Our comprehensive inspection of Meadow Lodge took place on 19 October 2018 and was unannounced. We last visited Meadow Lodge on the 23 and 24 August 2018 and following this inspection we rated the service as ‘requires improvement’. This demonstrated the provider had improved the service but due to our inspections prior to the previous one in August 2018 rating the service as ‘inadequate’ we completed this current inspection to check recent improvements were being sustained.

There were no breaches of legal requirements at the last inspection in August 2018. There were four conditions that had been imposed on the provider following an inspection in March 2018. This included, the provider to sending us an action plan each month of how they were meeting the regulations, the need for a deep clean of the premises, no admissions without CQC’s prior approval, to ensure that sufficient amounts of suitable and nutritious food should always be provided to meet the needs and preferences of people living at the home, and to take immediate action to obtain healthcare support for people with pressure sores or people losing weight. At this inspection we found the provider was meeting these conditions.

Meadow Lodge 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. Meadow Lodge is registered to provide care and accommodation to a maximum of 22 older people, younger adults and people with a diagnosis of dementia.

At the time of the inspection, there were 13 people living at the home. Two people who usually resided at the home were in hospital at the time of our inspection visit.

There was a manager in post who had applied for registration with CQC at the time 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager was present at the time of our inspection.

The provider understood their legal responsibilities, but had not formally notified us of some allegations of abuse, which were not raised by the provider, manager or staff, but other professionals. although, upon our request, had backdated these and forwarded them to us following our inspection. Systems for the governance of the service were more robust and the action plan we received from the provider following our previous inspection had been addressed. We did though identify some further areas where there was scope for improvement or resolution of issues that we made the provider/manager aware of following our inspection. With little exception, people had confidence in the manager, and were satisfied with the standard of care they received. People and staff could approach the management and express their views and these were acted upon. Staff felt supported by the provider and thought the service was improving.

People felt safe and we saw risks to people were assessed, understood and implemented by staff. There was sufficient staff to respond to people’s needs and keep them safe. Staff knew what constituted abuse and knew how to respond/report to allegations of abuse. People’s medicines were managed safely and given as prescribed. There have been improvements to the environment and these were continuing or being maintained in respect of their safety and cleanliness. New staff were checked to ensure they were safe to work with people.

People’s choice of, and the quality of the meals available had improvement, and we saw people could have more food at meals times if wished. People’s right to consent was sought by staff and any restrictions on their liberty were agreed with the local au

At the previous inspection in March 2018 we rated the service ‘Inadequate’ in the areas of Safe, Effective and Well Led. We found the provider had breaches in the regulations under 12, 15, 9, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant the service was awarded a rating of ‘Inadequate’ overall. This was the second time the service had been rated ‘Inadequate’ overall. At the inspection in November 2017, the provider was rated as ‘Inadequate’ in all five key questions with breaches in regulations 9, 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As the service was rated ‘Inadequate’ we placed the service in special measures following the November 2017 inspection. We asked the provider to send us an action plan each month of how they were meeting the regulations. We placed four conditions on the provider’s registration, telling the provider that a deep clean of the premises should be undertaken and that no-one should be admitted to the home without CQC's approval, and that sufficient amounts of suitable and nutritious food should always be provided to meet the needs and preferences of service users. In addition, we told the provider they must take immediate action to obtained healthcare support for people with pressure sores or people losing weight.

Services in special measures are 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 improvements are 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 the service. This may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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 and is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We inspected this service again on the 23 and 24 August 2018. The inspection was unannounced on the first day. On the second day of the inspection the provider and manager were informed we would return to the home. The inspection was to check on whether the provider had made the necessary improvements.

Meadow Lodge 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. Meadow Lodge is registered to provide care and accommodation to a maximum of 22 older people, younger adults and people with a diagnosis of Dementia.

At the time of the inspection, there were 13 people living at the home. Two people who usually resided at the home were in hospital at the time of our inspection visit.

There was no 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. A manager had been appointed at the home, and had applied to register with CQC as the registered manager, which was still under consideration by CQC.

We found improvements had been made at the home since our previous inspection. At our previous inspection we found the provider and registered manager did not always manage risks to

The inspection took place on 15, 16 and 23 March 2018. The inspection was unannounced. At the last inspection of the service in November 2017, the provider was rated as Inadequate in all five key questions and breaches in regulations 9, 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found that while some regulations had now been met, there continued to be breaches in regulation in other areas.

Meadow Lodge 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. Meadow Lodge is registered to provide care and accommodation to a maximum of 22 older people, younger adults and people with a diagnosis of Dementia. At the time of the inspection, there were 17 people living at the home.

