Ladymead Care Home

Ladymead Care Home is a care home registered to provide nursing and residential care for up to 27 people over 65. People living at the service had varying health conditions, including dementia, diabetes, Parkinson’s disease, heart failure and other age-related frailties. There were 17 people living at the service at the time of our inspection.

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

Quality assurance systems remained ineffective in monitoring the quality and safety of medicine administration. The provider’s auditing of medicines were not robust enough to identify or act upon low stocks of medicines. Staff did not consistently record medicine administration in line with legislation. This increased the risk of people not receiving their medicines as prescribed.

People were supported by some staff who did not always show them respect so not everyone had a positive experience. We observed some staff using language about people that was disrespectful and inappropriate. We received mixed feedback regarding staff, comments included, “The nurses don’t take a blind bit of notice. I don’t want to talk to a carer about my problem, I want to talk to the nurse about it.” And, “The carers and staff are brilliant.”

People were supported by staff who were busy and not always able to spend time with them. There were not always enough staff to meet people’s social needs in the morning and at lunch time. Staff were observed to be busy answering call bells and assisting people whilst other people had little or no interaction from staff. People were engaged in the afternoon whilst staff had time to spend hosting quizzes and completing jigsaw puzzles with them.

People were protected from risk of abuse; staff received training and knew how to recognise and respond to safeguarding concerns. Relatives told us they would feel comfortable to speak with the manager if they had concerns of safety. One relative told us, “My relative wouldn’t be backward in coming forward if they had problems, they said they feel safe, I know they are safe.”

People’s support and associated health risks were assessed. Improvements had been made to care planning which considered people’s health needs. People were involved in developing their care plans, and where appropriate, relatives were invited to contribute.

People, their relatives and staff commented positively on the changes since the appointment of the newly recruited manager. One relative told us, “With [manager] I have spoken with them several times, met them personally a few times and spoken on the phone. Suggestion wise, there has been a lack of an activity co-ordinator for a while, [manager] told us there is someone coming this month.” A staff member told us, “There has been so many managers, but this lot are really trying to get everything good.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had access to healthcare services and staff supported them to attend appointments. Professional guidance had been recorded in people’s care documentation and staff were further informed of changes at staff handover.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 January 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At the last inspection we found breaches of regulations 11 and 18, these were not checked at this inspection, so the provider remains in breach of these regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 10, 12 and 13 but remained in breach of regulation 17 Good governance.

This service has been in Special Measures since 18 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We carried out an unannounced comprehensive inspection of this service on 22 and 23 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focussed inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

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 inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ladymead Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection. We have made a recommendation about staff deployment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ladymead Care Home is a care home registered to provide nursing and residential care for up to 27 people over 65. People living at the service had varying health conditions, including dementia, diabetes, Parkinson’s disease, heart and respiratory failure and other age-related frailties. There were 19 people living at the service at the time of our inspection.

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

People were not always protected from risk of abuse; people had been deprived or their liberty without having their mental capacity robustly assessed.

People’s associated health risks were not appropriately assessed, care planning was not person centred and did not always consider people’s dignity and health needs. The service had a high reliance on agency staff. Without clear guidance from care records, agency staff were unable to provide a continuity of care to people. People did not always receive their medicines in a timely way and in accordance to best practice.

People were not always protected from COVID-19 infection prevention and control measures. Visiting professionals and agency care staff members were not always asked to prove their vaccination status or requested proof of a negative lateral flow device test result.

People, their relatives and staff commented on the high turnover of management at the service. One relative told us, “There has been too many managers.” The service had not learned lessons from previous inspections. The provider had submitted action plans to CQC which were not robust and had not been followed through. The provider did not always record and learn from complaints about the service. One relative told us, “The owners could do a lot more.”

People were not always supported to have maximum choice and control of their lives and staff did not 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.

We received mixed feedback about the food provided at the service. People were able to choose what they wished to eat. One relative told us, “The food is ok, typical care home food, it’s all bought in, the new chef is going to be cooking.” And, “Since my relative has been at Ladymead, they have put on a stone of weight, they are much better.”

People had access to healthcare services and staff supported them to attend appointments. Professional guidance had not always been recorded in people’s care documentation.

