Green Meadows is a residential care home providing care and accommodation for up to 42 older people, including those living with dementia. The service also provides short stays for people following discharge from hospital. There were 42 people using the service at the time of this inspection.

The inspection was unannounced and was carried out on 30 November and 9 December 2016.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. The assessments were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

We received very positive feedback about the service, the managers and staff. People and their relatives often felt the managers and staff went out of their way to support them in a kind, caring manner and went above and beyond what was expected to meet their needs. In particular, the managers and staff were skilled at supporting people at the end of their life and worked hard to ensure both the person and their relatives were looked after well at a difficult time.

The managers and staff understood the importance of involving people and their relatives in their care and providing care that was personalised to their individual needs.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

The service was responsive to people’s needs and staff listened to what people said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People were confident they could raise concerns or complaints and that these would be dealt with.

People and, when appropriate, their families or other representatives were involved in discussions about their care planning. People were encouraged to provide feedback on the service provided both informally and through a survey questionnaire.

People and their relatives spoke positively about how the service was managed. Staff felt supported by the management to raise any issues or concerns. The quality of the care and treatment people experienced was monitored and action taken to promote people's safety and welfare. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

During our visit we spoke with six people who lived at the home and two relatives visiting at the time. The registered manager was on annual leave on the day of our inspection. We spoke with a deputy manager and three members of staff. The service manager also visited the home and spoke with us. We also spoke with a visiting GP, a local authority care manager, and the local safeguarding team.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

The people we spoke with had no concerns about the support they received. People and their relatives told us about their satisfaction with the home and told us they felt safe. One person told us, “I feel safe here. I’m not worried about anybody who lives here or the staff.” We saw that care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had assessment tools in place to assist staff in establishing the level of risk for people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The home was working with a social worker on a DoLS application for one person. We saw there were suitable arrangements to ensure people were protected from the risk of abuse.

There were arrangements in place to deal with foreseeable emergencies. The service had a business contingency plan to deal with any short or long term emergencies such as loss of electrical power or loss of gas supply. The home had a contingency plan should the home become uninhabitable and people could not return to the home after an evacuation.

Is the service effective?

Each person had a plan of care and support. These explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required. However, the home did not have effective systems to regularly assess and monitor the quality of the home's care planning and reviews.

We observed staff supporting people. The care staff we spoke with were aware of the needs and preferences of people they cared for, and how people wanted their care to be delivered. We saw staff offering advice and support, enabling people to make their own choices and decisions. One person told us, “I feel well and I've gained weight. You can't fault the [staff] or the food.”

Is the service caring ?

We saw people being treated kindly and with dignity and respect. Care workers spent time chatting with people and responded promptly to people’s request for assistance. Staff had a good understanding of people’s needs. People described their satisfaction with the home. One person told us, "I like it here.” Another person said, “I’m quite happy here.” A visiting GP told us, “The people matter to the staff. They seem concerned about people.”

We heard staff speaking to people respectfully and staff using people’s preferred form of address. All of the people we spoke with told us the staff’ were kind and patient in their approach.

Is the service responsive?

Staff responded promptly to peoples’ requests for assistance. People had regular reviews of the care and support they received. However, not all people's records were updated promptly.

We saw people were able to participate in a range of activities. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service were asked for their views about how the home was meeting people’s needs, and any concerns or ways to improve the service were acted on.

Is the service well led?

The relatives of people who lived in the home told us they had regular contact with the home and said they could speak to a member of staff at any time. They told us they were kept informed about any issues which affected their relatives.

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These included the provider conducting regular audits including health and safety, inspections of the home’s equipment, and inspections of the property. However, people’s care records were not always reviewed in accordance with the home’s policy.

Staffing levels were assessed monthly by the registered manager. The provider also had a system in place to monitor staffing levels.

On this occasion we did not speak to people about their experiences as we were following up on compliance actions which related mainly to paperwork. We spoke to the registered manager and the deputy manager.

At the last inspection we found that there were minor shortcomings in relation to medicines, quality monitoring and record keeping. During this inspection we found that the home had made improvements in all these areas and were now compliant.

During our inspection we spoke to two relatives, three visiting professionals, three people who live in the home and the two members of staff. We also spent time in the main lounge observing how people were treated and cared for by staff.

We found it to be a very relaxed home where people and staff knew each other well and genuinely cared about each other. For example, a staff member who was going home because they were ill popped into the lounge to say goodbye. One of the people living in the home took her hand and showed her concern. We also saw examples of people living there showing concern for each other as well as chatting and laughing together. People told us about the activities in the home and were proud of some of the craft work that they had been supported to create. Relatives told us they had no complaints but could talk openly to the staff and management about anything. They gave examples of how their loved ones had "Improved" since moving in.

We saw that in general the practices for storing and administering medicines were safe. People we spoke to said they received their medicines on time and trusted the home to do this for them. However, improvements were required to ensure full compliance with this outcome.

We also found that although the home had very good quality assurance processes in place they were not always effective in ensuring that the paperwork was always accurate and up to date. We have also asked for improvement in these areas.

We spoke to three people living at the home in private and four people collectively in the lounge during our inspection. We also spoke to two staff privately as well as the registered manager and a deputy manager.

We found the home to be a relaxed and friendly place where the staff had a good rapport with people living there. We saw they chatted and joked with them as well as discussing upcoming events and enquiring after their well being. People told us it was a nice place to live and they were consulted and respected.

We found that improvements had been made since the last inspection and this meant people had more detailed and accurate information on their care files.

Staff told us they enjoyed their jobs, morale had improved and they felt supported by the management team.

Not all of the records we saw were accurate and up to date. Although there was no evidence of this impacting on the people living at the home, we have asked for improvements in this area as it poses a risk to people.

People said they had no complaints and they felt safe in the home. They said they were consulted on their care and there was a nice atmosphere in the home.