This unannounced inspection took place on 02 March 2017.

Meresbeck is a care home managed by SKR Limited. It is located in the small town of Carnforth, north of Lancaster. The home is registered to provide care and support up to a maximum of twenty people. At the time of the inspection visit there were fifteen people residing at the home.

There was a registered manager in place. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last carried out a comprehensive inspection of the service 18 and 19 November 2015. At this inspection we rated the service as requires improvement as we identified several concerns. The registered manager had failed to have appropriate systems to lawfully deprive a person of their liberty. Processes were not in place to ensure CQC was notified of all significant events. We also made a recommendation that improvements were made to the living environment to ensure it was safe and suitable for people. We carried out a focussed inspection 18 May 2016 to ensure all improvements had been made. We found the service had made all the required improvements.

At this inspection carried out in March 2017, people and relatives spoke positively about the care delivered. We observed staff being patient and spending time with people who lived at the home. People who lived at the home looked comfortable and happy in the presence of staff.

Arrangements were in place for managing and administering medicines. However, systems did not always reflect good practice guidelines. We have made a recommendation about this.

People told us staffing levels met their needs. We observed call bell waiting times and noted these were answered in a timely manner. Staff told us they had time to build quality relationships with people who lived at the home.

Staff treated people with kindness and compassion. People who lived at the home and relatives all commended the caring nature of the staff team.

People told us they felt safe and secure. Arrangements were in place to protect people from risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Recruitment procedures ensured the suitability of staff before they were employed. Staff told us they were unable to start their employment without all the necessary checks being in place.

People’s healthcare needs were monitored and managed appropriately by the service. People told us guidance was sought in a timely manner from health professionals when appropriate.

Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. People who lived at the home and relatives said they were involved in the care planning process. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Feedback on the quality of food provided was positive. People were happy with the variety, quality and choice of meals available to them. People’s nutritional needs were addressed and monitored.

Social activities were offered to people who lived at the home. We saw a variety of outside agencies visited the home to provide entertainment.

We saw improvements had been made to the living conditions at the home. The registered manager told us the refurbishment programme was ongoing. Certificates viewed showed us premises and equipment were appropriately maintained.

The registered manager had a training and development plan for all staff. Staff told us they were provided with relevant training to enable them to carry out their role.

Systems were in place to ensure people who were deprived of their liberty were done

We carried out an unannounced comprehensive inspection of this service on 18 and 19 November 2015. At this inspection breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Meresbeck on our website at www.cqc.org.uk

This unannounced focused inspection took place on 18 May 2016.

Meresbeck is a care home managed by SKR Limited. It is located in the small town of Carnforth, north of Lancaster.

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.

There were sixteen people residing at the home at the time of the inspection.

The service was last inspected on 18 and 19 November 2015. At this comprehensive inspection we found the registered provider was not meeting all the fundamental standards. We identified a breach to Regulation 13 of the Health and Social Care Act 2014 as the registered provider did not have systems in place to lawfully deprive people of their liberty. We also identified a breach to Regulations 16 and 18 of the Care Quality Commission (Registration) Regulations 2009 as the registered provider had failed to report notifiable events to the Care Quality Commission.

Following the comprehensive inspection in November 2015, we asked the registered provider to submit an action plan to show what changes they were going to make to become compliant with the appropriate regulations. The registered provider returned the action plan to demonstrate the improvements they intended to make. We used this focused inspection to look to check if the action plan had been completed and to ensure all fundamental standards were now being met.

At this focused inspection carried out in May 2016, we found improvements had been made.

Improvements to the living environment had commenced. Decoration within the building had started and unused equipment had been removed from communal areas. We were advised work to the environment was on-going. Following the inspection we asked the registered provider to send us a copy of the planned on-going maintenance plan to demonstrate when all works would be completed.

Systems had been implemented to ensure the registered provider worked in accordance with the Mental Capacity Act and followed the Deprivation of Liberty Safeguards. (DoLS.)

People who lived at the home told us they felt safe and they no longer felt their privacy and dignity was being compromised.

Systems had been implemented to ensure all notifiable incidents were relayed to the Care Quality Commission in a timely manner.

On the day of our visit we spoke with the manager, deputy manager, staff and residents. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Meresbeck.

We looked at care planning, complaint systems, meal arrangements and recruitment of staff. We also talked with residents about the home. Comments were positive and included, “The staff and manager are all caring people nothing is too much trouble.” Also, “The cook is first class, always homemade food and cakes and plenty of it.”

