About the service: Meadow Court is a residential care home that provides personal and nursing care for up to 37 people, some of whom are living with dementia. At the time of inspection 34 people lived in the service.

People’s experience of using this service: People were supported to take their medicines in a safe way however we found a few instances where medicines were not always safely managed. We have made a recommendation about the management of some medicines.

Everyone we spoke with told us Meadow Court was a friendly and lovely place to reside and visit, that staff were kind and caring and people were treated with respect.

Recruitment processes were robust and thorough checks were completed before staff started working in the home. We saw there were sufficient numbers of staff on duty to make sure people’s care needs were met. Staff had received training and supervision to ensure people received appropriate care.

The provider and staff knew what to do to keep people safe. Individual risks had been assessed and identified as part of the support and care planning process. We saw nice interactions between staff and people who used the service. We saw staff respected people’s privacy and dignity.

People’s nutritional needs were met and the menus we saw offered variety and choice. Records showed people had regular access to healthcare professionals to make sure their health care needs were met.

A complaints procedure was in place. People and a relative told us they would have no hesitation in raising concerns. All feedback was used to make continuous improvements to the service.

The home had good management and leadership. The provider and registered manager was visible working with the team, monitoring and supporting staff to ensure people received the care and support they needed.

More information is in Detailed Findings below.

Rating at last inspection: Requires improvement (report published 1 December 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection and the provider was no longer in breach of the regulation relating to recruitment. The service had improved and is now rated good overall.

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

We inspected Meadow Court Residential Home (known to people using the service, their relatives and staff as Meadow Court) on 30 and 31 October 2017. The first day of inspection was unannounced. This meant the home did not know we were coming.

Meadow Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides residential care for up to 37 people; at the time of this inspection 30 people were using the service. The building has two floors. There are communal lounges, a TV room, a conservatory and a dining area on the ground floor, and shared bathrooms and toilets on both floors.

Meadow Court was last inspected in February 2017. At that time we rated the home as ‘Requires Improvement’ overall, as it was deemed to be ‘Inadequate’ in the key question of ‘Safe’, ‘Requires Improvement’ in the key questions of Effective, Responsive and Well-led, and ‘Good’ in the key question of Caring.

Because there had been a rating of ‘Inadequate’ in one key question on two consecutive CQC inspections, we placed the home into Special Measures after the last inspection. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager had changed since the last inspection.

Records at the home could not evidence robust recruitment procedures were in place. As the only breach of regulation identified at this inspection, this showed that whilst much improvement had been made since the last inspection, some concerns relating to governance remained.

Risks to people had been assessed and managed. This included risks posed by the building, its utilities and equipment. Staff could describe how they kept people safe from abuse.

People told us, and our observations showed, sufficient staff were deployed to meet people’s needs.

Medicines were managed safely and administered in a person-centred way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice.

Staff had access to training, supervision and appraisal in order to help provide people with effective care and treatment.

Feedback from people and relatives about food and drinks at the home was positive. People were asked to feedback about the meals they received and this was used to change the menus.

People told us, and records showed, they had access to a range of healthcare professionals to help support their holistic health needs.

Meadow Court had been adapted to better meet the needs and preferences of people who lived there.

People and their relatives told us staff were kind and caring. All interactions between staff and people we saw were polite and respectful; we also observed plenty of banter and good humour was exchanged.

Staff respected people’s privacy and dignity. They could also describe people’s likes, dislikes and personal histories in detail.

The registered manager and registered provider promoted an open and inclusive culture at the home.

People’s care plans had much improved since

We inspected Meadow Court Residential Home (known to the people who live and work there as ‘Meadow Court’) on 23 and 28 February 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming.

Meadow Court is a residential care home for up to 37 people. It consists of one building with two floors. All bedrooms are single; 29 have ensuite facilities and eight have a sink but are located near a shared bathroom and toilet. On the ground floor there are two communal lounges, a TV room, a large conservatory and dining room. Both floors have shared bathrooms, toilets and shower rooms. The home has an enclosed courtyard area with seating.

At the time of this inspection there were 32 people living at the home; two of these people were using the service for respite care.

Meadow Court was last inspected in February 2016. At that time it was rated as ‘Requires Improvement’ overall. It was judged to be ‘Inadequate’ in the Safe domain, ‘Requires Improvement’ in the domains of Effective, Responsive and Well-led, and ‘Good’ in the domain of Caring.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager, although they had recently become the activities coordinator and were in the process of deregistering as manager with the Care Quality Commission (CQC). The plan was for one of the directors of the registered provider company to apply to become the registered manager. The director was managing the home at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 care plans did not always contain measures to manage risks that had been identified. Some care plans we saw had not been updated after incidents had occurred.

Relatives had made decisions for people without the correct legal authorisation to do so. Staff

The inspection took place on 8 February 2015 and was unannounced. Meadow Court is a care home providing personal care and accommodation for up to thirty seven older people. It is located in Slaithwaite, Huddersfield, West Yorkshire. At the time of the inspection there were 33 people using the service.

