About the service:

Ladycross is a care home that provides personal care for up to 35 people. The accommodation is split across four different areas on one level. Each unit contains bedrooms, bathing facilities, a communal lounge, with a dining area and kitchenette. One of these units is used for intermediate care. The aim is to facilitate discharge from acute settings, and to support people to return home, or prevent a further hospital admission, or long-term care. At the time of the inspection two people were using this facility. The other units were in use and at the time of the inspection there were 16 people using the service.

People’s experience of using this service:

Medicines were not managed safely to ensure people received them in line with current guidelines. Audits had been completed, however, for some areas this had not reflected areas which required improvement and this could place some aspects of care at risk. These included medicines and accidents and incidents. Care records had not been identified as an area of concern when aspects of care had not been reported. We needed to see sustained improvement in the good governance of this service to be assured of ongoing quality assurance.

Care plans were not always up to date or detailed to ensure the information required for people’s care was available. When people expressed themselves with anxiety which could cause themselves or other harm, there was no care plan in place to support their needs.

When people required care at the end of their lives, there was no care plan to reflect on any last wishes, arrangements or pain management.

People were protected from the risk of harm and safeguard measures were in place. Risk assessments had been completed to recognise any risk and guidance was available for staff to follow. People were protected from the prevention and any associated risks of infection. Lessons had been learnt in some areas to make improvements.

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 support this practice. Health care had a focus to ensure people’s ongoing wellbeing.

People were able to choose the food they wished to eat and had an opportunity to influence the menu planning. When people required support with their health and well-being, referrals were made and any guidance provided was followed.

Staff had training to support their role. There was support provided by the registered manager with supervision and staff meetings. This meant staff were well informed and had the support they needed.

People told us they felt cared for by the staff. They received the care they needed and it was delivered with respect and dignity. Peoples views had been obtained about the running of the home and a newsletter had been produced.

People were able to choose how they spent their time. This included being involved in activities or using the communal lounge to spend time with other people or play games.

The last inspection rating was displayed at the home and on the providers website. The registered manager understood their role and had notified us of events or serious incidents so we could monitor any actions taken. We saw that other audits had been used to drive improvements and that there was an improvement plan to reflect other areas still to be completed.

Rating at last inspection: Requires Improvement (Published April 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was Requires Improvement. At this inspection we found the service continues to be ‘Requires Improvement’ however we saw that improvements had been made in some areas.

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.

For more deta

This unannounced inspection took place on 30 May 2018. At the last inspection the overall rating was ‘Requires improvement.’ There were also regulatory breaches in safe care and treatment and good governance. At this inspection we found some improvements had been made, however some areas required further improvements. Following the last inspection in April 2017, the provider was asked to complete an action plan in July 2017, to show what they would do and by when to improve the key questions of safe, effective and well led to at least good. The home had been rated as requires improvement at the last two inspections. At this inspection we found that due to a range of breaches and the well led domain not being consistently maintained, the rating for the service remains requires improvement; with ‘Inadequate’ in the well led domain. .

Ladycross House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is on one level and divided into four separate ‘wings’ which were colour coded for reference. Each ‘wing’ had a small kitchen area, lounge or dining area. There was also an open space off the main reception area. The service was registered to provide accommodation for up to 35 people. At the time of our inspection 21 people were using the service.

At the time of the inspection Ladycross House did not have a registered manager; however they had recruited a person to the post who was completing their employment check before commencing their post. The provider had made arrangements with an acting manager to support the home; however they were not available for this inspection. 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 are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice

People enjoyed the meals; however some people’s dietary needs had not been followed to ensure their diet supported their health care needs. Areas of the environment had not been considered to support people in the development of the home or to support their long term conditions. Information was not accessible in different formats to aid peoples understanding and people’s cultural needs were not always reflected.

Audits had not been used to drive improvements. Where areas of concerns had been identified it was not clear how these had been addressed or when action had been taken. Informal complaints had not been addressed.

Staff had not always received training in a timely manner and ongoing support was described as mixed. Information relating to people’s needs was not always clear to enable the correct support to be made.

Health care professionals had been consulted and staff supported people to access appointments. Partnerships had been established to add value to people’s wellbeing and ongoing health.

People were able to personalise their own spaces and we saw that some people enjoyed the benefits of a pet within the home. The staff were caring and provided a warm friendly atmosphere which people told us they enjoyed. Peoples dignity was maintained and there was respect for peoples own environment and security.

