This unannounced inspection took place on 19 and 20 October 2016.

Meyer House Nursing and Residential Care Home is a care home service with nursing for up to 34 older people. There were 28 people using the service at the time of our inspection.

We previously carried out an unannounced inspection of this service on 29 December 2013. At that inspection we found the service was meeting all the regulations that we assessed.

The service had a registered manager in post. 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.

At this inspection we found that staff knew how to keep people safe. People who used the service told us they felt safe and that staff and the registered manager treated them well. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service which were up to date and included detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents, and to prevent them happening again. The service had arrangements in place to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff on duty to support to people when required. Staff supported people so that they took their medicines safely.

The provider had taken action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. However, we saw the provider had not completed the monitoring forms for the supervisory body as required. As a result of the inspection feedback, the provider reviewed systems and procedures to ensure any conditions placed on people’s DoLS authorisations were complied with and we noted that there was no negative impact on people who used the service.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

People or their relatives where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing. Staff prepared, reviewed, and updated care plans for every person. The care plans were person centred and reflected people’s current needs.

Staff supported people in a way that was kind, caring, and respectful. Staff also protected people’s privacy, dignity, and human rights.

The service supported people to take part in a range of activities in support of their need for social interaction and stimulation. The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

There was a positive culture at the home where people felt included and consulted. People and their relatives commented positively about staff and the registered manager. Staff felt supported by the registered manager.

The service sought the views of people who used the services, their relatives, and staff to help drive improvements. The provider had effective systems in place to assess and monitor the quality of services people received, and to make improvements where required. The service used the results of audits to identify how improvements could be made to the service. However, we found that the provider had not notified the Care Quality Commission (CQC) of the authorisations of Deprivation of Liberty Safeguards (DoLS) as required. As a result of the inspection feedback, we saw the provider had notified the CQC

People who used the service told us they were happy with the service they received. People told us that the staff were good, and information was provided to help them to make an informed decision about their treatment. One person said: “nothing is too much trouble for the staff”, and another said: “the staff are helpful and friendly”.

People told us they were always treated in a respectful manner, and the staff knew them well and understood how to attend to their needs. Everyone we spoke with said that the staff communicated well with them, explained what they were doing and involved them in decisions about their care. People said they felt safe and well cared for.

The staff understood how to keep people safe and understood their responsibilities for reporting concerns if necessary. There had been concerns expressed by one family regarding the care of their relative. This had been investigated by social services and action had been taken by the provider to ensure that people were safe and well cared for. Staff were supported to provide care safely through training and supervision, and said they felt supported by the management. Record keeping was well maintained although some records such as signing of care plans were not up to date.

At the time of our inspection there were 28 people using the service. During our visit we spoke with four people who use the service and four staff. We also spoke with a student nurse, district nurse and two relatives of people who use the service.

The people who use the service told us they enjoyed living at the home and that the staff were friendly and knew what they liked. They said that they could choose to be involved in activities if they wanted to and always had food that they liked. We saw staff being respectful towards people and talking to people in a friendly and caring way. Relatives and people who use the service said they felt there were enough staff to meet people’s needs and the staff confirmed that there was good teamwork.

Risks to people were minimised through staff understanding of abuse issues and what actions they needed to take if they suspected abuse.

People told us that staff are lovely.

People told us that they were happy with the care and staff were very kind, caring and professional.

A relative told me that the care and communication is very good. Staff always find time to sit with people.

Most people were happy with the food and told us that the cook would always offer to make something else if there wasn’t something on the menu they fancied to eat. People said that they looked forward to bacon and eggs at the week-end.