Meadowsweet is a small care home which provides care and accommodation for up to six adults. The service specialises in supporting people with learning disabilities. At the time of our inspection there were five people living in the home.

At the last Care Quality Commission (CQC) inspection in May 2015, the service was rated Good overall but we rated the service requires improvement for the key question, ‘is the service well led?’ We did not find the service in breach of regulations but the registered manager’s understanding of their legal obligation to submit notifications of events or incidents at the service to CQC needed to improve.

At this inspection we found the service remained Good. Improvement had been made to the well led question. The registered manager submitted notifications about events and incidents at the service without delay. We have revised the rating for the well led question to Good. The service demonstrated they met the regulations and fundamental standards.

People continued to be safe at Meadowsweet. Since our last inspection improvements had been made to fire safety arrangements in the home. The provider had also introduced new systems to check water hygiene in the home to reduce the risks to people from water borne infections. The environment was clean and staff demonstrated good awareness of the importance of infection control and hygiene in the home. The premises and equipment were regularly maintained and serviced to ensure these were safe. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people’s needs effectively. They communicated with people using their preferred methods of communication. This helped them to develop good awareness and understanding of people's needs, preferences and wishes.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

Staff were caring and treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. 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.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted. The provider ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

Further information is in the detailed findings below.

The majority of people using the service had complex needs which meant they were not able to tell us their experiences. We used other methods to help us understand the experiences of people using the service. We reviewed people's records, talked to staff, looked at minutes from residents meetings and observed the care provided. From documented reviews of people’s care needs and minutes of residents meetings we saw the majority of people were happy with the care and support they received.

During our last inspection of the service in December 2012, we identified essential standards of quality and safety were not being met in respect of Regulations 9 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following that inspection we asked the provider to take appropriate action to achieve compliance with these regulations.

The provider sent us an action plan on 7 February 2013 setting out the actions they would take to achieve compliance with these regulations. During this inspection we checked these actions had been completed.

We looked at people’s records and saw plans were in place to meet their care and support needs. Risks to their health, safety and welfare had been identified and plans were in place to manage these. From the records we looked at these had been reviewed and updated regularly so that staff had up to date information about people’s current care and support needs. There were enough staff to meet these needs.

Other records kept by the provider in relation to staff and the management of the service were kept securely and appropriately maintained.

Not all of the people using the service were able to share their views about living in Meadowsweet. We were able to speak with three people during our visit who told us the home was nice and staff looked after them. A relative told us, about one of people using the service, ‘I feel he’s in a very good place and I sleep well at nights knowing he’s looked after’. People using the service were supported and encouraged to live as independently as possible.

Although we saw that care was planned and delivered based on peoples individual needs, we found evidence that individual risks to the health, safety and wellbeing of people using the service had not been considered or assessed on a regular basis. We also found that appropriate steps had not been taken by the provider to ensure appropriate levels of staff worked in the home, particularly during the latter part of the day.

Staff received training to keep their skills and knowledge up to date. The provider carried out regular checks within the home to make sure the environment was safe for people using the service.

This inspection took place on 26 May 2015 and was unannounced. At the last inspection on 10 September 2013 we found the service was meeting the regulations we looked at.

Meadowsweet is a small home which provides care and accommodation for up to six adults with a learning disability. At the time of our inspection there were six people living in the home.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were happy at Meadowsweet. Relatives said people were safe. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Identified risks to people’s health, safety and wellbeing had been assessed and staff knew how to manage these to keep people safe from harm or injury. The home, and the equipment within it, were regularly checked to ensure they were safe. The home was free of clutter to enable people to move around it safely.

There were enough suitable staff to care for and support people. People were cared for by staff who received appropriate training and support. Staff felt supported by the registered manager and their views and concerns were listened to. Staff demonstrated they had a good understanding of people’s needs and how these should be met. Staff supported people in a way which was kind, caring, and respectful.

People were supported to keep healthy and well. Staff ensured people were able to access other healthcare services when needed. Medicines were stored safely, and people received their medicines as prescribed. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.

Support plans had been developed for each person using the service which reflected people’s specific needs and their individual choices and beliefs for how they lived their lives. Support plans gave guidance and instructions to staff on how these needs should be met. People were appropriately supported by staff to make decisions about their care and support needs. These were reviewed with them regularly.

The home was open and welcoming to visitors and relatives. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. Relatives told us they felt comfortable raising any concerns they had with staff and knew how to make a complaint if needed.

Relatives told us the service was managed well. However there was some inconsistency in the way the registered manager fulfilled their legal obligation to submit notifications to the Commission in a timely manner. This meant the Commission did not have all of the information needed to monitor how the service dealt with concerns or events that could affect the safety of people. The registered manager took immediate steps to remedy this during our inspection.

The registered manager sought people’s views about how the care and support they received could be improved. They carried out regular checks of key aspects of the service to monitor and assess the safety and quality of the service that people experienced.

The service regularly involved relevant healthcare professionals in the planning and delivery of people’s care and support. This gave staff access to best practice, research and guidance to improve the quality of care people experienced.

The manager had sufficient training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. These safeguards ensure that a care home only deprives someone of their liberty in a safe and correct way, when it was in their best interests and there was no other way to look after them.