The garden had been developed as a project for all the people, relatives and staff to enjoy. There was a sense of achievement by all those who had been involved. Other activities were available to provide areas of interest for people

People felt safe, however some falls had not been recorde

This inspection visit was unannounced and took place on 25 April 2017. At our last inspection visit on 8 February 2016 we asked the provider to make improvements to the responsiveness of staffing, the types of stimulation available and the management of the service. At this inspection, we found some improvements had been made. However further improvements were required in relation to some management aspects of the service.

The service was registered to provide accommodation for up to 35 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 24 people were using the service.

There was 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.

Medicines were not always managed safely. We saw administration errors had been made and these had not been picked up in the providers audit processes. Risks to people had not always been identified when support was provider by external health professionals ..

Assessments had been completed when people lacked capacity; however some staff had limited knowledge and were unclear how this impacted on the support required for the person. Not all the staff had received their training as required. There were no systems in place to ensure staff had the necessary skills and knowledge to carry out their roles safely.

The systems in place to monitor and review care were not always effective in identifying areas for concern. Audits had not been used to consider when risks were identified. Staff had not always received the support they needed to support them their role, following induction or training .

People told us they felt safe and staff knew how to recognise and report potential abuse. The staff were available to meet people’s needs and the provider had recruitment practices in place to check staff’s suitability to work with people.

People were encouraged to make choices about their meals and their weight was monitored to ensure they maintained levels of nutrition to support their wellbeing. Referrals were made to health professionals to support people’s health care needs.

Staff were kind and caring and treated people respectfully. Staff had established positive relationships with people. Relationships with their friends was encouraged and supported.

People’s individual needs were met and people and their relatives were involved in discussions about how they were cared for and supported. People were stimulated and supported to engage in a range of activities and areas of interest-.

The provider’s complaints policy was accessible to people and when accessed had been followed.

People’s views were sought and they told us they enjoyed living at the home.

We saw that the previous rating was displayed in the reception of the home as required. The registered manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

We found 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 back of the full version of the report.

This inspection was unannounced and took place on 8 February 2016. The service was registered to provide accommodation for up to 35 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 30 people were using the service.

The service was last inspected in June 2014, at this time we asked the provider to make improvements in relation to the care and welfare to people who use the service and staffing levels. At this inspection we saw that improvements had been made to staffing, however we found the required improvements had not been made to the care and welfare to people. This meant the provider had breached the legal requirements.

There was 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.

The provider had not completed audits to consider any trends or on going concerns which may have reflected improvements to the service. People had not been consulted in respect of the service developments and going changes to the building changes or restructure changes. People did not always feel the staff were responsive and that the stimulation within the home was limited.

The service had sufficient staff to support the current numbers of people living there and meet their basic needs. People felt safe within the home and their risks were assessed and managed to protect them from harm. People’s medicines were managed and administered safely.

Staff had received training in a range of areas to enable them to care for people and additional training was available upon request. Staff understood the support people required to enable them to make decisions when they lacked capacity.

People were offered a choice of nutritious food and adequate drinks to ensure they had a balanced diet. Staff were available to support people with their meals when required. Referrals were made to health professional when it was identified additional support was needed to help maintain people’s health and wellbeing.

The staff knew people well and treated with kindness and compassion. People were encouraged to maintain relationships and their privacy and dignity was respected.

People and relatives knew how to make a complaint and felt it would be resolved efficiently. Staff felt supported by the management team.

You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with ten people who used the service, five relatives, five members of staff and two members of the management team. We looked at a number of records including people's personal records and records kept in relation to the management of the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Ladycross House and that they were treated well. One person explained: “I do feel safe here, it’s a nice place and they make you feel at home.” A visiting relative told us: “I can’t say a bad word about them [the staff]. I don’t have to worry about my relative at all, they are all very good.”

Risk assessments were in place. Those checked on the day of our visit showed us that the risks associated with people’s care had been assessed and measures had been put into place to reduce that risk. This showed us that people’s health and welfare was, wherever possible, protected.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the registered manager understood when an application should be made and how to submit one. Staff spoken with during our visit also understood what it meant to deprive someone of their liberty and why this might happen. This ensured that the people who used the service were protected from the possibility of their liberty being deprived unlawfully.

