About the service: Ladywood is a residential care home registered to provide personal and nursing care for up to 38 people aged 65 or older some of whom were living with dementia. There were 35 people living there at the time of the inspection. The accommodation is based across two floors, with communal areas on the ground floor and several communal areas.

People’s experience of using this service:

The service met the characteristics of good overall with requires improvement in Well Led.

Staff did not always feel that their concerns were always listened to and responded to. The provider assured us that they would consult with staff so that they could share their feedback. People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

The care that people received continued to be effective. They 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. Staff received training and support to be able to care for people well. They ensured that people were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The environment was adapted to meet people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. They were some activities available for them to pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the registered manager managed any complaints in line with the provider’s procedure.

There were quality structures in place which were effective in continually developing the quality of the care that was provided to them.

More information is in the full report.

Rating at last inspection: Good: report published on 10 June 2016

Why we inspected: This was a scheduled inspection based on previous rating.

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.

We inspected Ladywood on April 26 2016 and it was unannounced. Ladywood provides accommodation and personal care for up to 38 people with health conditions including dementia. The accommodation is provided on two floors which are accessible via a passenger lift. There were 37 people living at the service when we visited. They were last inspected on 28 and 29 January 2015 and were found to require improvement in safe and well led which reflects an overall rating of requires improvement.

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.

At our last inspection we saw that the provider did not consistently manage risks to people’s health and welfare. At this inspection we saw that the provider had systems in place to assess risk, actions were put in place to reduce it and that their effectiveness was monitored and regularly reviewed. At our last inspection the provider did not always analyse accident and incidents and follow up on all findings. At this inspection we saw that they were analysed and reviewed and that actions were taken as a consequence of this. The provider had introduced new initiatives to ensure that there were several methods in place to monitor and review risks to people’s health and wellbeing and to respond to any accidents or incidents to reduce the risk of reoccurrence.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. People told us that there were always enough staff to meet their needs promptly. Staff developed caring relationships with the people they supported which were respectful and patient. They knew people well and provided care that met their preferences. They understood the importance of consent and always explained to people what care they were going to provide. People’s capacity to consent to their care and make their own decisions was assessed and reviewed when required. People’s privacy and dignity were maintained at all times.

People received the medicines they were prescribed safely and there were systems in place to reduce the risks associated with them. They were supported to maintain good health and had regular access to healthcare professionals. Their care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible.

The environment was homely and there was signage to help to orientate people. Mealtimes were not rushed and people said that the food was good. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk.

People were encouraged to pursue interests and hobbies and regular activities were planned weekly. Visitors were welcomed at any time and they were encouraged to provide feedback through meetings and more informally. People and their families worked with the staff team to organise regular fundraising events to provide funds for activities.

People told us that they knew the manager and felt confident that any concerns they raised would be resolved promptly. The provider completed quality audits to continually drive improvements.

People we spoke with told us they were satisfied with the care and support they received. One person told us “Everything is quite alright” and another said “The staff are good, very kind”.

We found that improvements had been made to how consent was obtained from people who were not able to verbally express their agreement and that the service had undertaken reviews and completed documents involving people and their relatives.

The staff we spoke with knew what support individuals needed and respected the individuality of the people using the service. They were able to describe how they managed challenging behaviour and how they ensured people were in agreement with the care provided.

We had received information in October 2013 suggesting there were issues with staffing and the provision of care. We looked at these areas on our visit and found that the service had taken action to address staffing although there were still issues relating to the deployment of qualified staff and that the issues raised regarding care were not verified.

Most people and their relatives praised the service and told us staff were respectful and one person said staff were “ever so good”. One person using the service told us that the staff were “all so good” and another said they were “quite happy here”.

One relative told us the person they were concerned with was “always clean and tidy” and another told us that they thought the service was “good”. One relative told us they thought the staff could do more for people on a social level; they said essential needs were met but “they do what they have to do and nothing more”. They thought this was due to not enough staff being available. Three people we spoke with commented that they never had to wait long for assistance.

People told us they enjoyed their meals. One person told us that the food was “very good”.

This inspection took place over two days. We arrived on the 28 January 2015 and returned on the 29 January 2015 to complete our inspection.

At the last inspection on 24 October 2013, we found that the service was meeting the regulations we inspected against.

Ladywood provides accommodation and personal care for up to 38 people with health conditions including dementia. The accommodation is provided on two floors which are accessible via a passenger lift. There were 33 people living at the service when we visited.

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 who used the service told us they felt safe with the support workers who looked after them and their relatives and friends agreed. They told us they were happy with the care and support they received.

We found that not all staff were moving and handling people safely. When people were found to have suffered a bruise, this had not always been looked into or acted upon.

Risks to the people who used the service had been assessed. This was to make sure that where and whenever possible, people where provided with a safe environment in which to live.

Checks had been carried out when new staff had been employed to check that they were suitable to work at the service. Training and on going support was then provided to enable the staff to properly meet the needs of those in their care.

Staff carried out their duties in a relaxed way and the people who used the service and their relatives felt that there were sufficient numbers of staff available to meet their needs.

People received their medicines as prescribed by their doctor. Their medicines were being handled in line with national guidance and the required records were being kept. We questioned the length of time it took to complete the morning medication round (it had taken until midday). The registered manager acknowledged this as unacceptable and explained that a new medication routine was to be implemented.

People’s needs had been assessed prior to them moving into the service and plans of care had been developed from this. People told us staff knew their care and support needs and they looked after them well. Relatives spoken with agreed.

People’s consent to the care and support they were to receive had been obtained when they first moved into the service and staff involved them in making decisions on a daily basis.

People’s health care needs were being met and relevant healthcare professionals were being contacted when people’s needs changed.

People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was being provided. Staff were not always recording when they had provided people with food and fluids particularly in the evenings and at night time. This meant that they could not demonstrate that people had received the nourishment they needed to keep them well.

We observed staff treating people with kindness and they supported them in a caring and considerate way. People told us the staff listened to them and acted on their wishes.

People who used the service and their relatives told us that they were treated with respect and staff maintained their dignity at all times. We saw this throughout our visit.

People had been involved in deciding what care and support they needed. Their plans of care reflected their personal preferences in daily living and they were supported to follow their own interests.

People were supported to make complaints and when complaints were made, these were taken seriously.

People told us the service was well managed and the management team were available to talk with when required. Staff felt supported by the management team and told us they felt able to approach the manager at any time.

Systems were in place to monitor the quality of the service provided, though not all of these were effective.

Staff meetings and meetings for the people who used the service and their relatives were being held and surveys were being completed. This provided people with the opportunity to be involved in how the service was run.

We found the service was in breach of one of the Health and Social Care Act (Regulated activities) Regulations 2010 which corresponds to one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.