Ladywood

Ladywood is a residential care home providing personal and nursing care for up to 38 people. The service provides support to older people and people living with a dementia. At the time of our inspection there were 21 people using the service. The home provides care over 2 floors with a range of communal spaces for dining, activities and relaxation.

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

There was no registered manager in the home. Management support was provided by interim management. The culture of the service did not always promote positive person-centred care. Quality assurance systems and checks were in place to monitor the service, however, did not always identify shortfalls in processes.

Mealtime experience was not always positive for people and people did not always receive appropriate support. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The home was pleasantly decorated and areas of the service was undergoing some renovation, however there was a lack of signage to help people orientate around the home.

People were protected from the risk of abuse. Staff received safeguarding training and understood the procedures of how to raise a concern.

People’s needs were assessed and risk assessments were completed to guide staff to support people safely. There was enough staff to meet people’s needs. Staff were recruited safely and appropriate pre-employment checks were completed prior to employment. People received their prescribed medicines safely and correct infection and prevention control measures were followed. Accidents and incidents were recorded and trends identified to prevent risk of reoccurrence.

Staff felt management were supportive and approachable. Staff received regular training and supervision to support them in their role. The service had good networks with external healthcare professional, which gave people access to a range of healthcare services.

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 04 March 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Follow up

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.

¿ Cohorting and zoning was used to manage the spread of infection. This meant staff were allocated to work in certain areas of the service. It also meant there was signage showing which areas were ‘red zones’ when people were self-isolating in their rooms.

¿ Enhanced cleaning and disinfection of all areas of the service continued to take place to reduce the risk of cross contamination.

¿ There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the corridors and nearby all of the rooms where people were isolating.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. The service were preparing to offer testing to relatives in the near future as part of the government roll out of this service.

¿ Preparation of an indoor visiting area and the supporting processes were underway to facilitate people being able to see their loved ones again when it was safe to do so.

¿ Permanent and bank staff did not work in any other care setting which reduced the risk of infection spread between services.

Further information is in the detailed findings below.

We found the following examples of good practice.

¿ A one way system was put in place to enter and exit the visiting area. The activities coordinator held responsibility for the booking system and effective cleaning before and after each visit. A collaborative approach was taken when garden visits were implemented to ensure all options for safe visiting were considered, and everyone's ideas taken into account.

¿ A 'Sunshine Scale' had been introduced. This tool facilitated an assessment with people of their bedroom, for example, any changes they would like made, what activities they would enjoy and what items they wanted there. This supported people in the event of self-isolating or if they were spending more time in their room.

¿ The service had collaborative working relationships with other health professionals and a clear pre-assessment process which included additional considerations due to Covid 19. This meant any admissions were assessed and planned fully, including requiring a negative test result prior to arrival.

¿ A Covid quiz was introduced which tested staff knowledge and understanding of good practice in using personal protective equipment (PPE) such as masks, gloves and aprons. This was strengthened by some games in team sessions, for example, who could put on and take off PPE the fastest, which reinforced processes in a light hearted but effective way. All staff undertook a PPE competency check.

¿ Staff uniforms were laundered on site. Staff who were allocated to work with people who tested positive for Covid 19 were able to shower at the service if they wanted before going home. These measures reduced the risk of cross contamination.

¿ Some staff undertook further training to become part of the 'IPC (Infection Prevention and Control) Army'. They were given extra time to undertake additional IPC responsibilities such as PPE competency checks and assisting with more frequent audits.

¿ An additional daily 'touch point' cleaning schedule was introduced to ensure all areas which were touched throughout the day were regularly cleaned, including for example door handles and electronic equipment.

¿ A large en-suite bedroom was available to be used as a Covid area in the event of an outbreak. This had space for several people to stay, and could be accessed easily from an external door and the kitchen without going through the rest of the service. This would significantly reduce the risk of the virus spreading.

¿ IPC audits were undertaken by several staff with the expectation that different staff may see different things which could be improved.

