The last inspection was undertaken on 19 and 20 January 2017 and three breaches of regulatory requirements were made in relation to Regulation 9, Regulation 11 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Additionally, as a result of our concerns the Care Quality Commission took action in response to our findings by issuing warning notices in relation to Regulation 12, Regulation 13 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. The provider shared with us their action plan and this provided detail on their progress to meet the required improvements. At this inspection we found that these improvements had been made.

Stambridge Meadows provides accommodation and personal care for up to 49 older people. Some people also have dementia related needs.

This inspection was completed on 5 and 6 July 2017 and there were 33 people living at the service when we inspected.

A registered manager was 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.

People told us the service was a safe place to live and there were sufficient staff available to meet their care and support needs. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. This meant that people received their prescribed medicines as they should and in a safe way.

Staff understood the risks and signs of potential abuse and the relevant safeguarding processes to follow. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed to ensure their safety.

Staff received opportunities for training and this ensured that staff employed at the service had the right skills and competencies to meet people’s needs. Staff felt supported and received appropriate formal supervision at regular intervals. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

The dining experience for people was positive and people were very complimentary about the quality of meals provided. Where people were at risk of poor nutrition or hydration, this was monitored and appropriate healthcare professionals sought for advice and interventions.

Where people lacked capacity to make day-to-day decisions about their care and support, we saw that decisions had been made in their best interests. The registered manager was working with the local authority to make sure people’s legal rights were being protected. People who used the service and their relatives were involved in making decisions about their care and support.

Care plans accurately reflected people’s care and support needs and people received appropriate support to have their social care needs met. People told us that their healthcare needs were well managed. Staff were friendly, kind and caring towards the people they supported and care provided met people’s individual care and support needs.

People and their relatives told us that if they had any concern they would discuss these with the management team or staff on duty. People were confident that their complaints or concerns were listened to, taken seriously and acted upon.

There was an effective system in place to regularly assess and

The inspection was completed on 19 and 20 January 2017 and there were 37 people living at the service when we inspected.

Stambridge Meadows provides accommodation and personal care for up to 49 older people. Some people also have dementia related needs.

At the time of the inspection a manager was in post. The manager was previously the deputy manager and had been in their new role as manager of the service since the beginning of November 2016. The manager was not registered with the Care Quality Commission and an application to be registered with us had yet to be submitted. An assurance was provided by the manager that this would be submitted as a matter of priority. 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.

Quality assurance checks and audits carried out by the provider were not as robust as they should be. They had not recognised the issues we identified during our inspection and had not identified where people were placed at risk of harm or where their health and wellbeing was compromised.

While the majority of people told us they felt safe, suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. Risk assessments had not been developed for all areas of identified risk. Bedrail assessments had not always been completed to determine that these were suitable for the individual person so that any risks identified were balanced against the anticipated benefits.

Although staff had received training relating to safeguarding, not all staff understood the importance or procedures to follow to ensure people’s safety and wellbeing. Despite staff having attended training, not all staff understood the relevant requirements of the Mental Capacity Act [MCA] 2005 or the key requirements of the Deprivation of Liberty Safeguards.

People and staff told us the service did not always have enough staff available to meet their needs. This meant that people had to wait on occasions for care to be provided. There was a high number of vacancies at the service and this was impacting on the above.

Improvements were required to ensure people received their medicines as prescribed and medication records completed appropriately. This referred specifically to codes on the Medication Administration Records [MAR] and PRN ‘as needed’ protocols being in place.

Staff had received formal supervision, however improvements were required to ensure that where subjects and topics were raised by staff, this was followed up and there was a clear audit trail to demonstrate actions taken. Improvements were also required to ensure that aims and objectives were set as part of annual appraisal procedures.

People and their relatives were not fully involved in the assessment and planning of people’s care.

Not all of a person’s care and support needs had been identified, documented or reviewed to ensure these were accurate and up-to-date. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

The dining experience was generally positive although some minor improvements were required on the first floor. People were supported to have enough to eat and drink. People were supported to maintain good health and have access to healthcare services as and when requ

A single inspector carried out this inspection. Below is a summary of what we found.

The summary is based on our observations during the inspection, from speaking with seven people who were using the service, four staff who supported them and with two visiting relatives. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included six support plans, daily support records, staffing records and service quality monitoring processes.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Appropriate safeguarding procedures were in place and staff knew how to safeguard the people they supported.

The home had detailed policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

Staff we spoke with said they had been properly trained for their roles. Staff told us that they received good support from the management team.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People’s health and care needs were assessed and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Most of the people we spoke with who were using the service said they were satisfied with their rooms and the facilities. However some people told us they would like the gardens and grounds to be kept in better condition and we found that not all areas of the premises and grounds were kept adequately maintained and suitable for people to use.

Is the service caring?

People were supported by kind and cheerful staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service we spoke with told us, “The staff are really lovely, I’m very happy to be here.” Another person told us, “I like it here, the staff have helped me so much since I moved in”. “I can’t fault the staff they are wonderful to me”.

A relative said, “We are so pleased that our relative is living in this home, the staff are kind and good at keeping us informed about our relative.” Other comments we received from relatives were, “The staff are very approachable, they listen to and take action on our requests, they are also caring and always busy trying to make sure our relative’s needs are being met.”

The responses and views of people who used the service and their relatives were asked for as part of regular quality monitoring reviews of the service. Any shortfalls or concerns raised were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to enjoy a range of activities and, mostly with family and friends support, were able to get out and about in the local community.

Since our previous inspection, in December 2013, afternoon staffing levels had been increased to try to ensure people’s needs were being fully met.

