We carried out this inspection on 23 August 2018. The inspection was announced. We contacted the service on 22 August 2018 to give notice of our visit on 23 August 2018 because this is a small service and people who live there are often out during the day. We needed to be sure people would be available when we visited.

The Meadows is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides personal care and accommodation for up to six adults who have a learning disability and/or autism.

At the time of our inspection there were four people living in the home. Two people received support with their personal care and two people were provided with accommodation but did not receive personal care. Only the people who were supported with personal care were receiving a regulated activity. CQC only inspects the service being received where people receive accommodation together with personal care; such as help with tasks related to personal hygiene and eating.

At our last inspection of this service in November 2016 we found the service had been redesigned and refurbished to provide four self-contained flats to give people a high standard of accommodation and the opportunity to gain greater independence. At that inspection there was only one person using the service. We found no concerns with how the service was being provided but judged it was too early to give a quality rating for the home.

There had been an experienced registered manager employed until 1 August 2018. A new manager had been appointed to oversee the day-to-day management of the service and had applied to be registered with us. 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 home was a good place to live and said they liked living there.

People were treated with kindness and respect. The staff knew people well and were trained to provide their support.

Although there were enough staff to provide people’s care, the staff told us there had been occasions when there were not sufficient staff to ensure the safety of the service. After our inspection the registered provider sent us detailed information about staffing levels and provided assurances that there were sufficient, suitably trained staff to ensure people were safe.

Safe systems were used when new staff were employed to check they were suitable to work in a care service.

The staff were trained in how to provide people’s care safely. Medicines were handled safely and people received their medicines as their doctors had prescribed.

The staff in the home were knowledgeable about The Mental Capacity Act 2005 and people’s rights were protected. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Hazards to people’s safety had been identified and managed.

People were provided with meals, drinks and snacks that they enjoyed and were supported to make healthy eating choices.

People were supported to access local and specialist health care services to maintain good health.

The staff supported people to gain greater independence. People’s privacy and dignity were respected.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live a

We carried out this announced inspection on 11 November 2016. We last inspected this service in August 2013. At that inspection we found that the provider was meeting all of the regulations that we assessed.

However the model of care since that last inspection under our old methodology has changed. In January 2016, The Meadows was redesigned and refurbished to provide four self-contained flats to give people a high standard of accommodation and to support them to gain greater independence. When we inspected in November 2016 there was only one person living in the home. Three other people were due to move into the home in early 2017. We have therefore judged that it is too early to give a quality rating for the home, although we saw that the person who was living there was safe and well cared for. We will provide a quality rating at our next comprehensive inspection.

The Meadows provides accommodation and personal care for up to five adults who have a learning disability and/or a physical disability. The home is a two storey building arranged as four flats. All of the flats have a bathroom and sitting, kitchen and dining areas. Three of the flats have one bedroom and one flat has two bedrooms. This could be used by two people who wished to share a flat or by a person who required a staff member to stay in their flat during the night. There is also a kitchen where staff could prepare or support people to prepare meals, a laundry room and an office for staff to use.

There was a registered manager employed in 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.

The person living in the home told us that they liked the staff and felt safe living at The Meadows. We saw that the person was comfortable around the staff and the registered manager and looked to them for reassurance when they felt anxious.

There were enough staff to provide the support the individual required. The staff were kind, friendly and respectful. They gave the person living in the home the time and support they needed to make choices about their life and support. Care was planned and provided to meet the individual’s needs. They followed a range of activities they enjoyed and were supported to maintain relationships that were important to them.

The atmosphere in the home was relaxed, homely and inclusive. The person was placed at the centre of their care and included in all decisions about their support. We observed the staff and registered manager included the person at all times. The individual enjoyed chatting and laughing with the staff and registered manager.

Good systems were in place to ensure the safety of people who used the service. New staff were checked to ensure they were suitable to work in a care home. Checks were also carried out on the premises and service to ensure the safety of people who used it.

Staff were well trained and felt supported in their roles. The staff knew the person who lived in the home well and provided their support as they wished.

The focus of the service was on promoting people’s rights and independence. The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards, (DoLS).

The registered manager and registered provider maintained oversight of the quality and safety of the service. Where areas were identified that could be further improved appropriate actions were planned and taken.

We visited the Meadows and looked at outcomes 4, 8, 11, 16 and 21. We found that the service was compliant with these outcomes.

Some people using the service had complex needs but were able to tell us their experiences. We used a number of different methods to help us understand the experiences of people living at The Meadows. For example using staff to help explain to us people’s individual communication styles.

We looked at records and found care and support was planned and delivered in a way that ensured people's safety and welfare. Care and support plans reflected people's needs, preferences, choices and diversity. They were detailed enough to make sure peoples' care and support would be provided according to their needs, choices and safety. Lifestyle information supported staff to provide a person centred approach to individual needs.

People's care and support was planned and delivered in a way that promoted their independence. People were involved in the local community and their time was arranged around what they wanted to do. Staff had written guidance how to support and protect people in different situations. There was enough staff that was trained to support people as and when they required it.

We observed people were comfortable and relaxed around staff and there were friendly respectful relationships between people.

People lived in a well-equipped and maintained environment that met with their needs and kept them safe.

We spoke with a range of people about the service. They included the manager, staff and people who lived at the home. We also had responses from external agencies including social services, in order to gain a balanced overview of what people experienced living at the Meadows.

Residents we spoke with had positive comments about their life at The Meadows, “I enjoy baking with C….” Also, “I like to go out to the shops or to eat out. We do that a lot.”

The service had systems in place to take into account peoples views and experiences in the way the service was provided and delivered, in relation to their care. People experienced care, treatment and support that met their needs and protected their rights.

We spoke with Lancashire council contracts monitoring department and they had no concerns or issues with the service.

Staff we spoke with told us they have worked at the home for a number of years and they all get along well. Comments included, “It’s like one big family.”

We spoke with a number of the people who live at the home during our visit and a selection of staff members. We received positive feedback and comments included;

Service Users

“The staff are really nice here.”

“I like the staff, they help me.”

“We sit and choose the meals each week.”

“I chose the things in my room with my key worker.”

Staff

“It is a nice place to work the staff and residents are great.”

“I have done lots of training in-house and outside. It has helped me look after the residents better.”