Archived: Ladyfield House

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe and well led, to at least Good.

At this inspection we checked if improvements had been made. We found that the registered provider had addressed all the concerns raised at our last inspection and the rating of the service improved to Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Ladyfield House’ on our website at www.cqc.org.uk.

Ladyfield House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ladyfield House provides accommodation for up to 50 people. The home consists of two separate units; Salvin and Hewitt. The service provides accommodation for people who require personal care, including people living with dementia. The home is located in the Kiveton Park area of Rotherham. At the time of our inspection there were 35 people using the service. This included people who were staying at the home for a short period of respite care.

At the time of our inspection the service had a registered manager. 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 were safeguarded against the risk of abuse. Staff confirmed they had received training in the subject and knew what action to take if they suspected abuse.

Risks associated with people care were identified and managed appropriately. Risk assessments were in place to guide staff in ensuring risks were minimised.

We observed staff interacting with people and found there were enough staff available to meet people needs. However, whilst most people we spoke with felt there were enough staff available, a minority of people told us there were not enough staff at busy times. Staff were recruited in a safe way, which ensured that suitable people were working at the home.

People’s medicines were managed in a safe way and people received their medicines as prescribed.

Staff had the skills and knowledge to deliver effective care. People were supported to maintain a healthy, balanced diet which meant their needs and preferences. People had access to healthcare professionals and their advice was followed.

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. The service was compliant with the Mental Capacity Act 2005.

During our inspection we found staff interacted well with people who used the service. Staff were kind and caring in their manner, knew people well and provided a homely atmosphere.

We looked at care records belonging to people who used the service and found evidence that staff were responsive to people’s needs.

Social activities and stimulation was available throughout the day of the inspection. This was varied to meet people’s preferences and people enjoyed participating.

The registered provider had a complaints procedure and people we spoke with felt able to raise concerns if they needed to. Complaints received had been followed up effectively and used to develop the service.

The registered provider had systems in place to monitor the quality of the service. Residents and relative’s meetings took place and people felt they had a voice.

Further information is in the detailed findings below.

The service did not have a registered manager. 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.

Before our inspection the provider had identified concerns in relation to the quality and safety of services provided and had appointed a new management team to identify and implement improvements and provide leadership and direction. A new regional manager was based at the service until a peripatetic manager was appointed to oversee the service. A peripatetic manager will manage the service until a new suitable permanent manager is appointed. Although we identified breaches of regulations at this inspection we saw that the new regional manager had identified areas that required improvements to be made and was in the process of implementing these. People who used the service and staff told us they had seen recent improvements had been made and spoke positively about the new manager.

Ladyfield House provides accommodation for up to 50 people. The home consists of two separate units; Salvin and Hewitt. The service provides accommodation for people who require personal care, including people living with dementia. The home is located in the Kiveton Park area of Rotherham. At the time of our inspection there were 30 people using the service, which included some people who were staying at the home for a short period of respite care.

Before this inspection we received information of concern. Concerns were in relation to staffing levels, and the management of the service. We therefore brought this comprehensive inspection forward. We found at times that there was insufficient staff to meet people’s needs.

The provider had safeguarding procedures in place and staff were aware of the process to follow if they suspected abuse. Staff we spoke with confirmed they had received training in this subject.

Care records lacked detail, while others had not been completed. Risk assessments were not sufficiently detailed to ensure staff could meet people’s needs.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration.

We found staff approached people in a kindly manner. However, at times staff did not have the time to interact with people as they were very busy meeting people’s personal care needs. We observed at times people had to wait for assistance. Staff we spoke with told us there was not always enough staff on duty to meet people’s needs. Relatives also commented they felt that people were not always safe due to lack of staff. Although they could see this had improved since the new management had been in post.

A refurbishment programme was underway in the service at the time of our inspection. Many communal areas had been redecorated and further improvements to the environment were planned. This included ensuring the home was dementia friendly meeting best practice guidance for people living with dementia. We found the service was maintained to a good standard of cleanliness but lack of domestic hours was impacting on staff being able to adhere to infection control measures.

We found that the recruitment of staff was robust and thorough. This ensured only suitable people with the right skills were employed by this service. New staff received an induction and were supported into their new role. Staff supervision had commenced and staff told us they felt supported by the new manager. Yearly appraisals for staff were out of date, but the peripatetic manager showed us a schedule for booked appraisals that would be completed in the next three months.

Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Most staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, we found two people who were admitted urgently for respite care had not been assessed and met the criteria for an urgent DoLS application; this was addressed by the peripatetic manager during the inspection.

A well balanced diet that met people’s nutritional needs was provided. However, we found the meal time experience varied depending on which unit people lived.

We observed no activities taking place during our inspection. People and their relatives told us that activities were very infrequent as there was no activities coordinator. Relatives and people who used the service raised concerns about the lack of social stimulation.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. Some complaints had been raised and dealt with appropriately.

There were processes in place to monitor the quality and safety of the service. However, these were new and were not embedded into everyday practice.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of this report.

Ladyfield House provides accommodation for up to 50 people. The home has two units; Salvin which provides residential care and Hewitt which provides residential care for people living with dementia. The communal areas of the home are accessible to people who use wheelchairs. The home is located in the Kiveton area of Rotherham. At the time of our inspection there were 37 people using the service. Some people were staying at the home for a short period of respite care.

At the time of our inspection the service did not have a 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. There was a manager in post who was in the process of registering with the Care Quality Commission, but at the time of our inspection the manager was on leave. Present at the home was a registered manager from another service who was supporting the manager in their new role and covering while she was away. The regional manager for the company was also present during our inspection.

We spoke with staff who knew how to protect people from abuse. Staff told us they had received training in this subject, which had given them information on the types of abuse and how to recognise and report situation.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified some improvements could be made.

We looked at care files belonging to people who used the service and found that risks associated with people’s care had been identified. However, risk assessments in place were not always up to date with people’s current needs and did not always offer guidance in how the risk could be minimised.

We observed staff interacting with people who used the service and saw that there was enough staff around to ensure people’s needs were met. Staff worked well as a team and were able to respond to people’s needs.

Recruitment systems were robust, so helped the employer make safer recruitment decisions when employing new staff. New staff had received an induction into how the home operated and their job role.

We looked at records in relation to staff training and found staff some training was required. However, staff we spoke with told us they attended training and completed training via e-learning.

People were supported to eat and drink sufficient amount to ensure they received a healthy balanced diet. People were assisted with an appropriate diet to suit their needs. Snacks and drinks were also available throughout the day. However, food and fluid intake was not always recorded effectively.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People who used the service had been assessed to determine if a DoLS application was required. The manager and regional manager had a good understanding and knowledge of this topic. However other staff did not have adequate knowledge on this subject to be able to apply it in practice. Although we found the regional manager was aware of this and was addressing it.

People had access to health care professionals when required. We looked at records belonging to people who used the service and found evidence that professionals such as speech and language therapist, physiotherapist and dietician had been involved when needed.

Throughout our inspection we observed staff interacting with people who used the service. We found staff were kind, caring and considerate. They worked hard to make sure people were happy and content.

People’s needs were assessed but care was not always provided in line with individual care plans. This was because they required more information and updating to reflect the persons current needs. However, we observed staff supporting people and found they did this in accordance with what the person required.

We saw care staff providing some activities; however, there was not a designated activity coordinator on duty at the time of our inspection. This post had been recently recruited to.

The service had a complaints procedure and staff knew how to handle and deal with concerns.

The management team was in the process of being developed. A new manager had been appointed and they were in the process of recruiting a deputy manager.

We saw audits had been completed and action plans had been devised to ensure issues were addressed. However, new systems and processes put in place to address actions required embedding in to practice.

We inspected the service on 3 March 2014 and found the provider to be compliant.

People were protected from the risk of infection because appropriate guidance had been followed.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent.

People who used the service had a care plan which was relevant to their individual needs. One person said, “I couldn’t find a better place, I like it here.”

Another person said, “Staff know me well and I am well looked after.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with said that the food was lovely and well presented.

People were not cared for in a clean and hygienic environment.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider had a system in place to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. One person said, “I don’t have any worries, but if I had I would talk to staff and they would do something about it.” A relative said, “The manager is always available to talk to and she is very welcoming.”

We found that the people who used the service had appropriate care plans in place which met their individual needs. People were supported to be as independent as possible and staff told us how they respected people's individuality. We spoke with five people who used the service and they commented that they were very happy living in the home and the care was good. One person said, 'I get on famous with the staff and my family visit every day.' A relative said 'things had improved, there seems to be more staff on duty and it's generally fine.'

We found that systems were in place to monitor the quality of the service. Records were clear and up to date. The manager used action planning where appropriate to address any issues that were raised during monitoring visits and audits.