The inspection took place on 14 August 2018 and was unannounced. The last comprehensive inspection took place in August 2017, when we identified four breaches of Regulation. People did not always receive care and treatment which was person-centred and met their needs. The registered provider was not always doing all that was reasonably practicable to mitigate risks associated with people’s care and treatment. Systems and processes in place to monitor and improve the quality of the service, were not effective and needed embedding into practice. There were insufficient numbers of staff to keep people safe and to meet their needs. The service was rated as Requires Improvement.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe and well led, to at least Good.

At this inspection we checked if improvements had been made. We found that the registered provider had addressed all the concerns raised at our last inspection and the rating of the service improved to Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Ladyfield House’ on our website at www.cqc.org.uk.

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

Ladyfield House provides accommodation for up to 50 people. The home consists of two separate units; Salvin and Hewitt. The service provides accommodation for people who require personal care, including people living with dementia. The home is located in the Kiveton Park area of Rotherham. At the time of our inspection there were 35 people using the service. This included people who were staying at the home for a short period of respite care.

At the time of our inspection 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.’

People were safeguarded against the risk of abuse. Staff confirmed they had received training in the subject and knew what action to take if they suspected abuse.

Risks associated with people care were identified and managed appropriately. Risk assessments were in place to guide staff in ensuring risks were minimised.

We observed staff interacting with people and found there were enough staff available to meet people needs. However, whilst most people we spoke with felt there were enough staff available, a minority of people told us there were not enough staff at busy times. Staff were recruited in a safe way, which ensured that suitable people were working at the home.

People’s medicines were managed in a safe way and people received their medicines as prescribed.

Staff had the skills and knowledge to deliver effective care. People were supported to maintain a healthy, balanced diet which meant their needs and preferences. People had access to healthcare professionals and their advice was followed.

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 service was compliant with the Mental Capacity Act 2005.

During our inspection we found staff interacted well with people who used the service. Staff were kind and caring in their manner, knew people well and provided a homely atmosphere.

We looked at care records belonging to people who used the service and found evidence that staff were responsive to people’s needs.

Social activities and stimulation was available throughout

The inspection was carried out 12 July 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. The service was previously inspected in November 2016 and was rated requires improvement with two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last inspections, by selecting the 'all reports' link for 'Ladyfield House' on our website at www.cqc.org.uk.'

The service did not have 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.

Before our inspection the provider had identified concerns in relation to the quality and safety of services provided and had appointed a new management team to identify and implement improvements and provide leadership and direction. A new regional manager was based at the service until a peripatetic manager was appointed to oversee the service. A peripatetic manager will manage the service until a new suitable permanent manager is appointed. Although we identified breaches of regulations at this inspection we saw that the new regional manager had identified areas that required improvements to be made and was in the process of implementing these. People who used the service and staff told us they had seen recent improvements had been made and spoke positively about the new manager.

Ladyfield House provides accommodation for up to 50 people. The home consists of two separate units; Salvin and Hewitt. The service provides accommodation for people who require personal care, including people living with dementia. The home is located in the Kiveton Park area of Rotherham. At the time of our inspection there were 30 people using the service, which included some people who were staying at the home for a short period of respite care.

Before this inspection we received information of concern. Concerns were in relation to staffing levels, and the management of the service. We therefore brought this comprehensive inspection forward. We found at times that there was insufficient staff to meet people’s needs.

The provider had safeguarding procedures in place and staff were aware of the process to follow if they suspected abuse. Staff we spoke with confirmed they had received training in this subject.

Care records lacked detail, while others had not been completed. Risk assessments were not sufficiently detailed to ensure staff could meet people’s needs.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration.

We found staff approached people in a kindly manner. However, at times staff did not have the time to interact with people as they were very busy meeting people’s personal care needs. We observed at times people had to wait for assistance. Staff we spoke with told us there was not always enough staff on duty to meet people’s needs. Relatives also commented they felt that people were not always safe due to lack of staff. Although they could see this had improved since the new management had been in post.

