live. People told us that they knew they were entitled to have a choice about where they wished to live.

Visitors we spoke with expressed their satisfaction with the way their relatives were being cared for. A healthcare professional told us that the home provided good care and that the information obtained by the manager about each person helped the staff to care for them effectively, by understanding and respecting their needs and wishes.

People told us that if they had any concerns they would feel able to speak with the manager and staff and were confident any issues would be addressed. Visitors we asked made similar comments.

People said that it was a homely environment. Visitors told us they had been encouraged to bring in belongings to make the rooms more homely and to meet people’s individual interests.