Archived: Ladyville Lodge

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service provides personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service has 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.

At our last inspection on 26 September 2017 the service was rated 'Requires Improvement'. We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found inconsistent practices in relation to infection control and the maintenance of equipment. At this inspection we found that this breach had been addressed. Therefore, we rated the service as ‘Good .’

People using the service and their relatives said they felt the service provided safe care and treatment. People were protected from the risk of infection. There were procedures in place to protect people from harm and staff were clear on how to recognise and report abuse. The service assessed and managed risks to people in a way that considered their individual needs. We found that ‘personal emergency evacuation plans’ (PEEP) were not readily available; a recommendation was made for the provider to ensure they follow best practice guidelines to keep people safe at all times. Recruitment systems were robust and staff had been recruited safely with appropriate checks on their backgrounds. There were sufficient numbers of staff employed by the service. The service managed medicines safely. Accidents and incidents were evaluated to continuously improve.

The service completed pre-admission assessments to ensure the service could offer them the best support. Staff received a thorough induction, undertook regular training and received regular supervision to enable them to feel supported to provide effective care. People were encouraged to live a healthy lifestyle and received holistic support from various health and social care professionals. The service had been designed and adapted with people’s preferences and support needs in mind. Staff understood the Mental Capacity Act 2005 (MCA) and gained consent before providing care and support. MCA is law protecting people who are unable to make decisions for themselves and where people were not able to do this, the appropriate authorisation procedures had been completed. These are referred to as the Deprivation of Liberty Safeguards (DoLS).

People were protected from potential discrimination and staff understood the principles of equality and diversity. However, there was no information available about people’s sexuality or relationships. A recommendation was made for the provider to ensure they follow best practice guidelines and support people to safely express their needs and receive safe care.

People and their relatives told us staff treated people with dignity and respect and confidentiality was maintained. People were supported to be as independent as possible. People and their relatives felt involved in the running of the service and could have an input into the care and support provided.

Each person had an individual care plan that reflected their support needs and were regularly reviewed. The service held a variety of meaningful activities to ensure people were engaged. The service welcomed people raising any issues they might have about the service and there were systems in place to respond to all complaints. The service supported people with their end of life wishes.

Staff felt valued and supported by the registered manager who was approachable and knowledgeable. The service demonstrated an open and supportive culture. Feedback was gathered from people, relatives, health and social care professionals and staff to assess, monitor and improve the quality of the service. Regular audits and spot checks were carried out to ensure people were receiving safe and effective care and support. The registered manager received support at provide level to ensure the service was well-led.

Ladyville Lodge provides accommodation and nursing care for up to 38 older people who have nursing or dementia care needs. At the time of our inspection there were 36 people living at the service of which one was on respite. The premises have 2 floors (the ground and 1st floor) with stairs and a lift. Each floor had a mixture of people with nursing and residential needs.

On the day of our visit there was 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.

We found inconsistent practices in relation to infection control. Handwashing was not always completed after direct care in order to prevent the spread of infection. There were also inconsistent approaches to the maintenance of equipment. You can see what action we told the provider to take at the back of the full version of the report.

Staff were aware of the procedures to follow to ensure that medicines were handled safely. However we found one medicine chart had not been dated correctly. Although risks to people and the environment were regularly assessed in order to protect people from avoidable harm, we found some risk assessments were not reviewed and updated monthly. We made a recommendation relating to following record keeping best practice guidelines.

We reviewed incidents and accidents and found they were handled and investigated properly. Learning had been made from an incident of a fall that resulted in an injury and another incident where there had been a delay in referral to the emergency services.

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.

People told us they felt safe. They were supported by staff who were aware of the procedures to protect them from abuse. Staff were enabled to support people effectively by means of training, appraisal and supervision. They attended regular staff meetings.

The provider ensured that there were enough staff available to cover for emergency and absences. There were two vacancies and a few shifts where there had been no full complement of staff.

There were robust recruitment checks which included criminal checks to ensure that staff were suitable to work in the health and social care environment.

Staff demonstrated an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards applied in practice. Although we found an instance where a capacity assessment was missing the last page.

People told us that they were treated with dignity and respect and that their wishes were respected. They were aware of how to make a complaint and thought that their complaint would be listened to and resolved by the registered manager.

People were supported to eat and drink sufficient amounts according to their tastes and preferences. They were enabled to access healthcare services where required.

People and staff thought the management team were approachable and open to suggestions made in order to improve care delivered.

There were systems in place to obtain and act on issues raised by people with the exception on two ongoing issues yet to be dressed relating to the dining experience and more wheelchair accessible bathrooms.

There was enough qualified, skilled and experienced staff to meet people's needs. People we spoke with said that, 'the carers are nice and are very helpful.'

We found that people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. People we spoke with told us that they always felt comfortable in raising concerns and knew they would be resolved. One person said 'I know who to complain to and I know they will listen.'

People told us that they felt safe and well looked after. They had no concerns about staff attitudes and told us that staff were 'caring."

Although we received positive feedback regarding staff, we found that there were not enough staff to meet people's needs. Staff told us that they found it difficult to cope at times with current staffing levels.