This inspection took place on 22 November 2018 and was unannounced. Meadow Bank House is registered to provide personal care and nursing care for 47 people. On the day of the inspection there were 17 people living on Poppy unit who required nursing care. On Primrose unit there were 23 people, of which six required nursing care.

Meadow Bank House is a purpose built care home in the Great Lever area of Bolton. There is limited outside garden space. Car parking is available at the front of the home and on the main road. The home is close to local amenities and public transport.

Meadow Bank House is a ‘care home’. People in care home 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.

At our last inspection on 3 April 2018. We rated the service as requires improvement. We found five breaches of the regulations. These related to appropriate care and treatment, dignity, safe care and treatment, governance and staffing.

On 10 April 2018 the home sent us an action plan showing us how they planned to make improvements and a timescale for when these would be completed.

At the inspection on 22 November 2018 we found that the breaches had been met. The home was working closely with the local authority quality assurance monitoring team, safeguarding team and the Clinical Commissioning Group (CCG).

The home had 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 2008 and associated Regulations about how the service is run.

People were safe from the risks of abuse and ill treatment. Staff had undertaken training in safeguarding vulnerable people and policies and procedures were in place for staff to refer to.

People were supported by enough staff to meet their needs.

Individual care records were in place. Information reflected people’s involvement where possible and had been reviewed and updated.

People told us that activities were provided both in the home and outside in the community.

People told us, and we observed, staff treat them with dignity and respect when offering care and support. Staff were said to be helpful and caring and understood people’s individual needs and wishes.

All relevant recruitment checks were undertaken prior to new staff commencing employment.

Relevant authorisations were in place where people were being deprived of their liberty. Care records showed that capacity and consent had been considered when planning people’s care and support.

Safe systems were in place for the management and administration of people’s prescribed medicines. People had access to relevant healthcare support so that their health and well-being was maintained.

Effective systems were in place to ensure the premises and equipment were regularly serviced and safe to use. Internal maintenance checks were completed. Issues identified during the inspection were immediately acted upon so that the building was safe.

Suitable arrangements were in place to minimise the risk of cross infection.

Systems were in place for the reporting and responding to any complaints and concerns. People and their visitors said they were able to raise any issues and felt they would be listened to and acted upon. The home had received a number of thank you letters and cards.

This inspection took place on 3 April 2018 and was unannounced. Meadow Bank House is registered to provide personal care and nursing for 47 people. On the day of our inspection there were 41 people living at the home. The home is a purpose built care home in the Great Lever area of Bolton. There is limited outside space and some people would need accompanying to sit outside safely. Car parking is available at the front of the home. The home is close to local amenities and is on a main bus route.

Meadow Bank House 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 home had a registered manager in place. 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 last inspection in September 2015, we rated the service as good. At this inspection we found that the service had deteriorated and was in breach of five regulations. This was because people living at the home did not receive appropriate care and treatment; were not provided with sufficient activities; their dignity was not always maintained; and were not safe in relation to health, safety and welfare. We also found that records were not accurate and the staffing levels were not always sufficient.

We asked people if they knew who the registered manager was in case they wished to speak with her. One person said, “I don’t think I have seen her, she’s very busy”. Another said, “Yes she does a good job”. A third person told us, “I’ve seen her but she doesn’t come round everyday”. A relative said, “The manager comes to see her [person who used the service]”.

Some staff told us they felt they could be better supported by the management team and that they did not always feel they were listened to and any concerns they raised were not taken seriously.

We asked people if they thought the home was well run. Comments included: “They [staff] are trying their best”. Another said, “It’s alright, it would be good if they had a few more carers”.

We looked at the Key Clinical Indicators Summary for February 2018. We were told this was an audit that was undertaken monthly. The document identified such things as; incidence of pressure ulcers, weight loss, falls, use of bedrails and infections. We were told the audit helped the registered manager and senior management to assess the safety and quality of their service.

We saw that the service was meant to ensure regular checks and audits were carried out. However, the audits were ineffective or inadequate as they had failed to pick up the concerns found during the inspection.

Three care records showed there were gaps of several months between reviews of the risk assessments. For one person the mattress checklist should be have been completed daily by the day and night staff. This was to ensure that the bed setting was correct for the individual. We only saw three dates of checking, namely, 30 and 31 of March and 1 April 2018 were recorded. This meant that the checks had not been carried out as required and the provider could not be assured that the mattress setting was correct, posing a risk to the person using i.e. found gaps in some of the weekly /monthly checks. For example, on one record of daily tasks to be completed we saw this had not been completed since 27 March 2018. The weekly checking of fire extinguishers and fire blankets had not been completed since 2 January 2018.

