The inspection visit took place on 21 September 2017 which was unannounced.

River Meadows is a residential home which provides care over three floors to older people including people who are living with dementia.

River Meadows is registered to provide care for 41people. At the time of our inspection visit there were 35 people living at the home.

At the last inspection, the service was rated good overall, however effective was rated as requires improvement. This was because people’s mental capacity to make certain decisions, was not always assessed and known by staff. At this inspection we found improvements were made to ensure support was provided in line with people’s capacity to make decisions.

At this inspection visit we found the service continued to be rated as Good overall however we found some improvements were needed to ensure people’s physical and emotional needs were met. People did not always have opportunity to feed into and receive support to pursue their individual hobbies and interests. Activities were planned throughout the month, however there was limited involvement for people to be supported with the things they wanted to do. For the majority of our visit, people spent time in their chairs asleep, watching each other or television with minimal engagement from staff or each other. The regional manager and regional support manager had plans to improve social engagement, especially for those people living with dementia.

There was a registered manager at the home. 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.

People and relatives were complimentary and satisfied with the quality of care provided. People were supported to remain as independent as possible so they could live their lives as they wanted.

People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes.

Care plans contained detailed and supportive information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing the care provided to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people were minimised. Staff understood people’s individual needs and abilities which meant they provided care in a way that helped keep people safe and protected.

Staff received training to meet people’s needs, and effectively used their skills, knowledge and experience to support people. Where training had not been received, training sessions were planned to ensure staff skills and knowledge remained updated.

People’s care and support was provided by a caring staff team and there were enough trained and experienced staff to meet their care needs. People told us they felt safe living at River Meadows and relatives felt involved in their relations care because they were kept informed about important changes. People were supported to maintain important relationships with family and friendships had been built between people living in the home.

Staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge ensured people received consistent support when they were involved in making some decisions. Staff always gained people’s consent before they provided care and support and families w

This service was inspected by a single adult social care inspector. In order to answer the questions below we spoke with twelve people in the service, one relative and viewed three people's care records. The service had forty one beds.

If you wish to look at our findings in detail please see the full report.

We used this evidence to answer the questions below. If you wish to look at our findings in detail please see the full report.

Is the service safe?

There were sufficient staff to meet the needs of the people in the service. Staff were trained to recognise safeguarding alerts and had the skills and experience needed to support people well.

Staff personnel records contained all information required. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support people who used the service.

Staff were trained to recognise safeguarding alerts and confident to raise concerns to the manager.

Care records were retained in secure areas and only accessed by authorised staff.

The premises were secure and the environment was people were living in was clean.

Is the service effective?

Each person had an individual care plan which detailed their needs. People said they were happy. Staff had a good understanding of people’s welfare. One relative told us, "They are all so very kind and good at their jobs.” Staff training was designed to meet the needs of the people living at the service.

People told us that they were happy with the staff support that was in place. Staff had a good understanding of people’s care and welfare and knew people well. One relative told us, "They are all so very kind and good at their jobs here, I cannot speak highly enough of them.”

There was a safe procedure for recruiting staff and for making sure they had the skills and knowledge to support people in this service.

Is the service caring?

People were supported by kind and attentive staff. Staff demonstrated patience and respect when supporting people.

People told us they were able to do things at their own pace and were not rushed. Our observations throughout the visit confirmed this.

One person told us, “They never rush me, even when I’m a little slow sometimes.”

A relative told us "We have no concerns at all, because everyone is so kind.”

A survey that had been sent to families was complimentary, with comments such as, “Staff are always helpful and polite” and, “the care given by everyone is wonderful”.

Is the service responsive?

People’s needs had been assessed before they moved into the service.

Care records reflected people’s individual needs and described staff interventions. This ensured that care and support was provided in accordance with people’s wishes.

People told us they met with their key workers once a month to update their care plans if necessary.

People had access to activities that were important to them and had been supported to maintain relationships with friends and relatives whenever possible.

Is the service well-led?

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Staff had a good understanding of the aims of the service.

Clear quality assurance processes were in place, including regular audits, monitoring of complaints and surveys.

People’s personal care records were accurate and complete. All risks had been assessed, and safeguards put in place where necessary.

Staff told us they were clear about their roles and responsibilities.

Staff were regularly supervised by senior staff.

Some of the people who lived at River Meadows were unable to express their views verbally, so we spent time observing how staff supported them. We were however able to speak with eight people who used the service to obtain their views.

We also spoke with a visiting professional, the manager and five care staff on the day of our visit.

We saw people’s care files contained detailed information about people. These were up to date and had been regularly reviewed.

People told us they felt safe at River Meadows. One person said “Oh yes, I feel safe here.” Staff demonstrated good knowledge about how to keep people safe.

We saw training records and we found care staff had received up to date training in key areas such as how to move someone safely. Staff told us they were well supported by their manager.

We saw systems were in place to monitor the quality of care at River Meadows.

We carried out an inspection at River Meadows. The visit was unannounced so that no one living or working in the home knew we were coming.

Some of the people who lived at River Meadows were unable to express their views verbally, so we spent time observing how staff supported them. We were however able to speak with six people who used the service to obtain their views.