People, their relatives and staff gave mixed feedback about the leadership and management at the service. Comments included, “I’m comfortable to feedback to the manager, since the old manager left, I feel I have more opportunity.” And, “The higher management team come and stick a plaster on the problems.”

Staff were observed to be kind and considerate to people. Staff told us they liked working with the people living at the service. Comments included, “Sometimes they make you feel happier and perk you up.” And, “The best things about working is here is the residents, the people, the staff, my heart is tied to this place. I get fulfilment and enjoyment. I can walk away feeling like I have achieved something.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 April 2021). There were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

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 received concerns in relation to lack of activities for people and concerns regarding falls, nutrition and staffing. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ladymead Care Home on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from risk of abuse, assessing risks to people, infection prevention and control, medicines management, implementation of the Mental Capacity Act 2005, staff training and supervision, dignity and respect, good governance and notifying CQC of events within the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Ladymead Care Home is a detached house and has been adapted over two floors. At the time of our inspection 16 people were living at the service.

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

People were not always protected from avoidable harm because the provider did not have effective procedures in place to make sure people were safe. Incidents were not always responded to or reported to the appropriate authority. Action was not always taken to mitigate the risk of harm to people. Infection control systems were not well managed, and this put people at risk. Medicines were not always administered in line with the prescriber’s requirements.

Risks to people's health and wellbeing were not consistently managed. Processes were not in place to ensure support plans and risk assessments contain detailed and person-centred information to accurately reflect the needs of people and mitigate identified risk.

There were no adequate processes or assessing and monitoring the quality of the services provided and that records were accurate and complete. People's care risk assessments lacked important detail to guide staff on how to keep people safe.

The delivery and planning of care was not consistently person centred and did not always promote good outcomes for people. Support plans did not contain detailed and person-centred information and therefore these did not always accurately reflect the needs of those who used the service. Staffing levels were not sufficient in meeting people's wellbeing needs in a person-centred way. Staff did not have time to sit and chat with people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives told us that they felt safe at the service.

People were cared for by staff who were kind and compassionate. The provider carried out checks before staff commenced employment to ensure their suitability to work with people. People received support from a consistent staff team who knew them well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 26 October 2020) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when they would improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, medicines management, records, staffing and the overall management of the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to providing safe care and treatment, medicines, protecting people from abuse and avoidable harm and the overall governance and management of the service including reporting of information.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

After the inspection we wrote to the provider about some of the urgent concerns found during inspection. The provider sent an action plan that informed us of the immediate actions they had taken to address our concerns.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ladymead Care Home is a nursing home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 27 people.

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

Quality assurance systems had been improved but these needed further time to be developed and embedded into practice to identify all shortfalls and implement changes. Where areas for improvement had been identified these had not always been addressed in a timely way, for example environmental changes.

Some improvements had been made to record keeping but some further improvements were required to ensure that records fully reflected the care people received. Improvements were needed to ensure risks to people in relation to some aspects of medicines management and risks related to infection control were managed safely.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Risk assessments provided guidance for staff about individuals. Staff knew people well and understood the risks associated with the people they supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was Requires Improvement (published 16 August 2019). Following this we received a number of concerns about the service and a focussed inspection was undertaken (published 18 October 2019). The focused inspection found four breaches of regulation. Regulation 12 Safe care and treatment, regulation 13 Safeguarding service users from abuse and improper treatment, regulation 17 Good governance and regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The last rating for this service was Requires Improvement (published 18 October 2019). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last three consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. Therefore, this report covers our findings in relation to the Key Questions Is it Safe? and Is it Well-led? only. At this inspection we found improvements had been made however the provider remained in breach of regulation 17.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led relevant key questions.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ladymead Care Home on our website at www.cqc.org.uk.

Enforcement

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. Please see then action we have told the provider to take at the end of this report.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit. If we receive any concerning information we may inspect sooner. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

Ladymead Care Home is a residential care home providing personal and nursing care to 22 older people at the time of the inspection. The service can support up to 27 people.

Ladymead Care Home accommodates 27 people in one adapted building.

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

There were not always enough staff available to meet people’s needs. People had to wait for staff to assist them. Not all people had access to a call bell, to attract staff attention so had to call out to staff. Some staff had left recently, and the manager was leaving and working their notice.