We found care plan records were up to date and people were happy with the service they were receiving. We found people were supported by staff who had been properly recruited and received induction training. One staff member we spoke with said, “I know all my checks had to be completed before I commenced work at the home. I had a thorough induction training period as well.”

The home had a complaints procedure which was available to residents. This was confirmed through talking with residents. It explained how to make a complaint and how this would be handled. A record of compliments and complaints was shown to us. No complaints had been received for over three years.

There were a range of audits and systems in place to monitor the quality of the service.

During our inspection we contacted the Lancashire contracts monitoring team. They told us they had no concerns about the service.

We spoke with a number of residents and one family member who was visiting. People told us that Meresbeck was a good place to live, with helpful staff and responsive management. We saw that people had a choice of how their rooms were decorated and personalised. People could chose what to eat and the two dining areas were pleasant. Visitors were made welcome. We checked a sample of care plans, and found them useful, accurate and up to date. We checked storage facilities and the safe administration of medicines and found these to be satisfactory. We talked with staff and checked training and supervision notes. Staff felt well supported and told us that the training they received helped them to do their job. We checked the quality of record keeping and found that records we saw were accurate and safely stored.

As part of the planning and site visit we spoke to a range of people about the service. Those we spoke to included, the registered manager, deputy manager people who live at the home, staff and visiting relatives. We also had responses from external agencies such as social services in order to gain a balanced overview of what people experience living at Meresbeck.

Responses from staff and people who live there were very positive and reflected how the home is run in their best interest. Comments included, "Oh we had a lovely Christmas, but its always nice living here.” Also, "It is more like one big family, most of the staff have been here for along time, so it shows we must be getting things right.”

Staff spoken to had a good awareness of individual care needs and the importance of treating people with respect and dignity. We saw evidence of this during our observations during the day and by talking to people using the service and those visiting. One person told us, "I can only say they do a really good job.”

None of the people we spoke with had any concerns or issues about the standard of care they were receiving. Three people we spoke to told us they liked living at the home and felt safe and secure. A visitor told us, "It all seems to run very smoothly and everyone seems to be well cared for." A person who lives at the home told us, "My daughter is happy I’m being looked after and she doesn’t have to worry about me.”

This unannounced inspection took place on 18 and 19 November 2015.

On the day of inspection there were thirteen people living at the home.

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.

The service was last inspected 11 February 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

Feedback from relatives and visitors was positive and people who lived at the home spoke highly about the quality of service provision on offer.

People were not always safe. We found processes for administering medicines were not consistently applied. We have made a recommendation about this.

The registered manager also failed to identify and act upon environmental hazards which had the potential to cause harm. We have made a recommendation about this.

All people had a detailed care plan which covered their support needs and personal wishes. We saw plans had been reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Observations made during the inspection demonstrated staff employed at the home were kind and compassionate and were committed to ensuring the comfort and well-being of the people who lived at the home. Activities were in place to ensure people were kept occupied throughout the day.

Staffing levels were assessed by the registered manager to ensure adequate levels of staffing were in place. The registered manager provided hands on support when staffing levels did not meet the needs of the people being supported.

Suitable arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Robust recruitment procedures were in place to ensure staff were correctly vetted before being employed.

Staff were positive about their work and confirmed they were supported by the manager. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs. New members of staff were supported through a formal induction.

Staff informed us they had received training in Mental Capacity awareness and Deprivation of Liberty Safeguards. However we noted procedures were not always followed to ensure compliance with the Deprivation of Liberty Safeguards (DoLS.) We identified one person being deprived of their liberty without legal authorisation.

During the course of the inspection we identified numerous incidents which were reportable under the Care Quality Commission (Registration) Regulations 2009. These incidents had not been forwarded as required, to the commission in a timely manner.

Privacy and dignity was not always promoted. We were informed of several incidents where people’s privacy had been compromised. We found no evidence this had been taken into consideration and actions completed following the incidents to further promote privacy. We have made a recommendation about this.

People who lived at the home, relatives and health professionals spoke highly about the way in which the home was suitably managed. Staff also praised the working atmosphere and the team work involved at the home.

People who lived at the home and relatives were encouraged to give feedback on the quality of the service through quality assurance questionnaires and residents meetings. Feedback received was positive.

You can see what actions we have asked the provider to take at the back of the full version of the report.