Meadowbrook House is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 30 people living at the service. Some of these people were living with dementia. The service occupies a detached house over two floors, however, at this time people were only occupying the ground floor.

This unannounced comprehensive inspection took place on 3 July 2018. The last inspection took place on 6 June 2017 when the service was not meeting the legal requirements. We were concerned about the processes used to monitor staff training requirements, gain appropriate signed consent from people or their representatives, and how staff were provided with accurate guidance and direction on how to care and support people well. The service was rated as Requires improvement that time and we issued a requirement notice. Concerns continued to be identified at this inspection and breaches of the regulations were again identified. The service has been rated as Requires improvement for a second time.

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.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. However, the acting manager was in the process of registering with the 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 and associated Regulations about how the service is run.

People were not always protected the from risk of harm because risks were not consistently identified and managed. Risks in relation to people’s daily lives were mostly identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible. Where people had been identified as losing weight timely action was not always taken to address the risk to the person.

Records of care provided were not always completed by staff in a timely manner. Where people needed to have some aspects of their care monitored there were gaps in these monitoring records.

There were systems in place for the management and administration of medicines. It was clear that people had received their medicine as prescribed. Regular medicines audits were being carried out and these were effectively identifying if any error occurred such as gaps in medicine administration records (MAR). However, we identified some people, who did not have capacity to decide for themselves, were receiving their medicines with food. There were no records to show that guidance had been sought, from an appropriate healthcare professional, to confirm if each person’s medicines were safe to take with food.

The service was comfortable with no malodours in the corridors or communal lounges. However, an equipment storage area was very malodourous and equipment seen used by staff was not always clean. Staff did not always follow robust infection control processes.

Staff were not supported by a robust system of induction training, supervision and appraisals. This was a concern at our last inspection. The manager had a record of staff training and support, however, there were many gaps in this record where staff had not received mandatory training or regular supervision.

We spent time in the communal areas of the service. Staff appeared to know people well and had an understanding of their needs and preferences. Staff provided care and support in an unhurried manner. People told us, “Brilliant staff,” “They [staff] know me, we get on well, they pop in for a chat, they like to chat with me” and “They [staff] are good and helpful.”

The service had

This unannounced comprehensive inspection took place on 6 June 2017. This was the first inspection for the service since registering as a new provider in December 2016.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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. There was a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.

Meadowbrook House is a care home which offers care and support for up to 42 predominantly older people. At the time of the inspection there were 28 people living at the service. Some of these people were living with dementia. The service uses a detached house with two floors. There were only people living on the ground floor of the service at the time of this inspection.

The service had been operating under new ownership for five months and had recently undergone a great deal of renovation and re-decoration of the premises. New equipment and bed linen had been purchased and additional staff had been recruited.

We reviewed the systems for the management and administration of medicines. It was possible to establish that people had received their medicines as prescribed. There were no gaps in the medicine administration records. However, there was a quantity of medicines that required stricter controls which had been drawn up but not used. This was found in a locked medicine cupboard with a date on it of 8 May 2017. The registered nurse and the registered manager were not aware of the presence of this syringe. The service raised an incident investigation immediately and the service took action to amend their medicines policy to include the actions to take in such a circumstance. Internal medicine audits were being carried out to monitor the management and processes in place for the safe administration of medicines however, the presence of the syringe had not been identified.

Care staff were directed in care plans to record in specific files in people’s rooms, when they provided care and support for people. While there was no evidence that people‘s needs were not being met, some records were not always completed accurately by staff. Some skin checks, weights and food records contained gaps where staff had not recorded care that was directed in people’s care plans. Some guidance in care plans was not consistent with information provided in the shift handover records or in people’s room records. Staff told us they knew people well and often did not refer to records to check what care and support to provide. However, this meant that new staff and agency staff were not always provided with accurate information to refer to about people’s needs.

The manager held a record of staff training. This record had not been kept up to date. We requested a revised training record which showed there were many staff who required updates in mandatory training subjects such as health and safety and fire training. Some training, such as safeguarding adults and Mental Capacity Act 2005 had been planned for with training sessions advertised in the service for the coming weeks.

Some information requested by inspectors took time to be located by the manager. This was being held by the deputy manager who was not working at the service at the time of this inspection. Inspectors were also provided with inaccurate information by the manager at inspection, such as the number of people living at the service and the current status of staff training.

The manager had recently created new roles for staff with more responsibility. A head housekeeper and two senior carer