This comprehensive inspection took place on 21 August 2018 and was unannounced. At our last inspection of the service in March 2017 we found a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made some recommendations to the registered provider about improving the quality and safety of the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good.

At this inspection we found that the provider had completed those actions and recommendations and we found the service was meeting the fundamental standards of quality and safety.

Meadowfield House Home for Older People 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. It is a modern two story building set in its own grounds with parking and a number of easily accessible, private and secure garden and seating areas. Accommodation and personal care is provided for up to 47 older people. On the day of the inspection there were 43 people accommodated across three units. Poppyfields is an 11 bedded residential care unit, Daisyfields is a 13 bedded unit mainly for residential care use and Rosemeadows is a 23 bedded unit designated as a community assessment unit that provides rehabilitation and reablement.

There was a 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.

We saw improvements had been made to the systems used in the home to ensure effective assessment and monitoring of the safety and quality of the service provided.

People received their medications as they had been prescribed. Appropriate arrangements were in place in relation to the storage, care planning and records for the administration of medicines.

There were sufficient numbers of suitable staff to meet people’s needs. However, we noted that the use of agency staff in comparison to employed permanent staff had been at times excessive. The provider was actively recruiting for staff and we saw how this was an ongoing process.

Staff had received sufficient training to safely support and care for people. However, we noted that some elements of training, mainly for newly appointed staff, were still waiting to be delivered. We saw that the provider had a training delivery plan in place which covered these aspects.

Staff were also supported through regular staff meetings, supervision and appraisals.

We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people and identified lesson that had been learned.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People living in the home were supported to access activities that were made avail

Meadowfield House Home for Older People is situated in Fulwood, a residential suburb of Preston. There is a range of shops close by and the home is on a bus route into the city centre. The home comprises of three units. Two units provide long term residential accommodation whilst the third unit provides intermediate care or discharge to assess. All bedrooms are for single use and contain a wash basin, 13 rooms are en suite. There are lounge and dining areas in each unit and outside there are two courtyards and a garden area.

The last inspection of this service took place over two days on 14 and 20 October 2014. The service was awarded a rating of 'Good’ and we identified no concerns at this inspection.

This unannounced inspection took place on 02 March 2017 and two follow up announced visits took place 06 and 31 March 2017. At the time of the inspection there were 46 people residing at the home. We undertook phone calls to staff 13 March 2017 as we were unable to speak to many of them on the inspection visits.

The registered manager of the service was present throughout 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 reviewed the audit records during this inspection .When audits had been completed we found the audit process was not always robust, as it had not picked up some issues that we found during the inspection such as issues with the cleanliness of the environment and medicines storage.

The provider had not ensured the processes they had in place to monitor quality and identify areas for improvement were effectively implemented. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We found the service was using a high level of agency staff and people who lived at the home said there were not always enough staff on duty. We have made a recommendation about this.

We found there was a range of effective assessments, which assessed the risks to people and the actions to reduce the risks. However, we found that peoples personal evacuation plans (PEEPs) were not always indicative of individual needs and placed people at risk of harm. We have made a recommendation about this.

Assessments were undertaken by management prior to any person being accepted into the service to ensure that individual’s needs could be met. However, we did see examples where these had not been completed fully. We have made a recommendation about this.

We found some issues relating to infection control procedures within the home, we have made a recommendation about this.

We checked whether the service was working within the principles of the Mental Capacity Act. We found that mental capacity had been considered however, recording was not always thorough and decision specific, we have made a recommendation around this.

We looked at how medicines were being managed during this inspection. We observed medicines administration to be safe and in line with good practice guidelines. However, we found medicines storage was not always suitable. We have made a recommendation about this.

We reviewed how the service continued to ensure people were safeguarded from abuse during this inspection. We found that people were protected from the risk of abuse because staff understood how to identify and report it.

Staff we spoke with said the training was very good and was on going throughout the year.

We found that people were supported to meet their nutritional needs and people were able to make choices about what they wanted to eat. People had a choice of what they wanted to eat and staff were aware of people’s needs.

We observed positive interactions throughout the inspection Staff approached peop

The home comprised of four units. An independent living unit providing rehabilitative care, two units providing personal care to older people and a unit for people with dementia. We spent time in each of the units at the home.

People using the service told us they were happy with the care and support they received. People described the staff as “very good” and “bang on.”

Feedback from relatives included; “He is happy here and well looked after.” And “My mother’s health has improved since she came here.”

Staff training, written guidance and good practice helped to safeguard people against the risk of abuse.

We found that medicines were securely kept, handled appropriately and safely administered.

Staff received appropriate training, professional development, supervision and appraisal. This helped to ensure care was delivered safely and to an appropriate standard.

There were effective systems in place to gain feedback about and monitor the quality of the service provided. People using the service, relatives and staff were enabled to share their views and influence how the service was run.

Risks within the home were identified, monitored and managed. Safety checks were carried out on equipment and services at the home. These measures promoted the safety of staff and people living in the home.

The home comprised of three units. An independent living unit providing rehabilitative care, a unit providing personal care to older people and a unit for people with dementia.

People in the independence unit told us that their rehabilitation programme was discussed with them and that they were fully involved in agreeing goals.

Individuals staying at the home told us that they were satisfied with the care provided by staff, with one person stating, “staff do very well.” The relatives we spoke to also expressed their satisfaction and comments included; “couldn’t be better.”

People living at the home told us that they were satisfied with the meals. One person told us;” they always ask if you’ve had enough or would like some more.” A visitor told us that her relative had specific dietary needs and could not eat certain foods and this diet was adhered to.

