We carried out this inspection on 16 January 2019. The inspection was unannounced.

This service was last inspected in February 2016 and was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Landona 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.

There were 34 people living in the home at the time we carried out our inspection.

There was an experienced registered manager responsible for the day-to-day management of the service. 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 had been working at the service for four months.

We looked at how the service managed its recruitment of new staff and saw that this was done well and all of the required checks were carried out before staff commenced working at the home. The home had an established staff team and did not use any agency staff. Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw that staff were very thoughtful in their approach to people.

We spoke with 11 people who lived in the home and three relatives and all gave positive feedback about the home and the staff who worked in it. They told us that the staff supported people well. We saw that warm, positive relationships with people were apparent and one person described the staff as “My life line as I’m now safe and well cared for.”

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The food served at the home was of a very high standard. Everyone we spoke with told us that they enjoyed the food and we saw that it was plentiful and good quality.

Care plans were clearly recorded. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. We saw that relatives were involved in supporting staff to understand how people wished to be cared for. There were many activities provided at the home and people told us that they enjoyed them and spoke highly of the activities staff.

The registered manager and the provider used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home. Feedback about the registered manager was excellent from the people who lived in the home, relatives and all the staff we spoke with despite them not having worked at the service for a long time.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

In this report the name Miss Katey Marie Harding appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

This is a summary of what we found:

Is the service safe?

The people we spoke with said they felt safe and comfortable in their home and were well cared for. One person told us, “I would recommend living here.”

We had received concerns from a person who wished to remain anonymous, who alleged that there were insufficient staffing levels to meet people’s needs. One person who used the service said that staff were always around if and when you need them. We observed that staff were available at all times to assist people when required. Another person who used the service told us, “The staff are marvellous you couldn’t ask for better.”

Discussions with the registered manager confirmed that the majority of people who used the service required assistance to take their prescribed medicines. We found that the management of medicines was not entirely robust. For example, one person told us that they had recently been prescribed a new medicine which they were able to take themselves. We found that this medicine had not been recorded. This meant that not all staff would be aware of the person’s current treatment and this could compromise the care the person received.

Care records contained risk assessments relating to people’s daily activities. This provided staff with information about how to promote people’s independence and ensure their safety whilst doing so. For example, one person who used the service told us about the level of support they required to mobilise and the equipment required. The risk assessment contained the information the person shared with us. We also found that staff were aware of the support this person required.

Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people who used the service were protected from avoidable harm, abuse and breaches of their human rights.

Is the service effective?

We spoke with a relative who confirmed that an assessment of their relative’s needs was carried out before they were admitted to the home. They told us that they and their relative were involved in the assessment. The registered manager said that an assessment of people’s needs was carried out before a placement was offered to a person. This assessment enabled the registered manager to find out whether they had the capacity to meet the person’s needs before they were admitted to the home.

Is the service caring?

One person who used the service told us about the level of support they required to meet their needs. They confirmed that they were provided with the relevant support. We spoke with three care staff who demonstrated a good understanding about how to care for this person and others. This meant that people were assured that their care needs would be met. We observed that people were well cared for and that staff were attentive to people’s needs. For example, we saw a care staff sat with a person in the garden talking with them in kind manner and saw the care staff discretely rearrange the person’s clothing to preserve their dignity. One relative told us, “When staff walk into the room X’s face lights up, they are so well cared for.”

One person confirmed that they had access to other healthcare professionals when needed and this was also identified in the care plans we looked at. This meant that people could be confident that their physical and mental health care needs would be met.

Is the service responsive?

Prior to our inspection we had received a complaint about staffing levels within the home and the impact this had on the care people received. We had shared these concerns with the registered manager who was prompt in providing a written response to the concerns identified. During the inspection we found that this complaint had been recorded and showed what action had been taken to address this. This meant that complaints were taken seriously and acted on to improve the service provided to people.

People who used the service said that they had no complaints about the care and treatment they had received. However, they told us they would share any concerns with staff or the registered manager. One person told us, “If I had any complaints I would speak to the manager, they always sort things out.”

Is the service well-led?

