Landemere Residential Care Home

Landemere Residential Care Home is a residential care home providing personal care to up to 41 people. The service provides support to older people, some who may be living with dementia. At the time of our inspection there were 36 people using the service.

People’s experience of using this service and what we found

Risk management and safety monitoring had improved since our last inspection, however, there were still some gaps. The provider’s governance and oversight arrangements and related service improvements were therefore not yet consistently demonstrated as fully embedded and sustained.

Care plans did not always reflect relevant information about people’s care needs and changes to these. Proactive measures staff were to take to ensure their safety were not always recorded in people's care plans.

Overall staff were effectively trained and supported to provide people’s care. However, the provider was still working to ensure all care staff completed first aid training. Care staff worked with other agencies to help people receive the healthcare support they needed. People’s needs were assessed to help them receive effective care and people received enough to eat and drink. The premises had been adapted and personalised to help meet people’s needs.

People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, records did not always show how some restrictions used to help keep people safe had been considered under the mental capacity act and best interests decision making processes.

The provider had systems in place that helped to protect people from abuse and avoidable harm. If things went wrong the provider looked to understand how things could be made better. The provider was in the process of implementing improvements to the quality and safety of its medicines management. The home was kept clean and risks from infection were reduced. There were enough staff to help keep people safe. Staff recruitment processes were followed, and checks were completed to help the provider employ staff that were suitable to work in care. People were able to visit freely.

Care staff completed other training relevant to people’s needs and staff received support from their managers. Care staff worked with other agencies to help people receive the healthcare support they needed. People’s needs were assessed to help them receive effective care and people received enough to eat and drink. The premises had been adapted and personalised to help meet people’s needs.

People’s privacy and dignity was respected, and staff supported people with their independence. People were involved in their care and their wishes and preferences were known and reflected in their care plans.

People received personalised care and staff knew them well. People’s communication needs were assessed and met. Complaints were investigated and the provider looked to learn any lessons to help improve the service and people’s experiences of care. People were supported to maintain relationships that were important to them and socialise so that the risks of social isolation were reduced. People could take part in a range of different activities that stimulated people’s interests and promoted social engagement with others. People had the opportunity to plan and discuss any advanced care plans they wished to make.

The provider operated a range of audits and checks to help ensure the quality and safety of services. The provider worked in partnership with others involved in people’s care. A person-centred approach was taken towards planning and supporting people’s care needs. The provider had a duty of candour policy in place and had shared information on events and incidents that were reportable to CQC.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 July 2022).

At our last inspection we found breaches of the regulations in relation to person-centred care, safe care and treatment, the numbers of staff deployed and how the provider monitored risk and improved care. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting these regulations.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Landemere Residential Care Home is residential care home providing accommodation and personal care for to up to 41 people. The service provides support to older people, some who are living with dementia. At the time of our inspection there were 35 people using the service. People have their own bedrooms within one main building, with communal lounges and kitchenette areas. The care home is over two floors, each of which has separate adapted facilities.

People’s experience of using this service and what we found

The registered manager did not have full oversight of risks in the service. Systems to assess, monitor and reduce risks and improve the quality and safety of care were not always operated effectively.

The provider’s systems to try and identify and improve when things had gone wrong did not always work effectively. Opportunities to improve care and continuously improve the service had not always been taken.

Not all people experienced good care outcomes. Not all complaints were recorded in the complaints log and therefore it was not possible to review for trends and lessons learnt.

Risks to people’s health and safely were not always mitigated or safely managed. Risks were not always reduced as there were not always enough staff deployed.

Evidence was not always in place to show the service had requested timely reviews and referrals for people at risk of falls and at risk of pressure sores.

People did not always receive person-centred care. For example, people told us they generally had two showers a week but would like to have more. It was not always evident what person-centred planning had been considered for some people living with dementia to enhance their experience.

Some people were anxious and worried, and it was not always clear what steps staff took to discuss this and support people and their emotional well-being.

Assessment frameworks were in place for areas of people’s health and care needs, however these had not always been kept up to date.

Staff received training in areas relevant to people’s healthcare needs and completed an induction when they started work at the service. However, only a small number of staff had completed any training in basic first aid.

Checks were made when staff were recruited to help ensure they were suitable to work with people at the service. Medicines were managed and administered safely. The provider had plans to replace some areas of flooring that were stained or not intact. Other infection prevention and control measures were in place to help protect against the risks of infection. Family and friends could visit freely. Safeguarding systems were in place to help protect people from abuse.

People enjoyed their meals and their choices and preferences were known. The service contained some adaptions to help people living with dementia orientate to their environment. The provider had plans to develop this further. People had access to healthcare services such as a dentist and GP.

People were supported to have maximum choice and control of their lives and staff mostly supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they liked the staff that provided care for them. They felt their privacy and dignity was respected and their independence promoted.

People were given opportunities to be involved in their care. Actions were taken to assess and meet people's communication needs. People were supported to see their friends and family and take part in activities they enjoyed. This helped to prevent people from social isolation.

The provider had taken steps to involve people in further developments of their home environment and develop staff in leading in areas of care, such as activities and infection prevention and control. The provider had policies in place to support their governance and oversight, including for the duty of candour.

No-one was receiving end of life care at the time of our inspection. Advance care planning templates were available for when this was required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 February 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, infection control and notifications of incidents. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. The provider sent us evidence to show what action they had taken to the concerns we raised with them as part of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Landemere Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safe care and treatment, staff being deployed to safely meet people’s needs, person-centred care and how well the service assesses and manages risks and improves the quality and safety of care at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

All visitors were expected to complete a lateral flow test (LFT), wear a mask, sanitize hands and complete a COVID-19 screening tool prior to entering the home.