The people we spoke to told us that they were happy with the staff team. One person commented; “I haven’t got a bad word to say about any of them.” A relative told us that staff were “very good and caring.”

We were told that staff responded swiftly to the call bell and that waiting time was not more than a few minutes. We were also told that there was always someone available when needed. Comments included; “There is always someone around. If my bedclothes come off in the night staff put them back on” and “when I ring the bell in the night they come pretty quick.” However, there were occasions when staff left the dementia unit for short periods of time, such as for the handover period or to take washing to the laundry. The people in this unit were not able to reliably use the call bell system, should they have needed help and were at risk of harm if left unsupported.

Those we spoke to told us that they felt able to raise any concerns and were confident that they would be listened to.

The home comprises of three units. An independent living unit providing rehabilitative care, a unit providing personal care to older people and a unit for people with dementia.

We spoke to service users in each of the three units and were told that staff are polite and respectful. We observed staff responding to service users with kindness and offering choices, such as what to drink and where to sit and then supporting individuals to communicate their wishes.

We received positive feedback from service users about the staff team and the care they provide. Comments included; “I am very happy with everything, I can’t grumble,” “The staff are very kind”, “I have no complaints and if I did I would say so” and “they are good lasses, you couldn’t have better.”

We also spoke to two relatives who were visiting and although both were happy with the care provided, one relative did have concerns about staffing levels at night. We spoke to service users in each of the three units about the availability of staff. One person in the residential unit told us that during the evening people may have to wait some time to be helped to get ready for bed. Some service users in the independence unit and in the residential unit told us that there was a need for more staff to be on duty during the night. We saw evidence to show that sometimes service users had to wait for a long time for staff to attend to them, after they had used their buzzer. The length of waiting time was unacceptable.

This inspection took place over two days on 14 and 20 October 2014 and was unannounced for the first visit and announced on the second visit.

Meadowfield House Home for Older People is situated in Fulwood, a residential suburb of Preston. There is a good range of shops close by and the home is on a bus route into the city centre. The home comprises of three units. Two provide long term residential accommodation whilst the third is short term community beds, providing step up/step down facilities to hospital services and some respite care. A step up/step down service is one where people who may have been treated in an acute setting such as a hospital, are moved to a care home environment where further assessments take place to identify their long term needs. This helps free up beds in the acute setting. All bedrooms are single and contain a wash basin. There are lounge and dining areas in each unit and outside there is an attractive courtyard area.

The home is registered with the Care Quality Commission (CQC) to accommodate a maximum of 45 people. At the time of our visit there were 44 people who lived at Meadowfield House.

There was a registered manager in place. 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.

All the people we spoke with told us they felt safe and relatives described how they felt certain their relative was looked after well. We were told by one person: “Dad has lived there for about 5 years. Yes he’s quite happy and settled, feels safe and at ease”. The home had policies and procedures in place to make sure any concerns about people’s safety were reported appropriately and in a timely manner.

The provider had systems in place to ensure people received their medication from trained and competent staff. The registered manager checked to make sure staff were competent with administering medication. People we spoke with told us that they received their medication at the time prescribed.

We found there were enough suitably qualified staff on duty to meet people’s needs. People we spoke with told us there were enough staff on duty to meet their needs, whilst one relative told us: “There could always be some more staff, but [named relative] still gets help when she needs it, so there are probably enough, and there are a few replacement (agency) staff now and again”.

Staff we spoke with told us there were enough staff, although some did say that when agency staff, who had not worked at the home before were used it caused problems for them, as they had to watch them to ensure correct care was provided. The home was actively recruiting more full time staff.

We were shown training records, which confirmed staff had completed essential training for their role and to meet people’s needs. Some had completed specialist training in areas such as, diabetes. Staff we spoke with confirmed they received regular training and supervision.

Policies and procedures were in place to guide staff in the use of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS are legal safeguards to protect the human rights of those people who may lack the capacity to make certain decisions for themselves. Staff we spoke with had a good working knowledge of this legislation and during our inspection we saw this put into practice.

Meadowfield house had systems in place to identify people who were at risk of poor nutrition and to make sure that the kitchen staff knew about people’s specialist requirements. People’s weight was monitored and action taken if concerns were raised. We saw that people were offered choices and where people required assistance with eating and drinking they received this support in a gentle and unhurried manner.

Peoples’ on going healthcare needs were met. A number of health and social care professionals worked on site at Meadowfield House and where required referrals were made and involvement sought form GPs, dentists and other health care professionals.

People we spoke with constantly told us throughout the inspection that staff were kind, caring and compassionate towards them. We observed good interaction between staff, people who lived there and their relatives. We saw people were treated with dignity and respect.

A full and individual assessment of people needs took place which formed the basis for a person centred care plan. We saw that people and their relatives had been fully involved in this process as well as any subsequent reviews of care.

Relatives and visitors were openly encouraged and a range of activities was provided to support people to remain engaged and involved in the community.

People we spoke with knew how to make a compliant or raise concerns. We were told that complaints and concerns were dealt with in a timely manner. Records we looked at showed this to be the case.

All the people we spoke with told us the registered manager and management team were friendly, accessible and approachable. There was good informal and formal communication processes in place. We were told about meetings for residents, relatives and staff, which gave people opportunities to have their views heard. Staff told us they were happy working at Meadowfield House.

The registered manager and the management team had an ambition to constantly improve the service provided. We found a range of audits in place to monitor and improve the quality and safety of the service. Many of these were person centred and innovative. For example regular checks on people’s appearance.

There was oversight and internal inspections by the organisation and regional manager, as well as external audits by accreditation schemes.