We saw that certificates were in place for the maintenance of the gas and electrical testing, testing of small electrical appliances (PAT), water testing, lifts and hoists. There

Meadow Bank House is a two storey purpose built home which is situated in the Great Lever area of Bolton and is close to local amenities. All rooms are single occupancy with en-suite facilities. The home is registered to provide accommodation for up to 47 adults, who required personal or nursing care. This was an unannounced inspection that took place on 02 September 2015. There were 40 people using the service at the time of the inspection.

We last inspected the home on 19 November 2013. At that inspection we found the service was meeting all the regulations we reviewed.

The home had a manager who was registered with the Care Quality Commission who was present on the day of the 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 of the Health and Social Care Act and associated regulations about how the service is run.

People who used the service told us they felt the home was a safe place to be. People were happy with the care and support they received and they spoke positively of the kindness and caring attitude of the staff.

We found people were cared for by sufficient numbers of suitable skilled and experienced staff who were safely recruited. We saw staff had received training and support to enable them to do their job effectively and care for people safely.

The service had appropriate safeguarding policies and procedures in place for staff to follow. Staff we spoke with were able to demonstrate their understanding of safeguarding issues and the whistle blowing procedures. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

We found the system for managing medicines was safe and we saw how the staff worked in cooperation with other health and social care professionals to ensure people received safe, appropriate care and treatment.

We saw risk assessments were in place for the safety of the premises. All areas of the home were clean and well maintained. Procedures were in place to prevent and control the spread of infection.

People’s care records contained enough information to guide staff on the care and support required. The care records showed risk to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk.

Staff we spoke with had a good understanding of the care and support people required. People looked well cared for and there was enough equipment available to promote people’s comfort, safety and independence.

People were offered a well- balanced and nutritious diet with a choice of meals available. Drinks and snacks were readily available throughout the day.

We saw arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), these provide legal safeguards for people who may be unable to make their own decisions.

The provider had systems in place to ensure that people received safe and effective care; systems were in place to monitor the quality of the service provided. Regular checks were undertaken on aspects of running the home and there were opportunities, such as meetings and questionnaires for people to comment on the facilities of the service and the quality of the care provided.

During this review we visited Meadow Bank House. We spoke with the registered manager, deputy manager, two care staff, two relatives and nine people who live in the home.

People spoken with confirmed they were treated with dignity and respect and were overall happy with the standard of care provided.

Comments received from people using the service included: “I’m being looked after”; “I’m perfectly happy living here”; “I’m alright. I have no concerns. The staff are always helpful and friendly”; “In an ideal world it would be nice to have more staff as they work very hard but my needs have always been met”; “The carers are great. The care is fantastic and staff are always available when needed” and “There is no place like home but I cant complain about this place. It’s the next best thing. The manager and all the staff have our best interests at heart.”

Likewise, feedback received from visitors included: “I have no worries. In my opinion there are sufficient staff and they are always smiling and helpful”; “I have always been kept up-to-date on any changes and this is reassuring” and “So far the service provided has been fabulous.”

We found a newly refurbished home that was clean, bright and airy. We found that people were cared for in single rooms and had the choice of eating in their rooms or in one of two dinning rooms, one on each floor. We saw that staff used two hot trolley's to take the food to the dining rooms and served the food direct from the trolley after probing to ensure the correct temperature.

We found the dining areas were bright and inviting and people were given the choice of where they wished to sit.

We found there was a choice of menu and the chef visited people the day before to discuss their requirements and preference of meals. We saw that wine was offered to people in the evening alongside other beverages.

People told us: "The food here is good". "I have been here four years and have never had a bad meal, sometimes I don't fancy what's available and they will find me something else". "I have porridge for my breakfast and my supper it's like being at home".

We spoke with relatives of two people. They told us: "We have been very impressed with how the home has communicated since X has been here". "I have had no concerns at all, I am always kept up to date" and "The carers are wonderful, I have no complaints".

People who used the service told us :

“I have no complaints, the girls are great. They look after me very well”.

“I can’t complain, the staff are good”.

“I am looked after ok but don’t see anyone very much”.

“My room is clean and tidied, I have no complaints”.

“I have no complaints about the cleanliness of the home”.