There were plentiful supplies of personal protective equipment (PPE) throughout the home which included gloves, masks and aprons.

There were PPE stations located around the home.

Staff participated in a daily testing regime prior to commencing work.

The registered manager completed weekly and annual audits of infection and prevention control in the home.

Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe.

Staff had completed training in relation to infection control, and the registered manager completed regular checks to ensure the staff used PPE correctly.

Landemere Residential Care Home provides accommodation for up to 41 people who need personal care and support. The service provides care for older people and people living with dementia. There were 40 people living at the service at the time of our inspection.

Rating at last inspection: Good (report published 27 July 2016).

What life is like for people using this service:

Improvements were needed to one person’s risk assessment to ensure they, other people, and staff were safe at the home.

People said they felt safe at the home because staff checked on them and assisted them to move safely. The home was well-staffed and people had their needs promptly met. Medicines were overseen and administered by trained senior staff. All areas of the home were clean, tidy and fresh and staff were trained in infection control.

Staff were well-trained and people said they were kind and helpful. People said they liked the food served. At lunchtime the dining room was well-presented with menus, condiments and serviettes on the tables. Staff ensured people’s healthcare needs were met knew when to seek medical assistance for people. The home was purpose-built and accessible throughout to people with limited mobility.

People made many positive comments about how caring the staff were. They said the staff talked with them and helped them to make choices about their lives. The home had an inclusive atmosphere, for example the staff had their Christmas party there because they wanted the people they supported to attend. Staff respected people’s privacy and dignity and encouraged them to be as independent as possible.

Staff were knowledgeable about how best to meet people’s needs. People had the opportunity to take part in a wide range of one-to-one and group activities at the home including chair-based exercise classes, bingo, quizzes, monthly cocktail parties with visiting entertainers, and church services. People knew how to complain if they needed to and were confident that complaints would be listened to and addressed.

The registered manager was approachable and knew the people using the service well. When she took up her post she moved her office downstairs so she could be nearer and more accessible to the people using the service. The provider had quality assurance systems in place to monitor the quality of the care provided and make improvements where needed. The home had links with organisations in the wider community, for example local schools and churches.

More Information is in the detailed findings below.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Landemere Residential Care Home provides accommodation for up to 41 people who need personal care and support. The service provides care for older people and people living with dementia. Accommodation is provided on two floors arranged into separate units. The service has single bedrooms with toilets. There were 38 people living at the service at the time of our inspection, with one person in hospital.

The registered manager of the service had been in post since January 2016. 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 using the service told us that they felt safe. There were good systems for making sure that staff reported any allegation or suspicion of poor practice and staff were aware of the possible signs and symptoms of abuse.

There were robust recruitment processes in place. Staff completed thorough checks before starting work at the service.

People's medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them. The arrangements for the storing and recording of medicines was good and this meant that people were protected from possible errors.

There were enough staff to provide safe and effective care. Staff understood the specific needs of people using the service and how to respond when people were agitated or confused. We saw that staff provided compassionate support that met people's needs.

The risks to people's safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people's safety. This meant that people were protected from risks to their welfare whilst being supported to be as independent as possible.

Staff told us they felt supported in their roles and the registered manager provided staff with clear guidance and leadership. Staff had completed training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care.

Staff were caring, compassionate and attentive in their approach to meeting people's needs. Everyone we spoke with praised the approach of care staff. Staff knew people well and took time to chat with them and provide assurance. Staff were friendly and helpful and showed warmth and affection towards people.

Throughout our inspection we saw examples of good care that helped make the service a place where people felt included and consulted. People and, where appropriate, their family members were involved in the planning of care. People were treated with dignity and respect.

People could choose how to spend their time. There was support for people to participate in activities and events.

There was a complaints procedure in place and people we spoke with felt confident their concerns would be listened to and acted upon.

People had their health needs assessed and care plans were put in place to meet their needs. Detailed plans were in place to guide staff in meeting people's specific needs to maintain their health and well-being. People's needs were reviewed on a regular basis and we saw that the service was responsive to changes in people's needs.

The registered manager operated an open and inclusive culture in the service, where the opinions of people who lived there, their relatives and staff were valued and respected.

The registered manager assessed and monitored the quality of care consistently. In addition to regular audits, checks and observations of staff, the registered manager consulted people in the service and their relatives to find out their views on the care provided. The provider used feedback to develop action plans which they used to make improvements to the service. This showed that the service was well-led.

People we spoke with told us they were satisfied with the care and support they received. One person told us 'I can't fault the care, it's excellent' and another 'it's very good here' and a third said 'I always get two people to move me'. A relative described the care as very good. We saw that staff had warm relationships with people and one person told us 'The staff are lovely'. One person said 'They always call the doctor when I need one'. This meant that the service ensured people's health needs were addressed.

Most people using the service also told us they enjoyed their food and described the meals as good, although we saw some people were not always offered encouragement with their meals in a timely manner.

We saw there were activities taking place during our inspection visit and people we spoke with confirmed they were able to go out into the community if they wished and that staff accompanied them where necessary.

We found medicines were well managed and there were sufficient staff on duty to meet people's needs. Complaints were dealt with properly.

We saw that the provider had quality checking systems to manage risks and assure the health, welfare and safety of people who receive care. The provider had also put in place additional monitoring systems to ensure that people are protected against the risks associated with the unsafe use and management of medicines.