This unannounced inspection took place took place on 8 August 2017. The service was last inspected in March 2015 and we rated the service Good. At this inspection, the service continued to be rated Good.

Meadowbanks Care Home provides accommodation and personal care to 40 older people. At the time of our inspection, 35 people were using the service.

A registered manager was 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 told us they felt safe living in the service. Risks to people, such as falls, were identified and managed to support people as safely as possible.

The service had made improvements in medication management following recommendations we made at our last inspection. People received their medicines safely from staff who were trained to do so. Medicines were recorded correctly after they were administered.

The premises were safe, clean and regularly maintained. Some damage had occurred to the building and the provider had taken action to resolve the situation and ensure people and staff were safe.

Staff received training on how to keep people safe and were able to describe the actions they would take if they had any concerns about people’s safety. The provider also had a whistleblowing policy which staff were aware of and they knew how to report on concerns they had.

The provider had safe recruitment procedures in place and carried out checks on new applicants. There were enough staff working at the service to meet people’s needs.

Staff were supported with regular training, meetings and supervision. Staff work performance was reviewed on a yearly basis. Staff told us they were not fully confident in meeting the needs of people who exhibited behaviours that posed a risk to themselves and other people.

The provider had systems in place to support people who lacked capacity to make decisions for themselves. Staff received training about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We have made a recommendation about seeking further guidance and additional training for staff on the MCA and managing behaviours that challenge the service, for further staff development.

Staff ensured people had access to appropriate healthcare treatment and that their nutritional needs were met so that people’s health and wellbeing was maintained.

Staff were aware of people’s habits, routines and preferences. People were treated with dignity and their choices were respected. Staff encouraged people to be as independent as possible.

People received personalised care and support, to ensure their individual needs were met. They were encouraged to participate in activities and pursue any hobbies and interests.

People and relatives were able to make complaints and they were confident their concerns would be addressed and investigated. They were also able to make compliments and suggestions to the management team.

Staff felt supported by the management team. The provider had systems in place to monitor the quality of the service provided to people. The registered manager and the provider worked well together to ensure improvements were made.

We carried out an inspection of Meadowbanks Care Home on 20 March 2015 and the inspection was unannounced. Following concerns shared with the Care Quality Commission we carried out a responsive inspection at 12.45am on 22 April 2015. We found no evidence to corroborate the concerns raised with us.

The last inspection took place on 31 January 2014 and found that Meadowbanks was meeting the regulations in relation to outcomes we inspected.

Meadowbanks Care Home provides accommodation and support with personal care to older people. At the time of the inspection they were providing personal care and support to 36 people.

There was a registered manager at the service 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 2008 and

associated Regulations about how the service is run.

Information relating to medicines was not always recorded correctly. We found that medicine had not been administered however the reasons for this were not clearly documented.

The home had comprehensive policies and procedures relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. DoLS ensure people who receive support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

People and their relatives told us they felt safe at Meadowbanks and that they were happy with the level of care and support they received. The service followed a person centred approach in the delivery of care which was tailored to people’s individual needs.

Comprehensive systems were in place to maintain people’s safety. We saw that risk assessments were in place and that staff were aware of the whistleblowing policy and the different signs of abuse and who to report concerns to.

Records indicated that people’s lives had been documented taking into account where possible people’s preferences regarding the care they received.

We observed staff interacting with people in a kind, respectful and compassionate manner ensuring that people’s privacy and dignity were maintained at all times. One person told us ”Nothing’s too much of a problem to the staff” and a relative told us “Magnificent, cannot fault them [staff], they treat mum with respect”.

Audits were carried out by the registered manager in relation to health and safety, fire safety, medicines, risk assessments and food safety, to ensure the service provision was regularly monitored and any areas of improvement were acted upon.

Staff received training on moving and handling, health and safety, medicines, falls prevention and dementia to carry out their job effectively.

We inspected this service in November 2013. We found that the arrangements for the care and welfare of people was not adequate. We also found that medicines were not being managed appropriately. On this visit we found improvements had been made.

We found that improvements had been made in both areas. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We found care plans had improved. Individualised risk assessments had been recorded and staff understood peoples care needs. People told us that staff had a good understanding of how to meet their needs.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Medicine audits had been carried out since our last visit. We found systems in place to report medicine errors.

Most people we spoke with told us they were happy with the care and support provided. One said "I am treated well" and "I am more than satisfied here." However, one relative said that the home was not meeting their relative's needs. We found that care plans were in place, but these did not contain a full assessment of people's needs or how to meet those needs. People had access to health care professionals including GP's and district nurses.

The service had procedures in place for safeguarding vulnerable adults and dealing with complaints. Staff we spoke with were aware of their responsibilities with regard to safeguarding vulnerable adults. People who used the service told us they felt safe living there. We found that robust staff recruitment procedures were in place which included obtaining employment references before staff began working at the service. Medication was stored securely. However, we found instances of poor practice with regard to medication record keeping.

People told us that Meadowbanks was a good place to live and that staff were kind. One person told us “I’ve been here since it opened and the staff are great, they do their best for us”. Another person told us that the doctor visited them and that they felt their care needs were being met. This was typical of what was said to us. We also spoke to relatives who told us that they felt Meadowbanks offered a good standard of care.

Although care needs were being met we found that issues of capacity were not being addressed. There was a lack of understanding of how issues of mental capacity applied to people with dementia. People’s nutritional needs were being met and people were safeguarded against the risk of possible or potential abuse. There was suitable staffing to meet the needs of people and checks were in place to assure people’s safety and welfare.