People’s experience of using this service:

The service met the characteristics of good overall with requires improvement in Well Led.

Staff did not always feel that their concerns were always listened to and responded to. The provider assured us that they would consult with staff so that they could share their feedback. People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

The care that people received continued to be effective. They 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. Staff received training and support to be able to care for people well. They ensured that people were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The environment was adapted to meet people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. They were some activities available for them to pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the registered manager managed any complaints in line with the provider’s procedure.

There were quality structures in place which were effective in continually developing the quality of the care that was provided to them.

More information is in the full report.

Rating at last inspection: Good: report published on 10 June 2016

Why we inspected: This was a scheduled inspection based on previous rating.

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

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.

At our last inspection we saw that the provider did not consistently manage risks to people’s health and welfare. At this inspection we saw that the provider had systems in place to assess risk, actions were put in place to reduce it and that their effectiveness was monitored and regularly reviewed. At our last inspection the provider did not always analyse accident and incidents and follow up on all findings. At this inspection we saw that they were analysed and reviewed and that actions were taken as a consequence of this. The provider had introduced new initiatives to ensure that there were several methods in place to monitor and review risks to people’s health and wellbeing and to respond to any accidents or incidents to reduce the risk of reoccurrence.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. People told us that there were always enough staff to meet their needs promptly. Staff developed caring relationships with the people they supported which were respectful and patient. They knew people well and provided care that met their preferences. They understood the importance of consent and always explained to people what care they were going to provide. People’s capacity to consent to their care and make their own decisions was assessed and reviewed when required. People’s privacy and dignity were maintained at all times.

People received the medicines they were prescribed safely and there were systems in place to reduce the risks associated with them. They were supported to maintain good health and had regular access to healthcare professionals. Their care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible.

The environment was homely and there was signage to help to orientate people. Mealtimes were not rushed and people said that the food was good. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk.

People were encouraged to pursue interests and hobbies and regular activities were planned weekly. Visitors were welcomed at any time and they were encouraged to provide feedback through meetings and more informally. People and their families worked with the staff team to organise regular fundraising events to provide funds for activities.

People told us that they knew the manager and felt confident that any concerns they raised would be resolved promptly. The provider completed quality audits to continually drive improvements.

We found that improvements had been made to how consent was obtained from people who were not able to verbally express their agreement and that the service had undertaken reviews and completed documents involving people and their relatives.

The staff we spoke with knew what support individuals needed and respected the individuality of the people using the service. They were able to describe how they managed challenging behaviour and how they ensured people were in agreement with the care provided.

We had received information in October 2013 suggesting there were issues with staffing and the provision of care. We looked at these areas on our visit and found that the service had taken action to address staffing although there were still issues relating to the deployment of qualified staff and that the issues raised regarding care were not verified.

People we spoke with told us they were satisfied with the care and support they received. One person told us 'They treat me lovely' and another said 'The staff are good'.

People told us they enjoyed their meals. One person told us 'The food is beautiful' and another said 'The meals are good'. Another told us 'They ask me what I like to eat'. Relatives also told us they thought the food was good.

The staff we spoke with knew what support individuals needed and respected the individuality of the people using the service but we found there were occasions when there were insufficient staff available.

We found there were appropriate arrangements in relation to the recording of medicine and we found medicines were safely administered. There were satisfactory records in place for the running of the service.

We had received information in 2013 suggesting there were issues with staffing, liaising with other providers and the provision of satisfactory care. We looked at these areas on our visit and found that the service had taken action to address the issues raised and that the people raising the concerns were satisfied with the outcome.

One relative told us the person they were concerned with was 'always clean and tidy' and another told us that they thought the service was 'good'. One relative told us they thought the staff could do more for people on a social level; they said essential needs were met but 'they do what they have to do and nothing more'. They thought this was due to not enough staff being available. Three people we spoke with commented that they never had to wait long for assistance.

People told us they enjoyed their meals. One person told us that the food was 'very good'.