A person who used the service we spoke with told us, “The staff are around if I need them and they ask me if I want anything, if I tell them I’m worried about something they try to sort it out for me.”

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the aims of the home and of the standards of care and support that was expected of them.

Regular service monitoring processes were in place. This helped to ensure that people received a good quality service at all times.

A relative we spoke with told us, “I am very happy that my relative is in this home, the staff are very good to my relative and the managers and staff are good at keeping me updated about my relative’s wellbeing.”

Prior to our inspection concerns were raised that falls management for people who used the service was inadequate and did not safeguard people living at Stambridge Meadows. In addition concerns were highlighted that medicines management was poor and staffing levels were inappropriate for the needs and numbers of people living at Stambridge Meadows.

We found that the provider had a falls prevention and management policy in place. Our evidence showed that the management team of the service was proactive in falls prevention and ensuring people's health and wellbeing. We found that medicines management was appropriate and protected people against the risks associated with the unsafe use and management of medicines. Improvements were required to ensure that there were sufficient numbers of staff on duty to meet the needs of people who used the service at all time.

Each person was noted to have a support plan in place detailing their specific care needs and how they were to be supported by staff. Records showed that people who use the service were supported to maintain their healthcare needs. We saw that staff arranged for people to be seen by their doctor when they became unwell or their medical or mental health condition required a review.

The atmosphere within the service was calm and relaxed and staff interactions with people who live there were noted to be positive. Staff were able to demonstrate a good understanding of people’s care and support needs. We spoke with two relatives and they confirmed that the quality of care and support provided for their member of family was very good. Comments included "I feel our relative's needs are met very well and nothing is too much trouble for staff", "I feel very relaxed knowing that our relative is so well looked after", "I feel the staff understand the needs of our relative" and "Our relative likes all the staff."

Records showed that the management of medicines at the service were good and there were appropriate arrangements in place for staff to receive a robust induction, training and supervision.

We spoke with people using the service but their feedback did not relate to this standard.

People spoken with told us that they were happy living at Stambridge Meadows and they found the staff to be nice and caring. Comments included “I couldn’t get better care, I am very well looked after and attended to” and “I am very happy with the care and support, the carers are very kind and caring. I have no complaints”. People also told us that they were treated well by care staff and that their privacy and dignity were respected.

People who use the service, their representatives and visiting professionals were asked, by the provider, for their views about the quality of care, support and services provided at the care home in November 2011. Records showed that 12 satisfaction surveys were returned. In general comments received were very positive and these included “As a family we are very happy with the care received”, “We always find the staff cheerful and accommodating and our relative always looks cared for. We are always informed if they are unwell or concerned about anything” and “Our relative is very happy at Stambridge Meadows and we know that they are well cared for. All staff that care for our relative are excellent.”

Areas for improvement, identified through the provider's questionnaires, related to activities for people who use the service and better communication within the home. Comments included “Telephone contact needs improving. No calls are returned”, “We would like our relative to be able to have some stimulation. They spend the majority of their time alone” and “Our relative does get a bit bored of a weekend especially if they have no activities.”

People with whom we spoke, told us, that they were happy living at Stambridge Meadows and they found the staff to be nice and caring. Comments included “The staff are lovely, they are very good” and “Oh the staff are so nice, nothing is too much trouble” and “Couldn’t wish for nicer staff.”

People told us that they felt safe and that, if they had any concerns or worries, they would discuss them with their relative or a member of staff. People also told us that they were treated well by care staff and that their privacy and dignity were respected. People confirmed that they were happy with the way that the home manages their medicines. One person told us that staff were "always on time" when giving them their medicines.

Four relatives with whom we spoke, told us, that they were very happy with the care and support provided to their member of family. Relatives confirmed that if they had any concerns they would be happy to raise these with the manager and/or staff. Relatives spoke positively about the manager and felt that the home was well run.

Stambridge Meadows provides accommodation and personal care for up to 49 older people. Some people also have dementia related needs.

The inspection was completed on 19 and 20 November 2015. There were 37 people living at the service when we inspected.

A registered manager was 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 our inspection on 26 February 2015 and 2 March 2015 we found that the provider was not always meeting the requirements in relation to sufficient staff available to meet people’s needs and we identified that the dining experience for people living with dementia was poor. In addition, we identified concerns relating to some staff did not know how to apply their training to their everyday practice and we identified that the environment was not suitably and adequately maintained for the people living there, in particular, for people living with dementia. An action plan was provided on 8 June 2015 and this confirmed the actions to be taken by the provider to achieve compliance. At this inspection we found that the required improvements as stated to us had been made.

Where appropriate, although people were supported with end of life care, no information for staff on how to manage people’s choices and wishes for their end of life care were recorded and improvements were required.

Although there was a complaints system in place, management arrangements to investigate complaints thoroughly and to evidence outcomes were inconsistent.

Risks to people’s health and wellbeing were appropriately assessed and managed but continual reviews required improvement. Although records were not always available to guide staff on how to meet all aspects of a person’s assessed care needs, actual care and support provided by staff was observed to be appropriate.

The provider’s systems to check on the quality and safety of the service provided were not always effective in identifying areas for improvement and required better monitoring.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported.

There were sufficient numbers of staff available. Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service. Staff told us that they felt well supported in their role and received regular supervision.

Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected. People had good healthcare support and accessed healthcare services when required. The management of medicines within the service ensured people’s safety and wellbeing.

People were supported to be able to eat and drink satisfactory amounts to meet their nutritional needs. The mealtime experience for people was positive.

People were treated with kindness and respect by staff. Staff understood people’s needs and provided care and support accordingly. Staff had a good relationship with the people they supported.