Lansdowne Care Home is a service for older people who need nursing care. Lansdowne Care Home provides accommodation to a maximum of ninety-two people some of whom may have dementia. The home is split into 3 units. On the day we inspected there were 90 people living in the 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.

We carried out an unannounced comprehensive inspection of this service on 13 April 2017 where one breach of legal requirement was found. We found that the service was not managing medicines safely. At our focused inspection on 11 July 2017, we judged that the provider had made improvements and had now met legal requirements. Whilst improvements had been made we were unable to change the rating for safe and well-led because there were still issues with medicines management and the service was rated as Requires Improvement.

The service had 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.

People were positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

Staff treated people with respect and as individuals with different needs and preferences. Relatives told us they felt welcome at any time in the home; they felt involved in care planning and were confident that their comments and concerns would be acted upon. The care records contained information about how to provide support, what the person liked, disliked and their preferences and interests.

The staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Most staff told us that they enjoyed working in the home and most staff spoke positively about the management of the service. Staff had the training and support they needed.

Risk assessments were in place for a number of areas and were regularly updated, and staff had a good knowledge and understanding of many health conditions.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people home.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration.

There was an open and transparent culture and encouragement for people to provide feedback. The provider took account of complaints and comments to improve the service. People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

Improvements had been made in medicines management and there was evidence of some good practice.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). 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 registered manager understood their responsibilities and ensured people, relatives and most staff felt able to contribute to the development of the service

The provider’s governance framework ensured quality performance, risks and regulatory requirements were understood and managed. There was good use o

We carried out an unannounced comprehensive inspection of this service on 28 February 2017 at which one breach of legal requirements was found. The registered provider did not manage medicines safely.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on 11 July to check that they had followed their plan and met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lansdowne Care Home on our website at www.cqc.org.uk.

Lansdowne Care Home is a service for older people who are in need of nursing care. Lansdowne Care Home provides accommodation to a maximum of ninety-two people some of who may have dementia.

The home has 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 and associated Regulations about how the service is run.

At our focused inspection on 11 July 2017. We judged that the provider had made improvements in medicine management and had now met legal requirements. However we found that improvements were still required in relation to protocols for the administration of medicines disguised in food or drink and the monitoring of fridge temperatures for medicines.

While improvements had been made we have not revised the rating for this key questions; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice

We will review the ratings for the service at our next comprehensive inspection.

This inspection took place on 28 February 2017 and was unannounced. At our last inspection in June 2015 the service was rated as good.

Lansdowne Care Home is a service for older people who are in need of nursing care. Lansdowne Care Home provides accommodation to a maximum of ninety-two people some of who may have dementia. The home has 92 beds split into 3 units. On the day we inspected there were 91 people living in the home.

The service had a registered manager who had been in post since April 2015. 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 positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

Staff treated people with respect and as individuals with different needs and preferences. Staff understood that people’s diversity was important and something that needed to be upheld and valued. Relatives we spoke with said they felt welcome at any time in the home; they felt involved in care planning and were confident that their comments and concerns would be acted upon. The care records contained detailed information about how to provide support, what the person liked, disliked and their preferences. People who used the service along with families and friends had completed a life history with information about what was important to people. The staff we spoke with told us this information helped them to understand the person.

The staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Risk assessments were in place for a number of areas and were regularly updated, and staff had a good knowledge and understanding of many complex health conditions.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

We found errors with medicines administration, recording and reviewing for some people using the service. We have asked the provider to take urgent action to address this.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration.

There was an open and transparent culture and encouragement for people to provide feedback. The provider took account of complaints and comments to improve the service. People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).We found that the service was working within the principles of the MCA, and conditions on authorisations to deprive people of their liberty were being met.

The management team provided good le

We inspected Lansdowne care home on the 9 June 2015. This was an unannounced inspection which meant the staff and the provider did not know we would be visiting.

Before we visited the home we checked the information that we held about the service and the service provider. This included statutory notifications and safeguarding alerts. No concerns had been raised and the service met the regulations we inspected against at their last inspection which took place on 17 January 2014.

Lansdowne Care Home is a service for older people who are in need of nursing care. Lansdowne Care Home provides accommodation to a maximum of 92 people some of who may have dementia. The home has 92 beds split into three units. On the day we inspected there were 87 people living in the home.

The registered manager had been in place since April 2015. 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 and associated Regulations about how the service is run.

People who used the service were supported by staff that were kind, caring and respectful of their privacy.

The care staff we spoke with demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Staff spoke positively about the culture and management of the service. Staff said that they enjoyed their jobs and described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided in one-to-ones and staff meetings and these were taken seriously and discussed.

The registered manager provided good leadership and people using the service, relatives and staff told us the manager promoted high standards of care.

There were safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were cared for and the staff listened to them and knew their needs well. The staff had the training and support they needed. Relatives of people living at the home were happy with the service. There was evidence that the staff and manager at the home had been involved in reviewing and monitoring the quality of the service to make sure it improved.

