11 May 2023
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The first day of this inspection was carried out by 2 inspectors. The second day of inspection was completed by 1 inspector.
Service and service type
Landemere Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post. However, the current manager had applied to become the registered manager.
Notice of inspection
This inspection was unannounced. Inspection activity started on 21 March 2023 and ended on 18 April 2023. We visited the location on 21 and 22 March 2023.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We spoke with 4 people and 2 relatives of people who lived at the service. We spoke with 11 staff in total, including 5 care staff, 1 team leader and 1 housekeeper. We spoke with the manager, district manager, regional manager and head of care.
We reviewed the relevant parts of 4 people’s care plans and multiple medicines records. We looked at audits, policies, training records and 2 staff recruitment files.
11 May 2023
About the service
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.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.