A refurbishment programme was underway in the service at the time of our inspection. Many communal areas had been redecorated and further improvements to the environment were planned. This included ensuring the home was dementia friendly meeting best practice guidance for people living with dementia. We found the service was maintained to a good standard of cleanliness but lack of domestic hours was impacting on staff being able to adhere to infection control measures.

We found that the recruitment of staff was robust and thorough. This ensured only s

The inspection took place on 29 November 2016 and was unannounced. The home was previously inspected in January 2015 and the service was meeting the regulations we looked at.

Ladyfield House provides accommodation for up to 50 people. The home has two units; Salvin which provides residential care and Hewitt which provides residential care for people living with dementia. The communal areas of the home are accessible to people who use wheelchairs. The home is located in the Kiveton area of Rotherham. At the time of our inspection there were 37 people using the service. Some people were staying at the home for a short period of respite care.

At the time of our inspection the service did not have 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. There was a manager in post who was in the process of registering with the Care Quality Commission, but at the time of our inspection the manager was on leave. Present at the home was a registered manager from another service who was supporting the manager in their new role and covering while she was away. The regional manager for the company was also present during our inspection.

We spoke with staff who knew how to protect people from abuse. Staff told us they had received training in this subject, which had given them information on the types of abuse and how to recognise and report situation.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified some improvements could be made.

We looked at care files belonging to people who used the service and found that risks associated with people’s care had been identified. However, risk assessments in place were not always up to date with people’s current needs and did not always offer guidance in how the risk could be minimised.

We observed staff interacting with people who used the service and saw that there was enough staff around to ensure people’s needs were met. Staff worked well as a team and were able to respond to people’s needs.

Recruitment systems were robust, so helped the employer make safer recruitment decisions when employing new staff. New staff had received an induction into how the home operated and their job role.

We looked at records in relation to staff training and found staff some training was required. However, staff we spoke with told us they attended training and completed training via e-learning.

People were supported to eat and drink sufficient amount to ensure they received a healthy balanced diet. People were assisted with an appropriate diet to suit their needs. Snacks and drinks were also available throughout the day. However, food and fluid intake was not always recorded effectively.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People who used the service had been assessed to determine if a DoLS application was required. The manager and regional manager had a good understanding and knowledge of this topic. However other staff did not have adequate knowledge on this subject to be able to apply it in practice. Although we found the regional manager was aware of this and was addressing it.

People had access to health care professionals when required. We looked at records belonging to people who used the service and found evidence that professionals such as speech and language therapist, physiotherapist and dietician had been involved when needed.

Throughout our inspection we observed staff interacting with people who used the service. We found staff were kind, caring and considerate. They worke

The inspection took place on 13 January 2015 and was unannounced. Our last scheduled inspection at this service took place in September 2013 and we found the service non-compliant with regulation 12, cleanliness and infection control. However, we completed a follow up visit to the service in March 2014 and found these issues had been addressed and the service was compliant.

Ladyfield House provides accommodation for up to 50 people. The home has two units; Salvin which provides residential care for older people and Hewitt which provides residential care for people living with dementia. The communal areas of the home are accessible to people who use wheelchairs. The home is located in the Kiveton area of Rotherham. At the time of our inspection there were 44 people using the service.

The service had a registered manager in post at the time of our 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.

We spoke with four care workers and the registered manager about their understanding of protecting vulnerable adults. We found they had a good knowledge of safeguarding and could identify the types of abuse, signs of abuse and they knew what to do if they witnessed any

incidents. We observed staff that responded well to people and understood their individual needs.

We saw that medicines were ordered, administered, stored and disposed of safely and in conjunction with the provider’s medication policy and procedure.

We found that people were supported by sufficient numbers of qualified, skilled and experienced staff. Staff had a programme of training, supervision and appraisal.

Suitable arrangements were in place to support people to maintain a healthy diet which included a variety of food and drink. Staff were aware of nutritional issues and ensured these were met effectively.

People had access to healthcare professionals where required and support plans reflected recommendations made by these professionals.

Staff had an awareness of the Mental Capacity Act 2005 and had received training in this area. Staff were clear that, when people had the mental capacity to make their own decisions, this would be respected. We spoke with the registered manager who had a good knowledge of this subject.

We saw that people were supported to make their own decisions and staff respected them. We spoke with staff and observed staff working with people and saw they had a good understanding of their needs and how best to support people. Staff were very caring and carried out tasks at the persons own pace.

People who used the service had their needs assessed and received individualised support. People had care plans which reflected each person’s current needs and how best to support the person.

We observed activities taking place which were led by the activity co-ordinator. Activities were based on what people enjoyed doing.

The service had a complaints procedure and responded, in a timely manner, to concerns raised.

People we spoke with felt comfortable to talk to staff if they had a concern. They also felt their concerns would be dealt with efficiently.

The service promoted a culture which was open and inclusive. The registered manager spent time with staff and people who used the service. The manager operated an open door policy so that people would feel at ease to approach her.

We carried out this inspection because when we visited the service on the 24 September 2013, we found that people were not cared for in a clean, hygienic environment. We wrote to the provider and asked them to take action to address these issues. The provider sent us an action plan which stated they would be compliant by 30 January 2014.

We inspected the service on 3 March 2014 and found the provider to be compliant.

People were protected from the risk of infection because appropriate guidance had been followed.

We were unable to ask the views of some people in the home because of the level of their dementia. However, we did speak with 6 people who used the service. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed the dining room when people were having their lunch. We saw staff including people in their conversations even if they were not able to respond fully. We saw that people were given choices and that their wishes were respected. We observed staff to be kind and caring in their approach.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent.

People who used the service had a care plan which was relevant to their individual needs. One person said, “I couldn’t find a better place, I like it here.”

Another person said, “Staff know me well and I am well looked after.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with said that the food was lovely and well presented.

People were not cared for in a clean and hygienic environment.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider had a system in place to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. One person said, “I don’t have any worries, but if I had I would talk to staff and they would do something about it.” A relative said, “The manager is always available to talk to and she is very welcoming.”

We spoke with five people who used the service and they told us that staff were very helpful and caring. We also spoke with four relatives who told us that they found the service very reliable. We found that people were involved in their care and were asked to sign their individual care plans in agreement. One relative said, “I am very involved, I love to get involved with the activities.”

We found that the people who used the service had appropriate care plans in place which met their individual needs. People were supported to be as independent as possible and staff told us how they respected people’s individuality. We spoke with five people who used the service and they commented that they were very happy living in the home and the care was good. One person said, “I get on famous with the staff and my family visit every day.” A relative said “things had improved, there seems to be more staff on duty and it’s generally fine.”

We found that systems were in place to monitor the quality of the service. Records were clear and up to date. The manager used action planning where appropriate to address any issues that were raised during monitoring visits and audits.

We were only able to speak to some people who used the service; this was because some people living at the home were not able to communicate in a meaningful way. However during our inspection we spoke to four people who used the service. They told us that the staff were good. Some parts of the home had recently been decorated and people who used the service told us that they liked the new décor. Some areas of the home had recently had new furniture and one person said “This new chair is very comfortable”.

We observed three people who used the service for a period of half an hour and recorded their experiences at regular intervals. This included people's mood, and how they interacted with staff members, other people who use services, and the environment. This method of observation is called the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Using this, we saw that there was very little interaction between staff and people using the service. Staff only communicated with people to convey a task.

We spoke to three people’s relatives. They told us that they did not feel involved in the way the service was run. They told us that their relative never went out of the home. Relatives told us that the staff were friendly and that the meals were presented well. Relatives told us;

“The gardens never look tidy”.

“The meals are always served nice and the food is excellent”.