Risks to people’s health and well-being were not always assessed and mitigated. When people had exhibited behaviour than may harm themselves, this had not been assessed and ways found to reduce the risk. When assessments showed that people were at risk of skin damage, ways to limit this had not been implemented. Risks about the home environment were not always mitigated, such as the closing of fire doors.

When things went wrong, lessons were not always learnt. Staff had not recognised all incidents appropriately and had not made records or referrals when needed. When people made allegations of abuse to staff, these were not always responded to appropriately.

People did not always receive their medicines safely. Staff had not always overseen people taking their medicines, when this was needed. Records of medicines given was not always completed accurately. When people were prescribed medicines ‘as required’, the time these were given, the dosage, reason and result were not recorded.

The home was not always clean. Infection control was not consistently well managed. The operations assistant recognised that cleanliness and the management of infection control required improvement.

Quality assurance systems had not assisted the management team to recognise and address areas needing improvement. Records did not always reflect people’s needs clearly and accurately.

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 requires improvement (published 16 August 2019).

Why we inspected

We received concerns in relation to the management of medicines, infection control, staffing, the management of risks to people and people’s nursing care needs. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement.

You can see what action we have asked the provider to take at the end of this report. Following the identification of these concerns the provider informed us they had taken action to mitigate the risks to people. We will follow this up at the next inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ladymead Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ladymead Care Home is a care home registered to provide nursing and residential care and accommodation for 23 people with various health conditions, including dementia and diabetes. There were 22 people living at the service on the day of our inspection. Ladymead Care Home is located on the edge of the village Hurstpierpoint in Mid-Sussex, and comprises a large Victorian House set in extensive gardens.

People’s experience of using this service:

People were happy with the care they received, felt relaxed with staff and told us they were treated with kindness. They said they felt safe, were well supported and there were sufficient staff to care for them.

Our own observations supported this, and we saw friendly relationships had developed between people and staff. A relative told us, “Staff are very kind”.

However, we identified issues in relation to people’s safety. Window restrictors were not in place on all windows, which placed people at risk. Additionally, people’s preferences around food were not always promoted or met. The provider gave us assurances that the above issues would be rectified and started to implement improvement straight away. However, we have identified these as areas of practice that need improvement.

Furthermore, it was clear from feedback we received and our own observation the service was in a period of transition which had impacted on the quality of care delivery. The manager was new in post, was well regarded by people and staff and had made improvements to the way the service was run. However, further time was required to ensure that the improvements identified by the manager and provider could be implemented and sustained. This is in order to ensure that people consistently received high quality care that met their needs.

People were cared for by dedicated and enthusiastic staff in a person centred way. Activities that took place daily and people were encouraged to follow their interests. One person took responsibility for looking after the services two cats and said, “I love the cats and one of them sleeps in my room”. Another person said, “I prefer to spend my time in my room as I have Sky Sports and love watching and listening to the cricket”.

People enjoyed an independent lifestyle and told us their choices in what they wished to do during the day were respected. One person told us, “I go downstairs for lunch, but come back straight after and that’s what I want to do as I like my own company”.

People were complimentary about the food and drink, they told us they could eat when they wished. One person told us, “I have sandwiches at supper time as its at 5:00pm and too near lunch, so I am not very hungry then”. People felt the service was homely and welcoming to them and their visitors.

People told us they thought the service was well managed and they enjoyed living there. One person told us, “I used to worry all the time what was going to happen to me and now I am very settled”. A member of staff told us, “I love working here and I love the residents. We’re like one big family. We fit around them and make them happy”. Our own observations and the feedback we received supported this.

Staff had received training considered essential by the provider. It was clear from observing the care delivered and the feedback people and staff gave us, that they knew the best way to care for people in line with their needs and preferences. A member of staff told us, “Training is regular and we all attend”.

The provider had systems of quality assurance to measure and monitor the standard of the service and drive improvement and that the provider learned from any mistakes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (report published 29 November 2016).

