Ladydale Care Home

At the previous five inspections we identified that improvements were needed to the quality of care and to governance systems in place to monitor care. This inspection was to check that improvements had been made. We found improvements had been made and sustained.

There was no registered manager 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. The deputy was acting as the manager until a permanent manager who would apply to the CQC to become registered could be found.

People told us they felt safe and we saw that measures had been taken, such as risk assessment and staff following these to ensure people were kept safe. When things had gone wrong the service had learned and action was taken to reduce reoccurrences. Staff were recruited safely and there were sufficient amounts of staff to meet people’s care needs.

People’s medicines were managed safely. There were effective systems in place to ensure people had their oral medicines as prescribed and improvements were made to the documentation of topical medicines following feedback.

People were protected from the risk of infection. The building was appropriately maintained and plans were in plan to help people evacuate in the event of an emergency arising. The building was also appropriately adapted to cater for the needs of the people living there.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) to ensure people’s rights were protected. Decision-specific assessments were carried out with best interest decision being recorded and appropriate referrals were made to the Deprivation of Liberty Safeguards (DoLS) authority.

People enjoyed the food and had a choice of food and drinks which we saw staff catering for.

People were supported to access other health professionals where necessary and health professionals felt referrals were appropriate. The service carried out assessments to ensure they could effectively support people.

Staff had appropriate training and support to be able to care for people well.

People felt they were treated with dignity and respect. Where possible people were supported to retain their independence and make decisions about their care. Staff supported people in a way that suited the person.

Staff knew people well and plans reflected people’s needs. People’s diverse needs and end of life choices had been considered. Activities were arranged for people to partake in.

People and relatives were able to complain and feedback was acted upon and responded to, overall.

Effective systems were in place to help identify improvements required and taken was taken to resolve any concerns identified. Further improvements were planned with the introduction of an electronic system. People, relatives and staff felt the acting manager was approachable and they could feedback their opinions of care. Notifications were submitted to the CQC as required and the previous rating was being displayed.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk. We found that improvements had been made in relation to all four previous breaches, so those regulations were no longer being breached.

The inspection took place on 10 May 2017 and was unannounced. Ladydale Care Home is a residential home for up to 54 people who have a variety of support needs, such as people with a physical disability, those with dementia or people who have a learning difficulty. There were 34 people living at the service at the time of the inspection.

There was 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 2008 and associated Regulations about how the service is run.

The principles of the Mental Capacity Act 2005 (MCA) were not always followed. Conditions for Deprivation of Liberty Safeguards (DoLS) were not always being followed. Mental capacity assessments were not always carried out to help determine if people had capacity to make decisions and evidence of Lasting Power of Attorney (LPOA) was not always in place.

Audits were now being carried out and whilst some had been effective, some actions had not yet been completed and further work was required to ensure the improvements continued and that all plans were updated to reflect that people had care and support that protected their wellbeing.

People told us they felt safe and their relatives confirmed they felt their loved ones were safe in the home. We found staff understood risks to peoples safety. For example, there were detailed plans in place to help people who needed support of they became agitated so that staff could effectively support them and action was taken to ensure people’s health and wellbeing was being protected. Medicines were being managed safely, however further improvements were required to staff training for topical medicine administration and guidance for staff on as required medicines. People, relatives and staff told they felt there were enough staff and our observations confirmed this. Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.

Plans were also in place for people who needed support to maintain their skin integrity and for those at risk of falls. We could see appropriate analysis and action had been taken following a person falling to try and reduce the risk of another fall occurring.

Up to date plans were in place for staff to follow in the event of an emergency evacuation of the home.

People were protected from abuse by staff who understood the different types of abuse, how to recognise it and to report it if they suspected someone was being abused. We saw appropriate safeguarding referrals had been made.

People were complimentary about the food and were supported to have food and drinks of their choice that were appropriate for their needs. People had access to other health professionals in order to maintain their health and wellbeing.

Staff and relatives knew who the registered manager was and felt able to go to them with queries. The manager was proactive in seeking and encouraging feedback from people and relatives, in the form of meetings and surveys, and this feedback was acted upon. Staff also felt supported and that they could approach the registered manager.

The registered manager had also been submitting notifications about the service, which they are required to do.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We undertook this unannounced comprehensive inspection on 31 January 2017 to check that the required immediate improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk. At this inspection, we found some of the required improvements had been made. However, two of the breaches of Regulations we identified at our three previous inspections were still present.

Ladydale Care Home is registered to provide accommodation with personal care for up to 54 people including people with dementia and people with physical and learning disabilities. On the day of the inspection there were 38 people living at the home. Although there was no registered manager in post a new manager had been recruited shortly after the last inspection and had submitted an application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found people were not always kept safe as risks were not consistently assessed or reviewed. People who presented behaviours that may challenge others were not always supported appropriately and guidance for staff was not available to ensure they received safe, consistent support. Improvement had been made to the systems used to manage medicines; however some people’s medicines were out of stock on the day of the inspection.

The provider had not always ensured that risks posed by potentially unsuitable staff were effectively managed to protect people. There were sufficient numbers of staff to respond to people’s care and support needs. People told us the presence of care staff enabled them to feel safe.

People were not always appropriately supported to make decisions for themselves. Assessments of people’s capacity to make certain decision about their care had not always been fully carried out. This put people at risk of having decisions made on their behalf without their consent. Improvements had been made in the way people were supported to access specialist healthcare supported when required, however improvements in how staff followed the advice given were required.

Improvements had been made to staff training, and people were now supported by staff who had received training relevant to their role, although there were still some gaps in staff knowledge, particularly in relation to supporting people to make decisions. Where the provider had taken action to deprive people of their liberty this had been done lawfully. People were happy with the food and drink they received and help was available from staff to support people with their meals.

