This inspection took place on 10 April 2018 and was unannounced.

Meadow View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Meadow View accommodates up to 60 people in one purpose built building. All room had en-suite facilities and there was an enclosed garden. There were 54 people living at the service at the time of the inspection.

There was a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission to manager 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 last inspected the service in February 2017. We found two breaches of regulations, the provider had not provided staff with detailed guidance to mitigate potential risks and maintain accurate, complete and up to date records for each person. At this inspection, some improvements had been made, however, this had not been sustained and embedded and there were continued breaches of regulations and an additional breach.

At this inspection, improvements had been made regarding the guidance that staff were given to mitigate risks when people were living with health conditions such as diabetes. However, not all potential risks had detailed guidance for staff. Some people displayed behaviours that may challenge and had additional health conditions that affected them during the night, staff did not have detailed guidance to be able to support people consistently and keep them safe.

Previously, accidents had not been recorded accurately and analysed to identify trends and patterns. The registered manager had recorded all accidents and there was detailed analysis including what action had been taken and lessons that had been learnt. The registered manager had not transferred this practice to the recording and analysis of incidents. Incidents involving people, who had displayed behaviours that challenge, had not been recorded consistently and there was no overarching analysis to identify triggers and create a management plan.

The provider and registered manager completed audits of the quality of the service. These audits had not been effective and had not identified the shortfalls found at this inspection. Some records such as care plans did not always contain accurate information. Some people’s care plans contained contradictory information about how people mobilised and the consistency of the diet they should eat. We observed staff not providing equipment to support people to eat independently, the need for the equipment was written in their care plan.

The registered manager attended meetings with registered managers from the providers other services to share ideas, learning and best practice. Staff received training and this was up dated as required, staff had not received training in specific health conditions such as Parkinson’s disease and had not received training in managing behaviours that challenge.

People, relatives and staff told us there were sufficient staff on duty to meet people’s needs, agency staff were used to cover any shortages. However, during the inspection, we observed that one person appeared not to have received the care they needed. The registered manager agreed that the person had not received a good standard of care and would investigate the incident.

People, relatives, staff and stakeholders were asked about their opinions of the quality of the service. The responses had been mainly positive; however, concerns had been raised about the lack of activities. People and relatives told us that there were not enough activities to take part in. Some analysis of the surveys had been completed and the regis

The inspection was carried out on 8 and 9 February 2017 and was unannounced.

Meadow View is a residential care home without nursing for up to 60 people living with dementia and/or physical disability. Meadow View is a purpose built care home which is situated in a quiet residential area of the village of Hersden. Accommodation and facilities are on two floors. There are several lounges and separate dining rooms. There is a large landscaped garden with raised flower beds and a sun terrace on the top floor. People’s bedrooms have en-suites facilities with a wet room. At the time of the inspection here were 39 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in 2016 and a new manager had been appointed in November 2016. The new manager had applied to the Care Quality Commission to be the 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.

Risks to people’s safety and behaviour were assessed but further detail of how to manage these risks safely and consistently were not always recorded. Details of accidents were not recorded accurately by staff, the information recorded was analysed to identify trends and to reduce the risk of a further occurrence.

People told us they felt safe living at the service. Staff had received training on how to keep people safe and knew the action they needed to take to report any concerns if they suspected abuse. The management responded appropriately when concerns were raised and liaised with the local authority to make sure people were safe.

People’s finances were protected as there were systems in place to ensure that people’s money was accurately recorded and checked.

Environmental and health and safety checks were carried out by staff to ensure that the premises were safe and equipment, such as hoists, were in good working order. The systems in place to record accidents were not always completed accurately to show how these were being monitored and what action had been taken.

Regular checks were carried out on the fire alarms and other fire equipment to make sure they were working properly. A fire risk assessment was in place and fire drills were carried out with all staff so they knew what to do in the event of a fire. The information in the personal evacuation plans for each person were not sufficient as they detailed instructions to staff to tell people what to do but people living with dementia may not be able to do this safely.

The service had an ongoing recruitment drive to ensure that there was enough staff to meet people’s needs. There had been a considerable amount of new staff, including the manager, deputy manager, and senior staff. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed. Systems were in place to ensure that people were recruited safely but not all staff had two references on file.

Staff received the training they needed to have the skills and competencies to perform their role. New staff received induction training which included shadowing more senior staff. Staff said they were supported by the new manager who worked with them to make sure people received the care they needed.

People received their medicines safely and when they needed them. The staff monitored people's health needs and sought professional advice when it was required. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services.

People were supported to have a healthy and balanced diet. Their nutritional needs were assessed and when required appropriate referrals to