About the service: Lower Meadow provides accommodation and personal care for up to 69 people. It provides care to older people, some of whom are living with dementia. Care is provided in four separate units over two floors. Each unit has their own lounge and dining room. At the time of our visit 30 people lived at the home as there had been a placement stop for 12 months and nobody had been able to move into the home.

People’s experience of using this service:

•Changes in managers meant there had been no consistent leadership at the home.

•The provider was working towards a service improvement plan (SIP) to address the issues that led to the placement stop being imposed. Improvements in practice had not been consistently maintained when managers changed.

•Due to the high level of vacant rooms and significant changes in the staff team, we were not able to determine whether staffing levels would remain effective when the home was fully occupied.

•Improvements needed to be embedded into the culture of the home under the new manager and with the new staff team to ensure they would be sustained, particularly when new people started to move to the home.

•Overall medicines were managed safely and people received their medicines as prescribed.

•Staff had received safeguarding training and knew how to keep people safe protecting them from harm or abuse.

•People’s risks to safety and well-being were assessed, recorded and reviewed to reduce the risk of avoidable harm occurring.

•People made decisions about their care and were supported by staff who worked within the principles of the Mental Capacity Act 2005.

•Staff were suitably skilled to meet people’s needs.

•People received enough food and drink to meet their dietary requirements.

•People had access to healthcare as and when required.

•Care plans focussed on people’s individual needs so staff could provide a personalised response to those needs.

Rating at last inspection: At the last inspection the service was rated as good. (The last report was published on 22 August 2017).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service is now rated as ‘Requires Improvement’ overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an unannounced comprehensive inspection of this service in August 2016. At that inspection we found one breach of the Health and Social Care Act 2008 (Registrations) Regulations 2009 and issued a 'requirement notice' to the provider, requiring them to make improvements in how they informed us about specific events that was a part of their legal responsibility. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the regulations.

We undertook this focused inspection on 24 July 2017 to check that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lower Meadow on our website at www.cqc.org.uk. At the time of our visit 56 people lived at Lower Meadow.

At this inspection, we found improvements had been made. This meant the provider was no longer in breach of the regulation. We decided to review the key question of whether the service was well led.

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.

Staff were complimentary about the management of the home and said they worked well as a team. Due to the re-development of the provider’s other homes, some people and staff had recently been relocated to, or away from Lower Meadow, as other homes re-opened following refurbishment.

Staff and management felt the transfer of people and staff into Lower Meadow mid-July 2017 had gone well and was well co-ordinated. People, staff and families were consulted and involved in discussions around the transfer between services.

Staff who had been relocated felt supported by the new staff team and said they worked well together. Staff said the integration was ‘seamless’ and some staff were positive of the provider who supported them with travel arrangements to their new place of work.

Staff said Lower Meadow was a home they were proud to work in and said moving people from one of the other homes planned for re-development had a positive impact on people’s health and wellbeing.

People and relatives had opportunity to share their views and feedback, for example at planned meetings and staff said the registered manager was approachable, listened and was supportive.

The provider completed regular checks to ensure they provided a good quality service and looked at ways to ensure the service continuously improved. The registered manager understood their legal responsibilities to submit to us relevant notifications in a timely manner. Complaints were dealt with in a timely way and learning took place to ensure similar complaints did not reoccur.

The inspection took place on 30 August 2016 and was unannounced.

This service was last inspected on 30 June 2014, when Lower Meadow was registered to provide accommodation and personal care for up to 47 people. We found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Lower Meadow reopened in May 2016 following a redevelopment and is now registered to provide accommodation and personal care for up to 69 older people, including people who are living with dementia. At the time of our inspection 58 people lived at the home.

The home is required to have 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. At the time of this inspection the home had a registered manager in post. Since our last inspection, there has been a change of registered manager. The new manager registered with us in May 2016 when the home reopened.

People enjoyed living at Lower Meadow and they considered it their home. People received care that enabled them to live their lives as they wished and people were supported to remain as independent as possible. People were supported to make their own decisions and care was given in partnership with their wishes.