Improvements had been made to how staff supported people’s right to be treated with dignity. We observed examples of staff supporting people in a respectful and dignified way. People’s individual preferences were known by staff and where possible their independence was promoted. People described staff as kind and caring and staff used positive language when supporting people and welcomed visitors in to the home.

People knew how to raise a concern if they were unhappy about the care and support they received and there were systems in place to manage any complaints received. Positive changes had been made to the information held in people’s care records, which offered guidance to staff about how to support people, however further improvements were still required to ensure people received safe, consistent care. People were supported to follow their interests and hobbies and activities provided on a daily basis were engaging and fun.

There were systems in place to monitor the quality of care provided, however these had not always been effective at identifying the concerns found at our inspection. The manager acknowledged that further improvements were required in relation to the monitoring of the service carried out by the management team. People and staff recognised there had been significant improvements made since the arrival of the manager, shortly after our last inspection. People and relatives were now been offered opportunities to give feedback about the service and staff felt involved in the on-going improvements and future plans for the home. The manager demonstrated a good understanding of the requirements of their role and had notified us of events required by law.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this unannounced comprehensive inspection on 23 September 2016 to check that the required immediate improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk.

At this inspection, we found the required improvements had not been made. The breaches of Regulations we identified at our two previous inspections were still present and we identified an additional new Regulatory breach. The service was again rated as ‘inadequate’. As a result of this, the service will remain in special measures.

The service is registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or mental health needs, such as dementia. At the time of our inspection 43 people were using the service. Two of these people were residing in hospital, one of whom was being treated for a serious injury they sustained whilst living at Ladydale Care Home.

The home had a registered manager. However, they had recently left the service. 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. An interim manager was in place during the registered manager’s absence and a new home manager had been recruited and was due to start working at Ladydale.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely.

Safety incidents were not analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

People were not protected from the risk of abuse because suspected abuse was not always identified or reported as required.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure people decisions about care were being made in people’s best interests when they were unable to make these decisions for themselves. We identified a person who was being potentially unlawfully deprived of their liberty.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. People’s health was not effectively monitored and managed to promote their health and wellbeing. Prompt referrals to health and social care professionals were not always made in response to changes in people’s needs or behaviours.

Effective systems were not in place to ensure people’s end of life care needs and preferences were met.

People’s care plans were not always accurate and up to date which meant staff didn’t always have the information they needed to provide safe and consistent care.

People and their relatives were not always involved in planning and reviewing their care. This meant we could not be assured that people’s care preferences were being regularly identified and met.

Effective systems were not in place to ensure concerns about the quality of care were reported, investigated and managed to improve people’s care experiences.

There was a programme of social and leisure based activities on offer to people. However, we found some people were not supported to engage in activities that were meaningful to them when they wanted or needed this intervention.

The provider did not always notify us of reportable incidents and events as required.

People spoke fondly about the staff and at times, we observed some positive interactions between staff and people. However, we found that people’s dignity was not always promoted and the choices people made were not always respected.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this focused inspection on the 14 July 2016 to check that the required immediate improvements had been made. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk.

At this inspection, we found the required improvements had not been made. Breaches of Regulations were still present and the service was again rated as ‘inadequate’. As a result of this, the service will remain in special measures.

The service is registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or mental health needs, such as dementia. At the time of our inspection 47 people were using the service.

The home had a registered manager. However, they were absent from the service at the time of this 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. An interim manager was in place during the registered manager’s absence. Staff told us they felt more supported in the absence of the registered manager.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely.

People were not always protected from the risk of abuse because suspected abuse was not always identified or reported as required.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure people had the ability to make decisions about their care. One person who was unable to consistently make decisions about their care was at times being potentially unlawfully deprived of their liberty.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. People’s health was not effectively monitored and managed to promote their health and wellbeing. Prompt referrals to health and social care professionals were not always made in response to changes in people’s needs or behaviours.

The provider did not always notify us of reportable incidents and events as required.

The service is registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or mental health needs, such as dementia. At the time of our inspection 48 people were using the service. Three of these people were in receipt of temporary respite care.

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 and associated Regulations about how the service is run.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely.

People were not always protected from the risk of abuse because suspected abuse was not always reported as required.

Most people told us they enjoyed the food. However, we found people’s risks of malnutrition and dehydration were not being effectively monitored or acted on.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. One person who was unable to make decisions about their care was being unlawfully deprived of their liberty.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. Prompt referrals to health and social care professionals were not always made in response to changes in people’s needs or behaviours.

There were gaps in some people’s care plans which meant staff didn’t always have the information they needed to provide safe and consistent care. People and their relatives were not always involved in planning and reviewing their care. This meant we could not be assured that people’s care preferences were being regularly identified and met.

People were reluctant to complain about their care and effective systems were not in place to promptly manage complaints to improve people’s care.

The provider did not always notify us of reportable incidents and events as required.

There was a programme of social and leisure based activities on offer to people. However, we found some people were not always supported to engage in activities that were meaningful to them when they needed this intervention.

People spoke fondly about the staff and at times, we observed some positive interactions between staff and people. However, we found that people’s dignity and independence was not always promoted and people’s right to privacy was not always respected.

People we spoke with told us that they had choices in their care and staff listened to what they wanted. We saw that people were treated with dignity and respect. One person told us, 'The staff are great and they make me feel comfortable'.

The provider had a sysem in place to protect people from the risks associated with the unsafe handling of medicines.

We saw that the service was sufficiently staffed on the day of the inspection. People who used the service told us that there was always enough staff available when they needed support.

We viewed training records, which showed that staff had received training relevant to their role. Staff told us that they received appraisals and the registered manager was approachable if they had any concerns.

In this report the name of a registered manager, Deborah Johnson appears, who was not in post at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.