We inspected this service on 20 and 21 July and the 17 August 2016. The inspection was unannounced.

Landermeads Care Home is situated in the Nottingham suburb of Chilwell. The service is provided from four buildings based around a Grade II listed central house which has been adapted to meet the needs of people living with dementia, young people with a physical disability and people who require neurological care and support. At the time of our inspection 85 people lived at the service although the capacity can be extended to 89 as some larger rooms can be converted to double occupancy if required, for example for married couples.

The service had a registered manager, who was also the joint owner, in place at the time of our visit. 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 told us they felt safe at Landermeads Care Home and did not have any concerns about the care they received. Staff showed a high level of understanding of how to keep people safe and protect them from harm. Safeguarding referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. Innovative methods and materials were used to ensure that people were kept safe with as few restrictions as possible. People were supported to take positive risks which enhanced their experience and enjoyment of life.

The building was well maintained and regular safety checks were carried out.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at Landermeads Care Home.

People received their prescribed medicines when required and these were stored and administered safely.

People received very effective care from staff who received thorough induction to the service. The provider and staff worked together to identify further training and support that ensured they could meet people’s current and future needs. This had helped to ensure people were able to lead a full and active life. Ongoing training and assessment for care staff was scheduled to help maintain and further develop their knowledge.

The provider kept up to date with latest research guidance and developments and had strong, established links with organisations that promote and guide best practice. The service had achieved and maintained accreditation from nationally recognised agencies for care. Staff had access to guidance and training which helped drive improvement of the service and enhance people’s quality of life.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

People told us they enjoyed the food offered and a strong emphasis was placed on ensuring people had access to sufficient quantities of food and drink to help them maintain healthy nutrition and hydration. Staff used innovative methods to encourage people who were reluctant or had difficulty.

Excellent links were established with healthcare professionals and people had access to these when required. Staff worked in partnership with healthcare professionals and followed their guidance which resulted in people maintaining good health.

People told us they were treated with compassion dignity and respect and staff ensured their privacy was protected. We observed very positive, caring relationships between staff, people using the service and th

Landermeads Care Home provides accommodation for up to 89 people who need nursing and/or personal care. In practice only 85 people can be accommodated because some bedrooms than can accommodate two people are usually only used as singles. The service provides care for  people who live with dementia, have special mental health needs, have a physical disability or have a learning disability. The accommodation is divided into a number of areas. The Meads can accommodate 28 people who live with dementia and who require special support. Nine people with similar needs but who need a quieter setting can live in Buttermeands. Lander House can accommodate 26 people who live with dementia. These people need less support and some of them do not need assistance to make decisions. A further 10 people can live in Stoppard House. Catherine Tam can accommodate 16 people who live with a learning disability and/or a physical disability.

There were 81 people living in the service at the time of our inspection.

This was an unannounced inspection carried out on 23 March 2015. There was 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.

We last inspected Landermeads Care Home in July 2013. At that inspection we found the registered persons were not meeting all the essential standards that we assessed. The arrangements that had been used to resolve a concern about person’s wellbeing had not been robust. In addition, there were shortfalls in protecting people from the risk of not eating and drinking enough, from the consequences of experiencing limited mobility and from the risk of acquiring infections. A further issue involved the fact that the registered persons had not consistently informed us about significant events that had occurred in the service. After the inspection the registered persons told us that all of these shortfalls had been addressed. At our present inspection we found that the registered persons had put these things right.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection the registered persons considered that none of the people living in the service were being deprived of their liberty. They were aware of the need to keep this matter under review to ensure that people continued to have their legal rights protected.

Some of the records needed to ensure that medicines were correctly administered were not accurate. Staff knew how to keep people safe from harm and how to promote their wellbeing including avoiding having accidents. There were enough staff on duty and background checks had been completed before new staff were appointed.

Some of the signs in the accommodation did not fully assist people to find their way around. However, staff had been supported to care for people in the right way including accessing healthcare services. People’s rights had been protected because the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were followed when decisions were made on their behalf.

People were treated with kindness and compassion. People who lived in the service and relatives were very positive about the way in which staff were caring and attentive. However, some of the arrangements used to promote people’s privacy and to respect their dignity were not robust. Staff recognised the importance of respecting confidential information.

People had not been provided with written information about their care that was easy for them to understand. There was a system for resolving complaints but people who lived in the service had not been fully informed about this arrangement. Although people had received all of the practical care they needed some people had not been fully supported to pursue their interests and hobbies. People had been supported to celebrate diversity by fulfilling their spiritual needs and embracing their cultural identities.

People had not been fully consulted about the development of the service and some quality checks had not been robust. However, the service was run in an open and inclusive way that enabled staff to provide people with consistent care. People had benefited from staff being involved in a national initiative to develop good standards in caring for people who live with dementia.

During our visit, we met separately with four people who used the service, the provider and four staff from different disciplines. One person said, “It’s alright here. I make the most of it. The staff are good and they come when I need help.”

Some of the people who lived at the service were not able to discuss what it was like to live at the service. We observed people were being well supported by staff. They were at ease in one another’s company, with no signs of stress or distress observed.

Fundamental changes were being made to the way people who used the service were supported, through the introduction of a new model of person centred care. They were in a transition phase when we inspected and the registered provider said the majority of staff would be trained by the end of 2013. One staff said, “We go into people’s world.” Another staff said, “It makes a lot of sense. It’s changed the delivery of care.” We found that the processes for sharing and coordinating information between staff needed to improve to provide adequate safeguards for people who used the service.

There were systems in place to help protect people from abuse or the risk of abuse. However, more needed to be done to ensure staff understood and responded appropriately to meet people’s needs and to whistleblowing information.

The environment was comfortable and stimulating but risks had not been appropriately assessed and managed to ensure that people were adequately protected.

We spoke with four people who were using the service during our visit. They told us their dignity and privacy were respected and staff knocked on their bedroom door before going in.

We observed the lunch time period in two of the dining rooms at the service. We used a specific way of observing care to help to understand the experience of people using the service. We observed that staff were polite and respectful and encouraged people to eat as much of their meal as they could.

We looked at the care plans for four people and saw that regular reviews of the care plans were taking place. The care plans we saw varied in the amount and quality of information available. Some care plans contained conflicting information.

We spoke with four people who were using the service during our visit. We were told, “I feel really safe.” Another person said, “Yes I do feel safe here.” They also told us they felt their belongings and finances were protected.

We spoke with four people who were using the service and asked for their opinion on the quality of service provided. We were told the service was, “Excellent.” Other people said, “It’s a nice place. I get on with the staff.” and, “It is adequate.”

Relatives said they felt listened to if they raised any concerns and one person said, “I believe this is the standard other homes should aspire to.”