Care plans contained relevant information for staff to help them provide the individual care people required, however care plans were not reviewed on a regular basis. People’s care and support was provided by a consistent, experienced and knowledgeable staff team who knew people well.

People were encouraged and supported by a caring staff team. People told us they felt safe living at Lower Meadow and staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions to take if they had any concerns for people's wellbeing or safety.

Staff received training to meet people’s needs, and effectively used their skills and knowledge to support people and develop trusting relationships.

People were supported to pursue various hobbies and leisure activities which enabled them to strengthen and build relationships within the home and wider community. Potential risks were considered positively so that people did things they enjoyed and kept in touch with those people who were important to them. Where potential risks to people's safety were identified, some of these were not always effectively monitored to make sure people remained safe and well cared for.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided.

People told us they could raise concerns or complaints if they needed to because the registered manager and staff were always available and approachable and people were confident they would be listened to.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. Some of these audits had not identified the improvements we found during our inspection visit. We found the reporting of some statutory notifications relating to serious incidents was not always effective. We found some serious incidents we should have been made aware of before the inspection visit, had not been completed and sent to us.

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.

This inspection was completed by one inspector. We spoke with five people and two relatives of people who used the service. We also spoke with the registered manager, the Regional Care Director and three staff who provided care to people who used the service. During our inspection we also spoke with a district nurse and a community nurse who visited people who used the service. The evidence we collected helped us to answer 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 using the service, their relatives, their friends and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: “Oh yes, the staff are really good”. Another person told us: “I am very well looked after because the staff are smashing.” A relative we spoke with said they were pleased with the support and care their relatives received.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager and staff were able to describe when an application should be considered and who should be involved in the process. The registered manager told us that there was no one in the home that required a DoLS assessment. The registered manager was aware of the recent High Court ruling and was seeking guidance from the relevant authorities to see what impact this had on the service. We saw records that showed a number of staff had received training in mental capacity.

The home was clean and tidy with no unpleasant odours. The registered manager had cleaning schedules in place which made sure people’s rooms and communal areas were regularly cleaned. People and relatives we spoke with told us they had no concerns about the cleanliness of the home or their relatives’ room. A person told us: “My room is cleaned every day, what more could I want.”

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

Employment records showed the provider had an effective system in place that made sure people received care from staff that were suitably qualified, experienced and fit for work.

We looked at a variety of records. Examples of the records we looked at were people’s care plans, risk assessments, daily records, audits and quality questionnaires. We found these records were available and were stored safely and securely.

Is the service effective?

People had an individual care plan which explained what their needs were. Risk assessments were regularly reviewed but did not always reflect current risks. We found two examples where the risk assessments did not reflect people’s current health needs. The registered manager told us they would make sure these were reviewed without delay. We spoke with two relatives who told us they had been involved in their relative’s care planning and were also involved in care plan reviews that had been completed.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff who provided care at people’s preferred pace. Staff were kind and attentive and responded appropriately to people’s requests. Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, diabetic specialists and district nurses.

The service had systems in place to monitor the quality of service people received. Relatives meetings had been held and any improvements to the service had been made.

Staff said they had a handover at the start of each shift to update them of any changes in people’s care needs since they were last on duty. Staff told us this helped them understand people’s current care needs and what levels of support people needed.

People told us that concerns were listened to and acted on. People and relatives told us the staff and managers were very approachable.

Is the service well led?

The service had an effective system in place that assured them of the quality of service they provided. The service completed checks and sought the views of people who used the service. The registered manager acknowledged they needed to improve their records so they could evidence what measures they had taken that led to an improved service.

When we visited Lower Meadow we spoke with ten people who used the service and two relative’s to obtain their views about the home. We also spoke with two visiting professionals, the manager, the deputy manager, the area manager, three care staff, the chef and a member of the administration staff.

People who lived at the home told us, “I am happy here, it’s nice” and “They look after me very well.”

We saw staff were kind and attentive when they delivered care to people. We saw people were supported and encouraged to maintain their independence.

We looked at four people’s care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. They told us they had not had a formal meeting with the manager on a one to one basis since January 2013.

We found the service was well led and had systems in place to monitor the quality of service provided at Lower Meadow.