There was no 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. A manager had been recruited and was in the process of applying to register as a manager.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Risks were not managed to ensure people were safe. Where risks were known, action had not always been taken as required to ensure people were safe. Infection control practices were poor and the home was visibly unclean with unpleasant smoke odours throughout the dining area and hallway. Staff were available to take care of people’s immediate care needs but did not have time to spend with people. Medicines were not always managed or stored in a safe way.

Staff had not received the appropriate training to enable them to support people effectively. People did not have access to sufficient amounts of fresh food and meals provided did not meet people’s preferences. Action was not always taken in a timely way to ensure that people had access to healthcare services when required. Staff knowledge of Deprivation of Liberty safeguards varied.

People were not always treated with dignity and were not consistently given choices in the

We undertook an unannounced comprehensive inspection of Meadow Lodge Care Home on 30 November and 01 December 2017. At our previous inspection undertaken on 20 and 21 June 2017 the provider was found to be in breach of Regulations 11,12,14,16 and 17. We served a Warning Notice in relation to Good Governance and asked the provider to complete an action plan to show us what they would do, and by when, to improve the quality and safety of service people received. This action plan was received by us within the requested time frame.

At our most recent inspection we found that improvements had been made in relation to Regulations 11 and 14, but no improvements had been made in relation to Regulations 12 and 16. The regulation specified in the Warning Notice had not been met. During our most recent inspection we also found a breach of Regulation 9, Person Centred Care.

Meadow Lodge 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. Meadow Lodge is a care home without nursing that can accommodate up to 22 people. At the time of our inspection 19 people were living at Meadow Lodge, some people lived there long term and others lived there for short periods of time such as respite care. This included a number of people who lived with dementia.

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. Meadow Lodge did not have a registered manager in post when we inspected. An acting manager had been appointed but they were not available to us throughout the inspection. During the inspection process the inspection team were supported by the provider and senior care staff.

People were not safe. Although people and relatives said they felt the service was safe, we found risks to people were not managed well and not always known or clearly understood by staff. Risks to people were not consistently assessed and therefore people were not kept safe from the risk of harm. Recording of these risks was not always evident, and in some cases the recording had not been reviewed as needed to reflect changes in people’s care needs. People were not kept safe from risks associated with some aspects of the environment. People did not have access to a safe open space. Risk assessments were not in place to support people to safely access the garden.

People were put at risk of increased infection as facilities and systems were not available for staff to maintain good hygiene People were put at risk due to poor prevention and control of infection. Bathrooms and communal areas were dirty. Medicines management had improved since our last inspection but there remained some areas of concern relating to ‘as required’ medication and when and how people were supported to receive pain relieving medicines.

Staff did not have time to spend with people, although we found that there were sufficient staff to meet people's immediate needs. Staff operated a task based approach to care. The provider operated a safe recruitment system. Staff understood their responsibility to raise concerns regarding potential abuse.

The provider had failed to ensure staff had the training or knowledge they needed to undertake their roles safely and appropriately. We found that whilst training had taken place, there were significant gaps in staff knowledge about current good practice. Some staff did not feel supported and the provider told us that supervisions of staff had not been consistently offered. We found that staff understood they needed to offer people choices and gain their consent but people told us this did

We carried out this unannounced inspection on the 20 and 21 June 2017. Meadow Lodge care home is registered to provide care to 22 older people with a variety of needs including the care of people living with dementia. At the time of our inspection 20 people were living at the home.

At our last comprehensive inspection in April 2016, we found that the registered provider was in breach of regulations. This was because the registered provider’s systems and audits had failed to identify the shortfalls we found related to staff practice and competency. These were related to the prevention of infection, compliance with the requirements of the Mental Capacity Act 2005 and protection and promotion of people’s privacy. We were advised that there were systems in place to audit the safety and quality of the kitchen equipment and routines. However, we saw that there had been inconsistencies with fridge and freezer temperatures there were no records to show what action had been taken to ensure that food storage was still safe. In addition we found that whilst feedback from people about their experiences of the home had been sought it had not been analysed or used to inform practice or to drive up improvements to the service. Following the inspection we met with the registered provider and they submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this unannounced inspection on the 20 and 21 June 2017 to check that the registered provider had followed their own plans to meet the breaches of regulations and legal requirements. Although the registered provider had started work to address the areas of improvement as identified in their plan, some actions were still outstanding or had not been completed as had been planned. The provider remains in breach of regulations as they had not taken the action required to ensure that effective systems would be in place to assess and monitor that the service would consistently deliver high quality, safe care. There were areas of further improvement required in respect of risk management, infection prevention, management of medicines, compliance and understanding of The Mental Capacity Act (2005) and The Deprivation of Liberty Safeguards (DoLS), nutrition, activities, the complaints procedure and the leadership and governance of the service.