The service was inspected in May 2013 and was not meeting one of the standards of the Health and Social Care Act regulations. It was inspected again in October 2013 and was found to be meeting all standards against which it was inspected.

There was 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.

Staff were aware of their roles and responsibilities in relation to safeguarding. Staff training in safeguarding was up to date.

Medicines were not administered safely. We could not see the provider had carried out any competency checks on staff who had been trained to administer medicines or completed effective medication audits.

People who used the service and staff we spoke with felt there were enough staff on duty and we observed call bells were answered in a timely manner. However, during the night when staff were busy offering personal care, there was no other staff available within the building to support people.

The accident records showed a high number of un-witnessed falls occurred during the night when there were only two members of staff on duty. Accidents and incidents had been recorded but not analysed. This meant the provider could not to establish any patterns or trends and put in plans to minimise the risk of harm.

There were no personal emergency evacuation plans (PEEPs) in place and fire drills had not been carried out on a regular basis.

We looked at the training matrix for the service and saw gaps in staff training for the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS).The registered provider was meeting the requirements of the MCA 2005 and associated DoLS.

The food looked appetising and people we spoke with told us they enjoyed the food. People had been weighed monthly and the provider had referred people with weight loss to the General Practitioner (GP).

There was a variety of activities on offer for people to take part in. In the care records we looked at we saw the people’s social preferences had been recorded.

Staff were aware and knew how to respect people’s privacy and dignity.

Management of the service was divided between the registered manager and the providers. However, we found it difficult to establish what the role of the registered manager was when the provider was involved in the day to day management of the home.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take in the full version of this report.

When we inspected this service in May 2013 we found that staff working at the home were not receiving supervision or appraisal from the manager. We said that improvements were needed.

The findings of this visit were that a programme of supervision and appraisal had been put in place.

Due to the focussed nature of this visit we did not speak with any of the people who lived at the home.

We have always received positive comments about the quality of care from people using this service. Again we were told care was good. Comments from people using this service included, "Care is good, I'd tell you if it wasn't," and "We're well looked after." The staff we spoke with also confirmed the quality of care was good and that the manager was very supportive of training.

We observed positive interaction between care staff, people using the service and visitors. On the day of our inspection it was a hot sunny day and we observed care staff encouraging people not to sit directly in the sun. The windows were open which ensured the home remained ventilated and cool. When people asked for assistance we saw that staff responded to their needs in a timely manner.

We looked at the care records belonging to three people and spoke with staff. The care records we looked at contained sufficient information which demonstrated the person's health and social care needs were being met. The care staff we spoke with demonstrated they knew these people well and the care they described corresponded with what was written in the care records.

We spoke with 10 people living at Meadow court, one visiting healthcare professional and one relative. Everyone we spoke with were very complimentary about the service. Comments included:

“Staff are very helpful you only have to say and they will do their best.”

“The food is excellent I really like the full English breakfasts.”

“The home is kept clean and tidy, and the laundry is looked after very well.”

“There are activities everyday during the week we do exercises, singing and crafts.”

“If you have to be in a home you couldn’t be in one better.”

A visiting healthcare professional told us they had a positive relationship with the staff telling us staff did not hesitate in contacting them if they had concerns about someone's health . They also told us they thought the care was excellent and they did not have any concers about the way in which people were cared for.

One relative told us they were informed when their relative had an accident and told us they felt staff were approachable.

We looked at four sets of care records and found they did not contain an accurate account of the care and support the person required. The care records were not person centred and it was unclear from the care plans what support people actually required and how they liked the support to be provided.

We carried out this inspection because we had recieved anonymous information relating to poor staffing levels and people who live at the home being got up at 5am in the morning.

Whilst we carried out the inspection we checked on progress with the compliance actions we had made at the previous inspection carried out on 3 November 2011.

We spoke to a number of people at the home and without exception they said they were very satisfied with the service they receive.

One person said ' the staff are lovely, couldn't be bette. There is always plenty on offer to do, the food is excellent'.'

One person said ' it's just like home without the housework'

One person said 'staff are very kind, they help you where you need it. The staff work hard and are busy but I never have to wait to be attended to. I can get up when I want to'.

One person said I can get up when I want to, I'm usually last to get up but nobody minds'.

People told us they were visited by the staff before they came into the home and knew the care they would receive.

During the visit we observed staff providing support to people in a sensitive and dignified way.

In the interest of people’s privacy and dignity, each person had a sign on their door indicating if they wished to be disturbed and asking staff to knock before finding out whether they were in or out.

However, people were not aware they were able to have a key to their bedroom door.

People told us they liked living at the home, the staff were kind and there was always plenty of things for them to do.

People told us,

“The food is generally good; you can’t expect to like everything”.

“The staff are very good”.

“They always ask me what clothes I would like to wear”.