Why we inspected: The inspection was prompted in part due to concerns received about staffing levels and care delivery. A decision was made for us to inspect and examine those risks.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

Ladymead Care Home provides nursing care and accommodation for up to 27 people. On the day of our inspection there were 18 older people at the home, some of whom were living with dementia. The home is spread over two floors with a passenger lift, communal lounge and conservatory, dining room and gardens.

The home 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 chose how to spend their day and they took part in activities in the home and the community. People told us they enjoyed the activities, which included bingo, interactive bowling and arts and crafts. However we found there was a lack of stimulation and interaction on a one to one basis for people and some people could be at risk of social isolation.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us “This is the safest place to be. I have lived in four different care homes and this is the best. Nobody is unkind and nobody shouts”. Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food and drink. One person told us “It is salmon for lunch today, I love salmon”.

People found staff to be kind, considerate and caring. Comments from people included “There is a core of long serving staff who are very good” and “Yes the staff are caring towards me and kind”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One member of staff told us “I haven’t been here long but feel confident and had a good induction with lots of training. Everyone is supportive and nice”.

There was a positive and open atmosphere at the home. People, staff and relatives found the registered manager approachable and professional. One person told us “The staff and manager work very hard they all seem happy and get on well together”.

The registered manager and provider carried out regular audits in order to monitor the quality of the home and plan improvements. There was a system in place to manage complaints and comments. People felt able to make a complaint and were confident that any complaints would be listened to and acted on.

We spoke with five people who used the service, and one of their relatives. We also carried out a structured observation to help us understand the experience of people using the service. We spoke with a range of staff including the manager, administrator, nurse, and care and support staff. We checked care and administrative records to help us determine if national standards had been met.

We found that care in relation to tissue viability protected people’s welfare. Although we found some weaknesses in record keeping, the delivery of care in relation to the prevention and treatment of pressure damage was appropriate.

We saw that the home was clean and hygienic. A relative told us “They do a good job here and it always looks clean everywhere.”

We found there were appropriate numbers of nurses and care staff who were supported by a range of administrative and other staff. A person who used the service told us, "The staff are wonderful here, very kind and caring. They are always checking to see if I’m all right.”

At this inspection we found that the provider had taken the steps they needed to achieve compliance. We toured the building and examined sanitary ware. We spoke with a person’s relative, with the registered manager, administrator, head of housekeeping, a care worker and a cleaner.

We found that systems were now in place that meant people who used the service were protected from the risk of infection because guidance had been followed. We also found that appropriate standards of cleanliness and hygiene had been maintained.

A care worker said, “It’s much better than it was six months ago; it’s nice to have more cleaners around.” A cleaner told us, “It’s much better and we work more as a team. It smells a lot nicer now.”

We found that people’s needs were assessed, that each person had an individual care plan and that care was delivered in line with the plan. People’s choices and diversity were respected and their health was monitored.

People were happy with the service provided. One said, “They’re very kind and helpful, they’re caring staff and I’ve been very well looked after.”

We found that not all government guidance in relation to infection control had been followed. We also found that sanitary ware had not been maintained in a clean and hygienic state.

The home was undergoing renovation, but was safe, accessible and fit for purpose. One care worker said, “We’re having a lot of work done, it needed improvement and things are moving along.”

The home had lacked a permanent manager for over six months, but the provider had made all reasonable efforts to appoint a suitable leader. A manager felt it was a credit to the staff that they had, “Kept things together.”

Staff had access to suitable training. A care worker said, “We’re always updating our training, you can’t fault it.”

We found the provider had systems to gather feedback in order to assess the quality and safety of the service.

We found that comprehensive and well maintained care plans enabled care workers to meet residents’ assessed support needs in a structured and consistent manner.

During our visit we talked to staff and five residents who said the home supported residents to be independent wherever possible. Residents told us they had been consulted and felt involved about how they wished to have care and support delivered and were given clear information on a daily basis regarding their care and treatment. They told us their preferences were always accommodated and they described a relationship of trust with staff and felt they were being listened to. One person said “everyone works hard to look after the residents even when they are under a great deal of pressure”.

Residents told us that although the fabric of the building was tired in places, they felt safe living at the home and that they would speak to any member of staff if they had any concerns or complaints. They said that if they had reason to speak to someone they had confidence that their concerns would be addressed immediately.