The inspection took place on 15 March 2017 and it was unannounced.

Meadow View is a single storey purpose built residential home which provides care to older people including people who are living with dementia. Meadow View is registered to provide care for 42 people. At the time of our inspection there were 31 people living at the home. Meadow View also provides a personal care service to people living in six individual bungalows situated next to the home, registered separately by the same provider. At the time of our visit, these bungalows were unoccupied so no care provision was provided.

Meadow View was last inspected in May 2016 and was rated as ‘requires improvement’. We returned to check if required improvements had been made in the reporting of safeguarding incidents and the overall governance and management of the home. At this inspection, we found improvements had been made.

There was no registered manager at the home, but a manager had been in post since December 2016. They were in the process of completing their registration with CQC. 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 and relatives were complimentary about the care and support they received. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were encouraged to make their own decisions where possible and care was given in line with their expressed wishes. People were supported to maintain relationships and keep in touch with those people who were important to them.

Care plans were detailed and contained accurate and up to date relevant information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions as well as reviewing their care to ensure it continued to meet their needs.

Where people were assessed of being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities and had time to refer to people’s records to ensure they continued to provide safe and effective care. Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

People’s care and support was provided by a consistent, trained and caring staff team and there were enough available staff to be responsive to their needs. People told us they felt safe living at Meadow View and relatives were confident their family members received safe care and treatment. Staff knew how to keep people safe from the risk of abuse. Staff understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

Some people were supported to pursue various hobbies and leisure activities and people had enough activities to keep them stimulated. The manager had plans to improve the activities programme to make it more person focussed and to better support those people living with dementia.

People had meals and drinks that met their individual requirements and people who required it, rece

This inspection took place on 14 June 2016 and was unannounced.

Meadow View is a single storey purpose built residential home which provides care to older people including people who are living with dementia. Meadow View is registered to provide care for 42 people. At the time of our inspection there were 29 people living at Meadow View. Meadow View also provides a personal care service to people living in six individual bungalows situated next to the home, registered separately by the same provider. At the time of our visit, these bungalows were unoccupied so no care provision was provided.

This service was last inspected on 9 May 2015 and we found two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. Breaches were found regarding a lack of mental capacity assessments and we found quality assurance systems were ineffective to monitor improvements. At this inspection we looked to see if the home had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found some areas of improvement had been made, for example with the completion of mental capacity assessments for people who lacked capacity, we found some improvements were required in other areas of the service although not serious enough to have breached regulations.

This service had a registered manager in post at the time of 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 and associated Regulations about how the service is run.

People told us they felt safe living at Meadow View and staff knew how to keep people safe from the risk of abuse. However, we could not be certain that we or the local authority had been notified of all potential safeguarding incidents that occurred at the home.

Staff knew what support people required and staff provided the care in line with people’s care records. Care plans contained relevant information for staff to help them provide the individual care people required. We found people received care and support from staff who had the knowledge and experience to provide care for people.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained and experienced staff.

Staff supported people’s choices and understood how the Mental Capacity Act (MCA) 2005 protected people who used the service. Staff understood they needed to respect people’s choices and decisions and where people had capacity, staff followed people’s wishes. Where people did not have capacity to make certain decisions, decisions were made on people’s behalf, sometimes with the support of family members. Where people did not have family or friends to help them with some of their decisions, independent mental capacity advocates provided support.

Deprivation of Liberty Safeguards (DoLS) are used to protect people where their freedom or liberties are restricted. The provider had submitted 14 DoLS applications to the authorising body which had been approved. These applications meant people’s freedom was restricted and provided protection to those people. The provider said they would continue completing further DoLS applications for other people whose freedoms may be restricted to see if this was the least restrictive method.

People told us they were pleased with the service they received. People felt comfortable to raise concerns but did not always know, who to discuss them with.

Staff told us they were not always confident the provider listened to them or addressed their concerns. Staff felt supported by each other and felt there was a good team spirit. Staff felt valued by the registere

We completed a follow-up inspection of this service as we previously found non-compliance in cleanliness and infection control and records on the 9 April 2013.

We spoke with the manager, three care workers and three relatives of people using the service. The manager and care workers told us of the new infection prevention practices, policies and procedures in place at the home. We also saw evidence of these practices were being followed during our inspection and saw that the home was clean and people well cared for. The three relatives we spoke with told us the home had been clean and was well maintained. One relative identified two infection prevention concerns which related to incidents she had witnessed. The manager was informed of these incidents so that they could ensure these practices were not repeated by staff.

We saw improvements had been made by the manager in relation to the completeness of people’s care records. Information was available relating to people’s care needs and risks. We pathway tracked these documents and found that the care plans and associated risk assessments had been followed in the two people’s records we reviewed. However, we did note that some gaps of information remained in some of the documentation. This meant that people could be at risk if not all their information is present.

We spoke with the manager, nine staff, five people using the service and two relatives. People said they liked living at the home. Some comments were: ‘’Nice living here; staff are very nice’’

People's needs had been assessed, risks identified and personalised plans of care developed for each person. We saw that people and / or their relatives had been involved in their care and that where needed consent had been obtained. We saw that people's ongoing healthcare needs were met.

The home was seen to be clean and well maintained. We observed that not all the systems identified within the PrimeLife Infection Control Policy were in place to ensure effective infection control. We were told by the manager that these systems were about to be put in place and that staff would be trained in these processes.

Staff identified that they felt well supported by the manager and had been able to access training to assist them within their role.

We saw that the provider had an effective system to regularly assess and monitor the quality of service people had received. We also saw a system in place which identified and managed risks.

