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 the