Little Meadows provides accommodation and personal care to older people some of whom are living with dementia. At this inspection, they were supporting 16 people.

There was no registered manager in post at this inspection. 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 were supported throughout by the head of care and the registered provider.

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

Little Meadows required improvements in how services were managed. People were not fully involved in decisions about their home or informed about changes. There had been no registered manager since May 2014; although a manager had been recently recruited they were yet to start work or register with the Care Quality Commission. Quality monitoring systems and staff support systems needed to be improved to ensure good care continued to be provided overall.

People remained safe as staff knew how to recognise and respond to concerns of abuse. There were enough staff to support people to meet their needs as they wished. The provider followed safe recruitment procedures when employing new staff members.

People continued to receive care that was effective and personalised to their individual needs and preferences. They were assisted by a staff team who had the skills and training to effectively support people.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. Staff were aware of current guidance which informed their practice and people’s rights were protected by the staff who supported them.

People received support that continued to be caring and respectful. They were supported by a staff team that was compassionate, thoughtful and respectful.

People’s privacy and dignity was respected by the staff that provided assistance. People were supported at times of upset and distress.

People continued to be involved in developing their own care and support plans. When changes occurred in people’s personal and medical circumstances, these plans were reviewed to reflect these changes.

People’s individual preferences were known by staff members who supported them as they wished. People and their relatives felt comfortable to raise any concerns or complaints.

Further information is in the detailed findings below

The inspection took place on 4 November 2015 and was unannounced.

Little Meadows provides care and accommodation for people who require support with their personal care for a maximum of 20 people. There were 19 people living in the home at the time of the inspection.

A registered manager was 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 2008 and associated Regulations about how the service is run.

People’s risks were assessed in a way that kept them safe from the risk of harm. Where possible people’s right to be as independent as possible was respected.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available to meet people’s care needs. Staff were trained to carry out their role and the provider had plans in place for updates and refresher training. The provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff understood people’s ability to make decisions and give consent.

People’s health needs were monitored and referrals to health care professionals had been made in a timely way. People had enough to eat and drink and were supported with their nutritional needs.

People told us that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld.

People received care and support how they wanted it and felt informed and involved in their care.

People had opportunities to be involved in hobbies and interests that were important to them. Activities and entertainment at the home were well managed.

The provider had a complaints procedure available for people who used the service. People and families thought that the manager was approachable and that complaints were appropriately managed.

Staff felt able to raise concerns about poor practice knowing that they would be supported to do so and felt supported by the registered manager.

The registered manager had systems in place to monitor and improve the service.

Appropriate records had not always been maintained in respect of care plans, daily care charts, staff recruitment and information about menus. Further improvements were planned to ensure controlled medication was stored appropriately. Parts of the home were in need of  redecoration and refurbishment. There was a plan in place for this to be done.

People who lived at the home were involved in how their care needs were to be met. People told us that they were happy with the care provided and that both themselves and relatives were involved in the planning and reviewing of their care.

People told us that they have choices of how their care is carried out and that staff providing care treated them with respect and dignity. Staff had received training to ensure that the care is carried out at an appropriate standard.

People were protected from harm and staff were aware of safeguarding procedures and how to act upon any concerns if people were being abused.

The home had systems in place to protect people from the risk of infection and staff were trained appropriately.

Staff had been recruited in an appropriate way and checks had been undertaken to ensure that they were suitable to care for vulnerable people.

The home had systems in place to gain the views and experiences of the people who use the service and had acted upon any suggestions that had been made.

We spent time watching how care and support was provided and how staff communicated with people. We observed natural and relaxed conversations and interactions between staff and people. Everyone received the same caring response from care staff and were included in the activities and conversations taking place. One person told us, “Staff are lovely. They respect my independence and we respect each other.”

People’s care was planned and delivered to meet and respect their individual needs. Every person had a plan of care, based on their physical health and other care needs. People's plans described what people needed help with, what they could do for themselves and how they should be supported. A family member we spoke with told us, “All the staff have patience and compassion – all credit to them.” They also said, “The staff are very caring people, they talk to dad like a person.”

During our inspection, everybody received unhurried care and support, at the time they needed it. Our review of the staff rotas at different times over the previous months showed that minimum staffing levels identified and planned for had been met.

We found there were effective processes to record and respond to complaints and other feedback received from people living at the home and their relatives. One family member told us they had previously raised concerns and told us, “These were all taken seriously and responded to almost immediately and they did not happen again.”