The home had a registered manager who was present throughout 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Whilst staff knew how to protect people and reduce risks associated with their specific conditions but the management of risk was not robust. The management of infection control and prevention and the cleanliness of the environment did not protect people from the risk of harm. Staff were not consistent with their explanations of the fire evacuation procedures. The management of medicines was not robust and always safe. People we spoke with told us they felt safe living at the home. Staff knew how to report any concerns so that people were kept safe from abuse.

People’s capacity was not always assessed and considered when decisions needed to be made to ensure their rights were protected in line with legislation. The registered provider had not ensured that the staff team knew which people were subject to a Deprivation of Liberty Safeguards (DoLS).

People who lived at the home told us they were not happy with the quality and variety of food provided. People were not consistently supported by staff to access health care when needed. Health care records did not contain sufficient information and guidance for staff to follow. Staff told us that they rece

We inspected this home on 19 and 20 April 2016. This was an unannounced Inspection. The home is registered to provide personal care and accommodation for up to 22 older people. The home provides care to older people with a variety of needs including the care of people living with dementia. At the time of our inspection 16 people were living at the home and one person was in hospital.

The service was last inspected in April 2015 when we found the service was not compliant with one of the regulations we looked at. The provider did not have suitable arrangements in place to ensure people who use services were protected against the risks associated with poor standards of hygiene and infection control. We asked the provider to make improvements to the risks of infection and at this inspection we found some improvements had been made. At the last inspection we noted that systems in place to monitor the quality of the service had improved and were more effective than they had been in the past. At this inspection we found that the progress had not been consistently sustained.

The registered manager was present during our 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 found that whilst there were some systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the service was consistently well led and compliant with regulations. Audits and monitoring systems needed to be improved; these included the monitoring of medicine management in line with practice guidance, monitoring and reviews of staff practices and the prevention of infection. In addition the service had not ensured they had effective systems in place to analyse feedback from people to develop and improve the service.

You can see what action we told the provider to take at the back of the full version of the report.

Through speaking with people and their relatives we found that people felt safe living at the home. Staff were aware of the actions they needed to take to ensure people stayed safe and were able to describe risk management plans for individual people. People were supported by staff who had received training on how to safeguard people from abuse and were protected by staff who had been safely and appropriately recruited. We found that some improvements had been made to prevent the risk of infection, however further improvements were needed. Medicines were administered as prescribed, however the safe management of medicines was not always adhered to in line with good practice guidance.

Most staff told us that they were provided with the appropriate training to ensure they had the right skills to meet the needs of individual people living at the home. However, some staff told us that they did not have the appropriate knowledge or skills to support people with their specific dietary needs. People told us they were offered a choice of meals at lunchtime, but expressed their views about the lack of variety.

Staff understood the need to undertake specific assessments if people lacked capacity to consent to their care. The registered persons had not taken all of the necessary steps to ensure that people’s legal rights were being protected. People were supported to access relevant health care professionals who were appropriately involved in people’s care.

Staff were seen to be kind and caring, however there were times where people had their privacy and dignity compromised.

Some people told us that they were involved in the planning of their care and were asked how they wanted to be supported. People and those that mattered to them did not always contribute to the reviewing of care plans. Some care pl

On the day of our inspection we found that 20 people were residing at this care home. We subsequently spoke to ten people who lived there, the owner of the home, his deputy manager and five members of staff.

We found that since our previous inspection of this home, some improvements and repairs had been made. Four bedrooms had been redecorated and five rooms had been fitted with new carpets. However, it was apparent that the care home was still ‘tired’ and in need of further refurbishment. We noted that some rooms were uncomfortably warm and the previous problems relating to fluctuations in temperature had not been fully resolved.

We spoke to people about their home environment. Comments included, “I would redecorate the home, it’s tired” and “The heat is sometimes quite overpowering.”

We concluded that although some improvements had been made to the care home, the concerns raised by us at our previous inspections had not been fully rectified and people were not cared for in safe, accessible and comfortable surroundings.

We examined care plans and found that people’s needs were properly assessed and that care and support was planned and delivered in line with their individual care plans. People were complimentary about care staff. Comments included, “The staff are nice to me,” and “The staff are very good.”

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

This inspection was undertaken as part of our scheduled plan of inspections, however we also checked whether improvements had been made in relation to the areas identified on the action plan.

We last inspected Meadow Lodge in June 2011. We found that the provider had not been compliant with regulations regarding the care and welfare of people who use services, meeting nutritional needs, cleanliness and infection control, safety and suitability of premises and records. The provider and the registered manager sent us an action plan following the last inspection. This detailed the actions they would take to ensure compliance was reached.