We reviewed the records outcome as it was triggered by the inspection visit. We reviewed two people’s records and found that documented care did not always reflect current practice or there were some gaps in information relating to their care. We also observed that dates of staff training did not correspond to the staff training records.

During the inspection we spoke with the manager, two care workers and three people using the service. The people using the service told us they liked living at the home. Some comments were: ‘’Fine living here’’ and ‘Very nice living here’’ and ‘’I’m happy with the food, you have a choice of meals.’’

We saw systems in place allowing people using the service and their relatives communicate their experiences of the care provided. Positive feedback had been given about the staff and care people had received through these surveys.

People's needs had been assessed, risks identified and personalised care plans developed. There was evidence of support by healthcare professionals to ensure people's ongoing healthcare needs were met.

The two staff we spoke with and the manager said there were sufficient staff available to accommodate people’s needs. Staff training records showed minimal staff attendance at some training sessions provided during 2012.

The provider may like to note that staff appraisal was not in place. Staff appraisal is important as it supports staff and promotes their development. We saw evidence of staff supervision and were told that guidance in the form of a staff supervision policy was not available.

Although the home has a local policy on the ‘Prevention and Detection of Abuse’ we have asked that the provider may like to note that the home did not have access to the ‘Warwickshire Adult Protection Procedures’.

We visited the home on 31 January 2012 in response to information we had received. The concerns raised included; lack of sufficient laundry and protective clothing and equipment for staff and concerns that the manager was not responding appropriately to sufficiently support staff in their role.

During our visit we spoke with the manager, seven care staff which included one senior, two members of the kitchen staff, a cleaner and the laundry assistant. We also spoke with a second senior care staff member who arrived during our visit.

We spoke informally with five people using the service.

We spent time during the morning and over lunchtime observing the care and support staff were providing to the people in the home, during which time we spoke to a number of the staff on an informal basis.

We spoke with three care assistants and a member of the kitchen staff more formally as a group during the afternoon.

People using the service that we spoke with told us that they were happy and that they liked the staff.

A large proportion of people using the service were unable to express clear views about their experiences so we spent some time observing the care and support they received.

The majority of people that were not so easily able to give us their views appeared content and relaxed.

We saw that the staff were busy providing care to people. Staff we spoke with told us that they did not have time to do anything other than meet people’s basic care needs “We are doing the best we can but want to do more.”

We looked at a sample of people’s care plans to see what information was available to staff to ensure that individual care needs were met. We saw that they were well ordered, with current information that was being evaluated and reviewed as necessary.

We also looked at the systems in place for the management of medication to ensure that people were not placed at unnecessary risk. We saw that on the day of our visit the systems in place for managing medication were safe.

Prior to our visit we were told that sometimes there were shortages of sheets and towels delivered from the external laundry service. A laundry delivery and collection was in progress when we arrived at the home. On the day of our visit we did not see any shortages.

During our visit we saw that staff had access to appropriate personal protective equipment including all sizes of gloves.

We were told by the manager and the four members of staff that we spoke with that staff did not receive regular supervision however the views as to the reasons for this were conflicting. The manager told us that staff appeared worried or intimidated by the thought of supervision, whilst the staff that we spoke with told us that they would welcome more supervision.

The manager told us that she was aware of the need to do more formal supervision with staff.

This inspection took place on 6 & 7 May 2015 and was unannounced.

Meadow View is a single storey purpose built residential home which provides care to older people including people who are living with dementia. Meadow View is registered to provide care for 42 people. At the time of our inspection there were 33 people living at Meadow View.

This service had a registered manager in post at the time of our inspection, however the registered manager was on a planned short term absence. The service was being managed for a period of time by a senior staff member. In the report, we refer to them as manager. 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.

People told us they felt safe living at Meadow View and staff knew how to keep people safe from the risk of abuse. However, we could not be sure that we or the local authority had been notified of all of the safeguarding incidents at the home. Following our inspection, we spoke with the local authority who confirmed they had not been notified of two safeguarding matters we became aware of at this home.

Most staff were caring to people during our visit, however we saw three situations where staff members were not kind and treated people disrespectfully. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent before any care was given.

Staff knew what support people required and staff provided the care in line with people’s care records. Care plans contained relevant information for staff to help them provide the individual care people required. We found people received care and support from staff who had the knowledge and experience to provide care for people.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained and experienced staff.

Staff supported people’s choices and understood how the Mental Capacity Act (MCA) 2005 protected people who used the service. Staff understood they needed to respect people’s choices and decisions and where people had capacity, staff followed people’s wishes. Where people did not have capacity to make certain decisions, decisions were made on people’s behalf, sometimes with the support of family members. However, we found no formal assessments of people’s mental capacity had been completed and records of best interests’ decisions had not been recorded or completed.

Deprivation of Liberty Safeguards (DoLS) are used to protect people where their freedom or liberties are restricted. The provider had submitted two DoLS applications to the authorising body which had been approved. These applications meant people’s freedom was restricted and provided protection to those people. The provider was in the process of completing further DoLS application for other people whose freedoms may be restricted to see if this was the least restrictive method.

Most people told us they were pleased with the service they received. Not everyone felt comfortable to raise their concerns, but those that did felt they were listened to and responses were timely.

Staff told us they were not always confident the registered manager dealt with their issues or concerns that had been brought to registered manager’s attention. Most staff told us they had little confidence in raising whistle blowing concerns to the provider because staff were not confident information would always be treated confidential.

Staff training was not up to date and this was partially due to staff having to attend some training courses on their planned days off. Staff felt unsupported by the provider in relation to training which meant people received support from staff who may not be up to date with current practices and techniques.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received, however actions and improvements were not always followed up and recorded.

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