Archived: Ladysmith Care Home

Updated 20 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 September 2018 and was unannounced. The inspection team consisted of two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience had expertise in caring for an older relative who lived with dementia.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also checked our systems for any notifications that had been sent in as these would tell us how the provider managed incidents and accidents that affected the welfare of people who used the service.

Prior to the inspection, we contacted various agencies for information. These included local authority safeguarding and contracts and commissioning teams.

We spent time in communal areas and observed how staff interacted with people who used the service throughout the day and at lunchtime. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with nine people who used the service and three people who were visiting their relatives. We spoke with the provider, the deputy manager and four members of the care staff team. We also spoke with an activity coordinator, a cook and a visiting health professional.

We looked at four care files which belonged to people who used the service. We also looked at other important documentation relating to them such as medication administration records (MARs) for 31 people and monitoring charts for food, fluid intake, weights, wound care and pressure relief. We looked at how the service used the Mental Capacity Act 2005.

We looked at a selection of documentation relating to the management and running of the service. These included four staff recruitment files, training records, the staff rota, minutes of meetings with staff and people who used the service, quality assurance audits, complaints management and maintenance of equipment records. We completed a tour of the environment.

Updated 20 October 2018

This inspection took place on 17 September 2018 and was unannounced. Since the last inspection on 6 January 2017, the provider has slightly changed the name of the organisation to bring their two services under one organisation, but it in effect remained the same. At the last inspection, we had concerns about the management of medicines, documentation relating capacity legislation, care plan records and quality monitoring; the service was rated as Requires Improvement. At this inspection, we saw significant improvements in all areas and the service has been rated Good.

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

Ladysmith is a large service set over two floors and can support a maximum of 90 people with a range of health care needs. Some people who used the service were living with dementia and there was a separate part of the service upstairs equipped to meet their needs. All the bedrooms are for single use and all have en-suite facilities. There are communal rooms, bathrooms and toilets on each floor suitable for people’s diverse needs. At the time of the inspection, there were 31 people upstairs in Orchid and Lilac units and 42 people downstairs in Heather and Lavender units.

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. The registered manager was on annual leave so the deputy manager and provider supported the inspection.

The overall governance of the service had improved. Advice and support had been externally sourced, which had provided structure to quality monitoring and facilitated staff development. Audits and checks were completed. Meetings with people who used the service, their relatives and staff took place, and surveys were completed. Shortfalls were identified and a service development plan produced to drive improvements.

People had assessments of their needs and the care plans produced to meet them had improved. They were much more individualised; they included guidance for staff in how to meet people’s needs in ways they preferred.

People received their medicines as prescribed; there was an improvement in recording when items such as creams and lotions were applied. Medicines were stored safely and re-ordered in a timely way so people did not run out of them.

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 documentation for capacity assessments and to support best interest decisions had improved.

People’s health and nutritional needs were met. Staff supported people to access health professionals when required and they could remain in the service for end of life care if this was their choice. People liked the meals provided to them, although some people said they could be hotter when served and they would like an additional choice at the main meal. The registered manager told us they would address this with catering staff.

People who used the service and their relatives had positive comments about the staff team and their approach when supporting people. People’s privacy and dignity was respected.

Staff had completed safeguarding training and knew how to protect people from the risk of abuse. They completed risk assessments and supported people to carry out daily tasks with the minimum of risk involved, without removing their choice and decision-making.

Staff were recruited safely and there were sufficient staff deployed to meet people’s needs.

Staff had access to training, supervision, support and development. They described the management team as supportive and available when they needed to talk to them.

There was a complaints procedure displayed in the service and people felt able to raise concerns and complaints.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection.