Ladymead Care Home

Updated 2 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by one inspector and an assistant inspector.

Service and service type

Ladymead Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we wanted to be sure management would be at the service to speak with us.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from Healthwatch, which is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with seven people who used the service and three relatives about their experience of the care provided. We spoke with eight members of staff including the operations manager, manager, deputy manager, registered nurses, care workers and the chef.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at policies and quality assurance records. We spoke with a relative of a person who used the service and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Updated 2 March 2022

About the service

Ladymead Care Home is a care home registered to provide nursing and residential care for up to 27 people over 65. People living at the service had varying health conditions, including dementia, diabetes, Parkinson’s disease, heart failure and other age-related frailties. There were 17 people living at the service at the time of our inspection.

People’s experience of using this service and what we found

Quality assurance systems remained ineffective in monitoring the quality and safety of medicine administration. The provider’s auditing of medicines were not robust enough to identify or act upon low stocks of medicines. Staff did not consistently record medicine administration in line with legislation. This increased the risk of people not receiving their medicines as prescribed.

People were supported by some staff who did not always show them respect so not everyone had a positive experience. We observed some staff using language about people that was disrespectful and inappropriate. We received mixed feedback regarding staff, comments included, “The nurses don’t take a blind bit of notice. I don’t want to talk to a carer about my problem, I want to talk to the nurse about it.” And, “The carers and staff are brilliant.”

People were supported by staff who were busy and not always able to spend time with them. There were not always enough staff to meet people’s social needs in the morning and at lunch time. Staff were observed to be busy answering call bells and assisting people whilst other people had little or no interaction from staff. People were engaged in the afternoon whilst staff had time to spend hosting quizzes and completing jigsaw puzzles with them.

People were protected from risk of abuse; staff received training and knew how to recognise and respond to safeguarding concerns. Relatives told us they would feel comfortable to speak with the manager if they had concerns of safety. One relative told us, “My relative wouldn’t be backward in coming forward if they had problems, they said they feel safe, I know they are safe.”

People’s support and associated health risks were assessed. Improvements had been made to care planning which considered people’s health needs. People were involved in developing their care plans, and where appropriate, relatives were invited to contribute.

People, their relatives and staff commented positively on the changes since the appointment of the newly recruited manager. One relative told us, “With [manager] I have spoken with them several times, met them personally a few times and spoken on the phone. Suggestion wise, there has been a lack of an activity co-ordinator for a while, [manager] told us there is someone coming this month.” A staff member told us, “There has been so many managers, but this lot are really trying to get everything good.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had access to healthcare services and staff supported them to attend appointments. Professional guidance had been recorded in people’s care documentation and staff were further informed of changes at staff handover.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 January 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At the last inspection we found breaches of regulations 11 and 18, these were not checked at this inspection, so the provider remains in breach of these regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 10, 12 and 13 but remained in breach of regulation 17 Good governance.

This service has been in Special Measures since 18 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We carried out an unannounced comprehensive inspection of this service on 22 and 23 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focussed inspection to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ladymead Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance at this inspection. We have made a recommendation about staff deployment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.