The home was managed by a registered manager and a recently appointed deputy. We found that they both had a good understanding of people’s care needs. The people we spoke with who used the service, relatives and staff were complimentary about the way the home was run, to ensure people received an effective service.

The registered manager told us that they had various audits in place to monitor the quality of service provided to people and we saw these. The people we spoke with confirmed that they were happy with the service they had received.

The registered manager told us that meetings were carried out with people who used the service and their relatives and this was confirmed by the people we spoke with. Access to these meetings gave people the opportunity to have say about how the home was run.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

This inspection was carried out because we had received information of concern about this service. We looked at records kept at the home, talked to people who lived there as well as their visitors, the staff and the managers.

People who lived in the home and their relatives said that they were well looked after. They told us the staff talked to them about how they would like to be cared for. They said staff were always mindful of their privacy and treated them with respect.

We saw that new sitting areas had recently been completed with new furnishings and carpeting in many of the areas. We saw that people’s bedrooms were clean, tidy and odour free.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “I’m very happy. I have the life of a lady”.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like to be assisted. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the proprietor, the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “They take good care of me” and another said, “These staff are lovely”.

We spoke with six people who lived at Landona House. There were 22 people living at the home on the day of the inspection. We also spoke with the manager, two members of staff, a relative that was visiting and the hairdresser.

People were very satisfied with the way they were looked after and the standard of the service at the home. One person said that, "It's perfect here". A relative told us that the home always had a, "Very good atmosphere".

We saw that people were offered choices about how their care was delivered and how they spent their time. We observed staff being kind and courteous towards people.

Care records were kept securely and generally detailed people's needs and how these were to be met. Staff knew how to find information about each person's care needs in the care plans. Some people were able to remember being asked about how they wanted their care to be provided.

Measures were in place to protect people from the risk of healthcare associated infections.

Recruitment procedures made sure that the people working at the home were suitable.

Systems were in place to make sure that people were safe and could raise any concerns or complaints.

People told us that they love living at Landona House. People consider it to be their home.

We were told that,

“The home is first class. Staff can't do enough. It is a lovely place with lovely staff”.

“I like it here, it is lovely. Staff are kind”.

“I am looked after well and I am very happy here”.

These comments reflected those made by others living at the home.

Relatives were equally complimentary. Everyone we spoke with referred to the people living and working at Landona House as being, “one big family”. One person told us that getting their relative into the home, “was the best thing we've ever done”.

Relatives and visitors spoke highly of the manager and the staff team. We were told,

“The staff team can't do enough for them”.

“We have been made to feel very welcome”.

“The staff go out of their way to help people.”

“It is like coming into a second home when I visit”

One person said, “It is the best place ever” and went on to say that, “the manager is wonderful. Nothing is too much trouble”.

This inspection was unannounced and took place on 18 February and 1 March 2016.

Landona House provides accommodation and personal care for up to 41 people some of whom were living with dementia. On the days of our inspection 37 people were living there.

The home had a registered manager who was present for the 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 felt safe living in the home and staff knew how to keep them safe. Staff had access to risk assessments to support their understanding in providing care in a safe manner. Staff were always nearby to support people when required. Medicines were managed appropriately to ensure people received their prescribed treatment.

People received care and support from staff who received regular training to ensure they had up to date skills and knowledge. Staff received one to one sessions to support them in their role. People were supported to make decisions about their care. Their human rights were protected because staff were aware of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Arrangements were in place to ensure people had a choice of meals and access to drinks at all times. Staff obtained relevant healthcare services on people’s behalf when needed. The environment was dementia friendly and helped people to find their way around the home.

People were treated with kindness, compassion and were involved in decisions about their care and the support they required. Care was provided in a way that promoted people’s right to privacy and dignity.

People were encouraged to be involved in their assessment and were supported to pursue their hobbies and interests. Complaints were listened to and acted on to improve the service.

Arrangements were in place to support people to maintain links with their local community and to have a say in the running of the home.  There was a clear leadership in the home and people were aware of who the registered manager and provider was.  Systems were in place to monitor the quality of service provided to people.