This inspection was carried out over two days on the 30 January and 6 February 2018. Our visit on the 30 January was unannounced. At the last inspection on 24 and 27 November 2014, we rated the service as requires improvement overall. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medicines administration.

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service. People received their medicines safely and as prescribed by their doctor.

Meadway Court is a care home standing in its own grounds. Accommodation is provided over two floors with a passenger lift as well as stairs between the floors. The home is situated in the village of Bramhall and is close to the local shops and other community facilities. Mead way Court is registered to provide care and accommodation for up to 42 older people some of whom may also have a diagnosis of dementia. All bedrooms are single and 25 have en-suite facilities. The service offers nine recovery beds to assist people transferred from hospital to continue receiving support. At the time of this inspection the service supported 41 people. Meadway Court is one of eleven care homes owned by Borough Care Limited, a not-for profit registered charity.

At the time of this inspection the manager was in the process of applying for registration with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

We saw the food looked and smelt appetising and was attractively presented with good size portions. People told us they enjoyed the food.

From our observations of staff interactions and conversations with people living at the service, we saw staff had good relationships with the people they were caring for. The atmosphere was relaxed and people told us they felt comfortable. We observed staff being kind, patient and caring to people. We saw that people's privacy and dignity was respected.

We saw that meaningful activities were provided by the Activities and Lifestyle Facilitator (ALF) a full time activity co coordinator who based a lot of planning on people's personal preferences. The service utilised the supply of games, visiting entertainers and activities to help provide access to regular events throughout the week.

Staff understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support.

Procedures were in place to minimise the risk of harm to people using the service. Staff understood how to recognise and report abuse. This helped make sure people were protected by well trained and informed staff. People living at the service and staff spoken with said they thought safe care was provided.

People were supported by sufficient numbers of staff to support them to participate in their daily activities within their home. Staffing levels had been recently revised by the registered provider to provide senior staff and deputies on duty each day. This initiative provided access for everyone to senior leadership and consistent management of the service over a seven day period. We recommended the registered provider reviews published guidance to help them to demonstrate how staffing levels are calculated to meet people’s needs.

Staff were recruited following a safe and robust process to make sure they were suitable to work with vulnerable people.

The building was clean and well maintained. We saw st

During this inspection we checked that concerns highlighted during out last inspection in November 2012 had been addressed. We found that improvements had been made.

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We spoke with four people who lived at the home who all told us that they were happy with care and support provided.

We spoke with four family members who told us they considered the care to be good.

We found that there were systems were in place to monitor the quality of the service provided.

We found that systems were in place to ensure people were protected from the risk of harm and abuse and we saw evidence to show that people were able to make comments, suggestions and complaints with timely feedback provided by the service.

We saw that processes were in place to protect people from the risks of the unsafe use of medicines.

We spoke with six people who lived at the home who said they were happy with the care and support provided and how they were looked after. They told us that staff respected their rights, privacy and dignity. All six people we spoke with said they felt safe. Comments included "The staff are very kind, very helpful” and “they are very respectful to me.” People told us that they liked their room and that staff attended to them quickly if they used their call bells. They said they had choice and were involved in the daily activities if they wished to be.

We spoke with four family members who regularly visit the home. All four relatives said that they considered the care to be good. Comments included,” I am confident that Mum is cared for” and “It’s very good here.”

We also looked at sample of care records. These contained up to date information regarding the needs and wishes of individuals and were reviewed regularly to ensure peoples wishes and needs were accurately reflected.

During the visit the manager told us that she will review the frequency of safeguarding training to ensure that staff knowledge of external reporting procedures remains up to date.

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.

People told us that when they first moved to Meadway Court they were given information about the service, what they could expect from the service and what facilities were provided. People told us that in the main their expectations had been met.

People told us that if they wanted to spend most or all of their time in their bedrooms, this was not a problem and that they could join other people in the communal and lounge areas if they wished.

People told us that they felt staff listened to them and that had been asked questions about the way they wanted to be cared for.

People told us that staff treated them in a respectful way.

One person told us that staff were alway 'courteous' and described them as being 'very capable.'

People told us that the soups were always nice and these were all homemade.

People and visitors told us that the home was always clean and always smelled nice.

People told us they felt safe living at Meadway Court and that staff treated them well.

People told us that if they had a problem or any concerns they could speak to the manager and that she was very approachable.

People told us that breakfast was the best meal of the day, there was plenty of choice and it was a good opportunity to meet other residents.

People at Meadway told us that sometimes there was not always enough staff on duty, particularly at breakfast time.

This inspection of Meadway Court was carried out over two days on 24 and 27 November 2014. Our visit on 24 November 2014 was unannounced.

Meadway Court is a care home standing in its own grounds. Accommodation is provided over two floors with a passenger lift as well as stairs between the floors. The home is situated in the village of Bramhall and is close to the local shops and other community facilities.

The home provides personal care and accommodation for up to 42 older people. All bedrooms are single and 25 have en-suite facilities. There were 36 people living at the home at the time of our inspection. We last inspected Meadway Court on 10 May 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

The manager took up the position of acting manager in July 2014 and had been in permanent post since October 2014. At the time of this inspection visit they were in the process of applying for registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

During the inspection we observed care and support in the communal areas of the home, spoke with staff, visitors, visiting healthcare professionals and people living at Meadway Court. We also looked at care and management records.

Throughout our inspection we observed that people looked comfortable and relaxed with the staff who supported them. We observed that people were treated with respect and dignity by the staff and people told us they happy were living at Meadway Court.

There were social activities taking place if people wished to participate which included various Christmas activities over the festive period.

Visiting relatives we spoke with were positive about the care and support that was given at Meadway Court.

Visiting healthcare professionals, staff and visitors to the home all said they thought standards in the home had improved since the new manager had taken up post.

There were systems in place to monitor the quality of the service and the manager operated an open door system where people were encouraged to raise any issues or concerns they had.

We saw people enjoying a lunchtime meal. People told us generally the food was good but some people told us that the meat was regularly too tough for them and they had to choose meals a week in advance which they said was too far in advance. The manager was aware of this and was taking action to address it.

There were service contracts in place to ensure equipment and services were in good working order and safe to use.

We identified that improvements were required in relation to medication administration because the service provider was not complying with the relevant regulations. We found examples where people had not received their medication as prescribed by their General Practitioner (GP) which could have resulted in unnecessary risk or discomfort to the person.

You can see what action we told the provider to take at the back of the full version of this report.