We also, spoke with three relatives, a visiting professional, the manager, the operations manager and five care staff on the day of our visit.

We saw consent to care and treatment had been signed by either the person who used the service or their representative.

People who used the service and their representative told us they had been involved in their care planning or that of their relative.

We saw people’s care files contained up to date information and these had been regularly reviewed.

People and their relatives told us they felt safe at River Meadows. They said “Care staff are nice to me and not rude.”

We looked at training records and we found care staff had received up to date training in key elements such as safeguarding vulnerable people. We were told by care staff that they met regularly with their manager. We saw records which confirmed this.

Systems were in place to monitor the quality of care at River Meadows. These included a weekly ‘drop in’ surgery operated by the manager and regular monthly audits, for example medication checks.

We visited the home on 23 January 2012 in response to concerns raised with the commission regarding the home’s management of people with pressure areas, medication administration and the staff’s ability to care for people with behaviours that may be challenging.

We spoke with the manager, one of the senior care staff, five care staff, a member of the kitchen staff and two relatives of people living in the home. We also spoke with one of the local district nurse team that visited the home on a regular basis to care for people with a pressure area, or other clinical needs.

We looked at people’s records and care plans to see what directions were available to offer to staff to ensure that people received their care in a safe way and that met their individually assessed needs. We also looked at the home’s systems to monitor the administration of medication, to ensure this was done correctly and safely.

Due to the needs of some people living at the home who were unable to verbally share their experiences, we spent time observing the support given to people and how they spent their day.

Although some people were unable to give clear views on whether they were satisfied with the care provided for them at River Meadows, we noted people appeared to be content, with very little sign of people being distressed.

We spoke with three people in their rooms and some in the lounges and dining areas. We asked about how staff provided stimulation or activities as we saw some people were asleep in front of a television set. The manager said that that day was a pamper day as the hairdresser was in the home. We did see one person in their room reading a newspaper and some ladies in the hairdressing room having their hair washed and set.

One person we spoke with in their room appeared unhappy, not understanding why she was where she was. We saw staff interacting positively with her, offering reassurance.

We spoke with the relatives of one person living at the home, who said they were regular visitors at different times of the day and were very pleased with the home. They told us; “Mum’s very happy here.

Staff spoken with were knowledgeable about people’s needs and how to care for people in a way that they preferred.

The district nurse told us that staff informed her promptly when there was a concern and followed instructions given. She said that if she had any concerns she would discuss this with the manager who always responded appropriately.

We asked staff and visitors about the quality of the food, and watched lunch service. We asked relatives if they felt that there was sufficient choice. They told us; “Mum is always offered a choice, on two plates, so she can make a choice there and then what she wants”.

Staff spoken with were aware of the special diets required by certain people.

This inspection took place on 19 & 20 May 2015 and was unannounced.

River Meadows is a three storey purpose built residential home which provides care to older people including people who are living with dementia. River Meadows is registered to provide care for 41 people. At the time of our inspection there were 22 people living at River Meadows.

This service had a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

People told us they felt safe living at River Meadows and staff knew how to keep people safe from the risk of abuse. There were policies and procedures to minimise the risks to people’s safety. Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns. The registered manager had processes in place that regularly checked the environment, equipment and fire safety systems to ensure people were cared for in an environment that helped keep them safe.

There were enough staff to meet people’s individual needs and staff received training essential to provide care to people living at River Meadows. Some staff training was not up to date which had been recognised by the registered manager who was planning training for staff to attend.

Staff were caring to people during our visit, especially when people displayed behaviours that challenged others. Staff were kind and treated people with respect. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent before any care was given.

Staff knew what support people required and staff provided the care in line with people’s care records. Care plans contained up to date and relevant information for staff to help them provide the individual care people required. We found people received care and support from staff who had the knowledge and experience to provide the care people required.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent which meant people received their medicines from suitably trained and experienced staff.

Staff supported people’s choices and understood how the Mental Capacity Act (MCA) 2005 protected people who used the service. Staff understood they needed to respect people’s choices and decisions and where people had capacity, staff followed people’s individual wishes. Where people did not have capacity to make certain decisions, decisions were made on people’s behalf, sometimes with the support of family members. However, we found no formal assessments of people’s mental capacity had been completed and records of best interests’ decisions had not been recorded or completed.

Deprivation of Liberty Safeguards (DoLS) are used to protect people where their freedom or liberties are restricted. The provider had submitted two DoLS applications to the authorising body which had been approved. These applications meant people’s freedom was restricted and provided protection to those people. The provider was in the process of completing further DoLS applications for other people whose freedoms may be restricted. The registered manager also recognised when urgent applications were required.

People told us they were pleased with the service they received. People we spoke with said they felt confident to raise their concerns and found staff and management approachable. People said their concerns were listened to and responses were timely. Staff told us they had confidence in raising whistle blowing concerns to the registered manager and outside agencies. Staff told us they believed the home was managed effectively and had improved in recent months.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received. Action plans recorded what improvements had been made and outstanding actions continued to be monitored to ensure improvements and follow up actions were made.