During this inspection of Meadow Lodge we used a number of different methods to help us understand the experiences of people who lived there. We spent time with most of the people who lived at the home, spoke with all of the members of staff on duty, spoke with two visitors and spent some time with the registered manager and provider.

People told us that they were happy with how their care and support needs were being met at the home. A person that was living at the home told us “Everybody is well cared for.” However we found that arrangements were not always in place to check that people’s needs were being met.

We saw that people were relaxed and at ease with staff and within their home environment. We saw that staff interacted with people in a friendly, courteous and respectful manner.

We found that people were treated with respect and that in most instances their dignity and choices had been considered by staff. A relative of a person that was living at the home told us “Everybody is lovely and friendly. They all understand my father’s needs.”

People that were living at the home told us that, overall, they were satisfied with the choices of food provided at the home. People told us “Food is good – we have a proper chef, she is very, very good. You couldn’t want better.”

People that were using the service told us that, overall they were happy with the levels of cleanliness within the home. A person that was living at the home told us “My room is clean enough.” The findings of our inspection identified that further improvements were needed in this area.

During our review, we requested information about the quality of the service provided at the home from local authority staff involved in monitoring the home. At the time of writing this report, we had not received any feedback from them.

People we spoke with told us they are satisfied with the service they receive at Meadow Lodge. Their comments included, "The staff are kind, they help me if they can"

"It is all right here, thank you. It is not like home, but I am getting used to it."

We spoke to relatives, as not all people living at Meadow Lodge were able to share their experiences with us. Relatives said, "It is all right, staff are friendly, if you ask they will help you if they can"

"The care is all right, but the home itself is on the dreary side, it could do with sprucing up"

We inspected this home on 8 and 9 April 2015. This was an unannounced inspection. Meadow Lodge Care Home provides accommodation for a maximum of up to 22 people. There were 18 people living at the home when we visited although two of the people were in hospital. Each person had a single bedroom. Bedrooms were located on ground and first floors of the home and there was a chair stair lift fitted to one of the sets of stairs to provide access for people to the first floor. Shared shower-rooms, bathrooms and toilets were located on both floors of the home.

The home had a registered manager, who was present during the visit to the home. 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 previous inspection of this care home in November 2014 the provider was not meeting the requirements of the law in relation to staffing; obtaining consent from people and acting in accordance with the law in respect of deprivation of liberty; suitability of the premises and how the quality assurance of the service was being monitored. Following that inspection we met with the provider and manager to discuss our concerns. After the meeting the provider sent us an action plan to tell us the improvements they were going to make. During this inspection in April 2015 we looked to see if these improvements had been made in line with the action plan that had been produced by the provider.

We saw that some improvements had been made within the home, and other measures were planned, included the provision of some new furniture in the lounges and improvements to the garden and patio. Some issues related to infection control in the home were in need of attention. We found that the majority of the home, including communal rooms and peoples bedrooms, were cleaned regularly but we found that the management of infection control and some aspects of cleanliness was not protecting people from the risk of infection. This was not meeting the requirement of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.

People living at the home and their relatives told us that the staff were kind, considerate and caring. People had regular access to a range of health care professionals which included general practitioners, district nurses, dentists, chiropodists and opticians.

People’s safety and care needs were met by sufficient numbers of staff who knew how people liked to be supported and the records were mostly reflective of the level of support that people needed. Staff were trained to provide care and support and were supported to obtain qualifications to enable them to ensure that care provided was safe and appropriate.

The Mental Capacity Act 2005(MCA) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications for authority to deprive someone of their liberty The manager had ensured that referrals had been made to the authorising body (the Local Authority) in respect of people who were unable to exercise choice in respect of their ability to go out from the home safely. Whilst all staff had received training not all staff who were interviewed during the inspection were confident about how they would respond to people who were intent on exercising choice in respect of decisions which placed them at risk. Further improvements are needed to ensure that all the staff were confident about how to comply with the MCA and DoLS.

Some people told us that they were very happy at the home and were happy with the care provided. Our own observations were that people were supported by staff who were intent on making sure that people received care that met their needs in ways that they preferred. Some people preferred to stay in their own rooms and did not spend any time in communal areas of the home and we saw that staff took action to check regularly on people to ensure that they were not isolated. People who lived at the home told us that activities organised and provided met their needs although some people expressed no interest in taking part in any organised activities and preferred to watch television in their own rooms and occupy their time alone.

The systems in place to check on the quality and safety of the service had improved since our last inspection. We found the checks and audits had started to be effective at identifying issues that required improvement and this had resulted in the home running more smoothly with an improved experience for people living at the home. The current systems and plans in place to make further improvements had ensured that people who used the service and their relatives were consulted with and more involved than in the past. Staff had started to be involved in identifying aspects of the home that could be improved to better meet the needs of people living in the home.