Staff spoken with knew what to do if they suspected that someone was being abused. One staff member explained: “I would go straight to the office and tell them.” Another staff member told us: “I would tell the deputy manager and if something wasn’t dealt with, I would go further. I would go to the manager and voice my concerns.”

People who used the service told us that there were not enough staff on duty and their care and support needs were not always met. One person explained: “The staff are very good, there’s just not enough of them.” Another person told us: “The staff are worked to the bone, my only concern is the waiting to be taken to the toilet, it is awful and you lose your dignity.” There were not enough staff on duty to properly meet the care and support needs of the people who used the service.

Is the service effective?

We spoke with people who used the service and they told us that overall, they were satisfied with the care and support they received. However, they said that they would receive a better service if there were more staff around to help them. One person told us: “They don’t always come when I ring my bell and more times than not I have to wait.” Another person explained: “On Saturday it was half an hour before anyone came to take them to the toilet.”

Care plans provided staff with information about people’s care and support needs. It was clear from our observations and from speaking with staff, that they understood the needs of the people they supported. One person told us: “The staff are lovely, I have a shower and the girl who helps me is champion.”

Is the service caring?

We observed staff going about their work. They treated the people they were supporting in a kind and respectful way. They provided them with the time that they needed in order to carry out a task, whether that was assisting them with their meals or assisting them to use the bathroom.

People told us that the staff were caring and that they did their best to support the people who used the service. One person explained: “The staff are very good, it is just that they need more of them and people need more attention.” A relative told us: “She [their relative] always looks well cared for. The staff know what help she needs, they do a tremendous job.”

Is the service responsive?

Relevant professionals had been involved in people’s care. Records showed that visits had been arranged when someone needed to be seen by their doctor or by a district nurse. Other professionals involved in peoples care included opticians and dentists. Where people had been identified at being at risk of choking, the local speech and language therapy team had also been involved. This ensured that the people who used the service received the care and treatment they required.

A complaints policy was available and this was accessible to both the people who used the service and their visitors. This enabled people to know their rights and show them how to make a complaint if they wished to do so. People spoken with knew who to talk to if they had a concern of any kind. One person told us: “The staff listen if you have a complaint. If I have a complaint, I take it straight to the office.”

Is the service well-led?

An appropriate quality assurance system was in place. This enabled the manager to regularly assess the service to ensure that people received the best service possible.

Staff had a good understanding of their roles within the service. They felt supported by the management team and they explained that they were able to talk to them, if they had a concern of any kind. One staff member explained: “I feel very supported, I know I can go to the manager and she would listen.”

Meetings had been arranged for the people who used the service and staff meetings had also taken place. This enabled everyone involved in the service to have a say on how it was run.

Not everyone we spoke with who was able to converse with us said they understood their care plan or had agreed to the help provided. Several people told us they were not sure if they had ever been asked for their consent. We also saw that consent forms had not been signed. This meant there was the potential for a person using the service to have important decisions made about them without being fully informed. We also found staff training in the Mental Capacity Act was not up to date.

One person told us “I really like the staff” and another “They do their best”. Relatives we spoke with said they were satisfied with the care provided to their family member. One said “I’m really pleased with the care here” and another said “The care is superb”. They confirmed they were kept informed of any health issues and one relative told us their family member’s health had improved since using the service.

People we spoke with told us they were satisfied with the cleanliness of their rooms and thought the home was always hygienic. One person told us “Everything is always clean and tidy”.

We saw there were sufficient staff on duty to meet people’s needs although some people using the service felt there was a shortage of staff. We found there was a clear complaints procedure and people’s concerns were addressed.

People and their relatives praised the service and told us staff were “respectful” and they confirmed that personal care was undertaken in a dignified manner. One person described staff as “very kind”.

One person using the service told us that the service was “very nice” and another said they were “very pleased” with the support and described staff as “marvellous” and “great”. One relative said the care “couldn’t be better”.

We received mixed feedback about the food. We were told the menus had changed recently and some people told us they thought the food had deteriorated as a result. However, other people described the food as “good” and “very, very good”.

People told us that they liked living at the home and that they felt well cared for and staff were ‘kind’ ‘friendly’ and ‘helpful’. They also felt some areas of the building could be cleaner, for example the toilets, and that issues they raised through staff forums were not always addressed. Most people enjoyed the meals although one person told us they were ‘soft’ and ‘bland’.

People visiting the service spoke positively about the staff and said they were ‘pleased’ with the care provided.