About the service:

Meadowside 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.

Meadowside is registered to accommodate a maximum of 10 people at any time. It is a respite service, offering occasional overnight stays for people with learning disabilities, who usually live with family members or carers. Meadowside provides access to respite support for 84 people in total. At the time of the inspection there were six people staying at the service, one was on long stay placement, meaning they were living at the service until a more suitable place could be found.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People were encouraged to be a part of the local community; attending clubs, the library, pubs, visiting local shops, cafes, swimming pools and gyms. People were supported to move on to supported living services to become more independent.

Since the last inspection, where we found four breaches of regulations, we found that improvements had been made so the service was no longer in breach and now met the characteristic of good in all areas.

¿ People were provided with the support they required. People and their relatives/carers took an active role in developing their care and support plans and these were reviewed each time a person revisited the service to ensure information was up-to-date.

¿ We asked people if they felt safe and they nodded. Relatives told us that they felt their loved ones were safe and well cared for.

¿ There were safeguarding and complaints information in easy read and pictorial form for people and the information was communicated to people in resident's meetings.

¿ Risks to people were identified and mitigated. Since the last inspection, the fire system had been completely replaced and new fire doors had been fitted throughout.

¿ New positive behaviour training and support plans had been implemented so staff had a greater understanding of people's behaviour and how to manage and overcome it safely.

¿ There were enough staff who had appropriate training to support people and it was clear to see that people felt relaxed and comfortable in the company of staff. Staff knew people well and we saw agency staff and staff who had little contact with people previously reading people’s care plans and communication aids before they met them.

¿ People had access to medicines which were stored safely and checked by staff. People were encouraged to take their medicine independently.

¿ Incidents and accidents were investigated and learnt from so the risk of reoccurrence was reduced.

¿ People received the necessary support when they were physically or mentally unwell as staff worked closely with medical professionals and people's relatives/carers.

¿ People had a choice of what they had to eat and drink. Refreshments were available throughout the day and people were encouraged to make their own drinks and help prepare meals.

¿ The environment was adaptable and met people's needs. It was clean, and the premises had been redecorated throughout.

¿ People's privacy and dignity were respected.

¿ Personal independence was promoted, and people were challenged to try new things and learn new skills.

Rating at last inspection: At the last inspection we rated the service requires improvement. (Published 1 March 2018).

Why we inspected:

Scheduled inspection based on previous rating of requires improvement.

Follow up:

We will continue to moni

This inspection took place on 9 January 2018 and was unannounced.

Meadowside 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.

Meadowside is registered to accommodate up to 20 people. It is a respite service, offering overnight stays for people with learning disabilities, who usually live with family members or carers. Meadowside provides respite support for 84 people. At the time of the inspection there were six people staying at the service, two were on long stay placement, meaning they were living at the service until a more suitable place could be found.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to at least good. At the last inspection there were five breaches of regulations.

The provider had not always assessed and managed risk to people, had failed to ensure any supervision and deprivation of liberty was lawful, people were not always enabled to make choices and receive care as they preferred. The provider had not ensured there were enough staff on duty, staff did not always have appropriate supervision, support and training. The provider had failed to assess, monitor and improve the quality of the service and maintain accurate records for each person using the service. At this inspection some improvement had been made but there continued to be breaches of regulations and the action plan had not been complied with.

The service had a new registered manager in post, who had started working at the service in October 2017. A registered manager is a person who is 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.

At the previous inspection we identified that the care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service had been built to support up to 20 people. At this inspection, the registered manager told us that the service would now only be supporting a maximum of 12 people. The building was being redesigned to provide a more inclusive environment for people.

At our previous inspection the registered manager had told us that the provider’s maintenance department was slow to respond to requests for works to be completed. At this inspection we found that essential maintenance works to keep people safe in the event of a fire had not been completed in a timely manner. Regular checks and audits had been completed on the environment and equipment to make sure they were safe.

Previously risks to people’s health and safety had not always been assessed and there was not detailed guidance in place to mitigate risks. We found that there had been no improvement. There was no detailed guidance for staff to mitigate risks when supporting people to mobilise. Staff did not consistently record or monitor people’s behaviour. Staff did not complete incident forms when incidents had occurred, analysis had not been completed to reduce the risk of the incidents happening again. There was no detailed guidance for staff to follow to manage people’s behaviour.

At the last inspection, staff had not received the training and support they required to complete their role effectively. Improvements had been made, however, further improvements were needed. Staff had not received training to meet people’s specific

This inspection was carried out on the 13 and 15 September 2016 and was unannounced.

Meadowside is registered to provide accommodation and personal care for up to 20 people. It is a respite service, offering overnight stays for people with learning disabilities, who usually live with family members or carers.

People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

Downstairs there was a kitchen, dining room, activities area, lounge and several bedrooms and bathrooms. Upstairs there were more bedrooms and bathrooms, and a small lounge.

At the time of the inspection there were nine people staying at the service. Two people were there on a long stay placement, meaning they were living at the service until a more suitable place could be found.

The service had a registered manager in post. A registered manager is a person who is 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.

Some people needed support to communicate. Although they had communication books to assist them to make their needs known staff did not use them. We saw one person sign to staff that they would like a drink and staff did not act or understand what they wanted. There was a lack of accessible communication within the service so it was not always clear to people who would be supporting them. People with more complex needs were not given choices in a way they could understand, about what they wanted to eat.

Staff did not always treat people with respect. Staff discussed a personal, private matter in front of people.

Medicines were not always stored safely and at the correct temperature. Some medicines had specific storage requirements and these were not always adhered to. Thickener powder, used to thicken people’s drinks if they had difficulty swallowing, was not stored safely. There was a risk that people could pick it up and accidentally swallow it.

Staff did not consistently record or monitor people’s behaviours. We saw three different staff members react in a different way to one person’s behaviour, as there was a lack of guidance for staff to follow. Sometimes staff did not complete incident forms when incidents occurred meaning further analysis was not done to look to reduce the chances of them happening again in the future. Staff did not update people’s care plans and risk assessments when their needs changed.

Some people needed help with eating and drinking or moving safely. People’s care plans explained how to manage these risks and ensure that people received the care they needed to minimise the risks from occurring. Other risks, such as those relating to unstable health conditions such as epilepsy were not assessed fully.

There was a number of staff off sick. People told us that they sometimes did not ask staff for assistance as they were aware of the high sickness levels. Some people needed one to one support but staff were engaged in other tasks so were unable to provide this level of care at all times. We saw some people becoming distressed and staff not responding immediately as a result.

People and their relatives told us they were not always able to go out as much as they would like. One person liked to go out but needed extra assistance from staff so did not go out as often as they would like. People were engaged in a variety of activities on the day of the inspection, including a music workshop and craft activities.

Due to the high levels of staff sickness, staff had not had regular one to one meetings with their manager or team meetings to discuss any issues and reflect on their practice. Staff received training on key topics such as safeguarding; however, some

We considered the evidence we had gathered under the outcomes we inspected. We spoke with three people who use the service, two members of staff and the person in charge, as the manager was not on duty. We also looked at six support plans and records related to the management of the service. Our inspection team was made up of one inspector. We used the evidence to answer five questions we always ask.: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People told us that they felt safe. Safeguarding and whistleblowing procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the provider to maintain safe care. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At the time of inspection, no-one was subject to Deprivation of Liberty Safeguards authorisation.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that care plans reflected their current needs.

Is the service caring?

We spoke with people who live at the service. We asked them for their experience about the staff that supported them. Feedback from people was positive, for example one person said, "I don't have anything negative to say. I enjoy living here". Another person told us, "I love it here. I can do what I want".

People who live at the service and their families were asked to complete a satisfaction survey by the provider. These were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The home worked well with other agencies and services to make sure people received care in a coherent way.

People knew how to make a complaint if they were unhappy.

People engaged in a range of activities both in the home and in the wider community.

Is the service well-led?

The service operated a quality assurance system which identified and addressed shortcomings. As a result, a good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

We spoke with three people staying at Meadowside for respite care. They told us “The staff are good”, “I have a choice of two meals every mealtime”, “I really like it here; I get to choose my room. The staff are friendly and talk to me about what I want to talk about”, “It’s very relaxed and laid back here”.

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. There was also strong evidence on people’s records that staff advocated for people and involved outside agencies as required.

Care records showed that peoples’ views had been considered when planning their care. People told us that staff always asked their permission before helping them with care tasks and this was supported by written records.

People told us that they had choice within the unit. We could see from the records that care was planned and information from family and outside agencies helped plan this care.

We saw that medication was stored correctly and there was a procedure in place. Storage areas were meticulously clean and medication records were up to date.

From speaking with staff and inspecting records relating to training and supervision we concluded that staff were supported. As the needs of the people staying in the unit were increasing, there was a need to provide specialist training.

Record keeping relating to people using the service needed attention; there were inconsistencies on care records and out of date information.

Some of the people living in the home were unable to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Some people using the service expressed that they were happy. They were participating in activities which they were enjoying.

We saw that people were responsive in the company of staff. They were able to let staff know what they wanted and we saw staff responded in a caring and positive way.

People using the service told us that they enjoyed staying at the home. They said the staff were polite and respectful.

People said: "I can get up and go to bed when I like, I go out as much as possible, everything is 'A1' here". "The staff support me to do what I want". "I've got everything I need here I would recommend the service".