The procedures to manage risks associated with the administration of medicines were followed by staff working at the service. There were suitable arrangements for the safe storage, management and disposal of medicines.

Staffing levels were sufficient to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff worked at the home.

CQC monitors the operation of the Mental Capacity Act (MCA) Deprivation of Liberty Safeguards (DoLS) and reports on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act. These safeguards protect the rights of adults by ensuring that if

there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The manager had knowledge of the MCA 2005 and DoLS legislation and referrals for a DoLS authorisation had been made so that people’s rights would be protected.

Activities provided entertainment and stimulation for people living in the home including those unable to leave their rooms.

There was a system in place to monitor the quality of the service and action had been taken when necessary to make any improvements.

.

This was a themed inspection programme to assess how people with dementia were cared for and how their needs were met. There were 92 people using the service on the day of the inspection, of which 50 people had dementia. We spoke to four people with dementia and three relatives. They told us they had been asked about their needs before using the service. One relative said, "they understood my relatives needs when they came to live here." We saw that staff understood how to meet people’s needs. For example, when assisting them to mobilise. People and relatives were positive about the care provided by the service. One person with dementia described their care as, "lovely."

People and relatives confirmed that the service made sure they had access to a range of medical professionals to meet their care and treatment needs. One person told us that, "I am seeing a physiotherapist and staff here had arranged this for me." People's care records showed that where there had been admitted to hospital an appropriate plan had been put in place when they were discharged to ensure they received the care and treatment they needed. Where people's needs had changed they had been assessed and referred to the appropriate professional promptly.

The manager explained that they carried out regular audits of the care provided to people with dementia. We looked at two recent examples of care plan audits, and these showed that checks were carried out to make sure that people were receiving appropriate care and treatment. Risk assessments were in place for each individual and showed how people could be supported safely to do the things they wished. The manager explained that there were regular meetings with relatives and people with dementia so that they could give their views of their care and treatment.

People said that they received the care and support they needed. A typical comment was, "staff understand my needs.” Staff were approachable and listened to what people had to say. A relative said, “staff were kind and very caring.” People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans reflected the needs of people who use the service and these were linked to risk assessments.

People were provided with a choice of suitable nutritious food and drink. One person told us, "I can eat what I want, there's always a choice at mealtimes." People's preferred meals were recorded in their initial assessment and care plans. Staff spoken with understood the importance of providing meals that people liked to eat and in the quantity they preferred. There were enough staff available to met people’s needs. People told us that there were always enough staff to meet their needs. A person said, "there's always someone there to help me when I need it.”

There were ninety-one people who use the service in the home during our visit. We spoke to a total of nine people. All the people we spoke to were able to express themselves and offer an opinion on the care provided. With one exception, all people who use the service expressed satisfaction with the care provided and they indicated that their care needs had been attended to.

We observed that people who use the service appeared comfortable and appropriately dressed. Staff were seen assisting them with their meals and drinks. Their care needs had been carefully assessed and plans of care had been prepared for them. The care provided had been carefully monitored and there was evidence that the healthcare needs of people who use the service had been attended to. There were arrangements to ensure that pressure sores are attended to.

The nutritional needs of people who use the service had been assessed and there were arrangements to ensure that they are provided with nourishing food and drinks at intervals. Monitoring forms and charts had been completed. We however, noted that one person who use the service had to wait several minutes before being fed.

Arrangements were in place to ensure that people who use the service are protected from abuse. People who use the service indicated that staff were responsive and we noted that staff responded promptly when the call bell was activated. However, some staff indicated that staffing levels were affected when staff did not turn up on duty at short notice due to sickness or for other reasons.

There were arrangements to ensure that staff received regular supervision and support from the manager and deputy manager. Essential staff training had been provided. We observed that staff communicated with each other and they worked as a team.

People were positive about the care and treatment they received. They said they were involved in their care and treatment. For example, one person said: “I can decide what I want.” Another person told us that the staff explained things to them and these helped them make their own decisions. A number of people said they felt respected and the staff treated them well. One person commented: "The staff are marvellous". People told us that the staff turnover was low which meant that people received consistent care. People said they trusted the staff. However, people were not confident that the home had sufficient numbers of staff to meet their needs. One person said: "The staff are extremely efficient; but they could do with more".

People told us that the meals provided were good. We were told by the people that their dietary and cultural needs were met by the meals provided at the home. People confirmed that they were consulted about the meals. They told us that they had drinks and jugs of water in their rooms. People said that staff were available to support them with their meals.

People felt that the home was clean. For example, one person commented: “I like my room; my bedroom is always clean," and “The home always smells fresh." The visitors also told us that whenever they visited they found bedrooms clean and tidy.

People felt that they knew how to make complaints if they were not satisfied with the service they were getting. One person said: "I had complained before and the issue was dealt with".

People were confident that their medication was given to them on time. They said they knew their medicines and why they were taking them. For example, one person said: “I know the medicines I am taking”.