We inspected Meadowyrthe on 23 February and it was unannounced. Meadowyrthe provides residential care for up to 41 older people living with dementia; 31 places are for permanent residents and 10 are for respite accommodation. There were 38 people living at the service when we visited. The service had a registered manager. 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.

Meadowyrthe was last inspected in February 2016 and we judged that it required improvement. At this inspection we saw that improvements had been made in most areas. Improvements were still needed because people did not always have enough social stimulation to assist them to engage in activities and interests. The provider was implementing a personalised approach to supporting people but this had not been fully embedded. Some of the records which help to ensure that people received care which met their preferences and needs were not always up to date or clear for staff. There were enough staff to meet people’s needs safely but not always to spend time supporting them socially in some areas of the home.

There were systems in place to drive quality improvement which included regular audits, developing the staff team and working closely with relatives. There was a complaints procedure in place and they were responded to in line with it, although the manager recognised that the responses could be more informative at times.

People were protected from harm because risk was assessed and actions were put in place to assist people to be safe. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They understood their responsibilities to detect and report abuse. Medicines were managed to ensure that people had them when they should and that the risks associated with them were controlled.

Staff had caring relationships with the people they supported which were respectful and patient. They knew people well and provided care that met their preferences and they ensured that they could make choices. People’s independence was encouraged and their privacy and dignity were maintained at all times.

Staff ensured that people consented to their care and that if they were unable to do this, then appropriate capacity assessments were made and decisions were made in their best interest. Mealtimes were planned to ensure that they were a pleasant experience for people and they were given a choice of meal. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk. People were supported to maintain good health and had regular access to healthcare professionals.

Staff had caring relationships with the people they supported which were respectful and patient. They knew people well and provided care that met their preferences and they ensured that they could make choices. People’s independence was encouraged and their privacy and dignity were maintained at all times.

Staff ensured that people consented to their care and that if they were unable to do this, then appropriate capacity assessments were made and decisions were made in their best interest. Mealtimes were planned to ensure that they were a pleasant experience for people and they were given a choice of meal. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk. People were supported to maintain good health and had regular access to healthcare professionals.

We inspected Meadowyrthe on 3 February 2016 and it was an unannounced inspection. This was the first inspection for the new provider. The home provides residential accommodation for people who were living with dementia. There were 29 people living there at the time of our inspection, and four people were receiving respite care.

The home had 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.

Some risks to people’s health and wellbeing had not been effectively assessed, monitored or actioned to reduce them. Some of the care that we observed was not in line with the recommended support agreed and put people at potential risk of harm. Staff we spoke with told us that they did not think that they received the training and support that they needed to assist them to do their jobs effectively. For example the staff we spoke with had an inconsistent understanding of the Mental capacity Act (2005) and people’s ability to consent to care. However, we saw that assessments had been completed for people and best interest meetings had taken place withsenior care staff to support important decisions. Some people were legally deprived of their liberty, but care staff were unclear who had a DoLS in place and what this meant to the care they received.

We saw that there were not always enough staff to meet people’s needs safely. Staff told us that they found it difficult to provide personalised care within the current staffing levels. We observed that staff were often task focussed and sometimes used language which was not about people but referred to them in terms of tasks. People also had their privacy and dignity compromised when staff spoke about them in communal areas and did not always ask for their consent before providing care and support.

The mealtime experience was inconsistent and in one dining area people had limited choice and the assistance they received was rushed and inconsistent. People and their relatives said that the food was of a good quality and anyone who was nutritionally at risk was monitored and provided with specialist diets.

Some of the care staff told us that they did not feel supported by the provider and did not think that they would be listened to if they wanted to raise concerns or suggestions. Supervision and appraisal had not happened regularly and staff did not feel that they were up to date with developments within the service. The provider recognised that there had been a period of uncertainty and transition and that systems were being developed to address this. Some audits had recently been introduced to monitor the quality of the service and although they identified some areas for improvement they had not been in place long enough to make a significant difference.

Medicines and the risks associated with them were effectively managed to keep people free from harm. Staff knew people well and care plans contained enough detail to support them. Staff were aware of how to protect people from abuse and knew how to report any concerns. Recruitment procedures had been followed to ensure that staff were safe to work with people. People were monitored and referrals were made to relevant healthcare professionals when needed to ensure they maintained good health. They had monthly reviews and relatives told us that they felt well informed of people’s changing support needs. When concerns or complaints had been raised they had been responded to in a timely manner and actions put in place to avoid repetition.

We saw that people were encouraged to pursue their interests and they were supported by volunteers and a programme of activities to do this.