The inspection took place on 31 May 2018 and was unannounced. Ladydale Care Home 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. It can accommodate up to 54 people in one adapted building, split into two floors with one unit on each floor. There were 43 people using the service at the time of our inspection.

At the previous five inspections we identified that improvements were needed to the quality of care and to governance systems in place to monitor care. This inspection was to check that improvements had been made. We found improvements had been made and sustained.

There was no 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. The deputy was acting as the manager until a permanent manager who would apply to the CQC to become registered could be found.

People told us they felt safe and we saw that measures had been taken, such as risk assessment and staff following these to ensure people were kept safe. When things had gone wrong the service had learned and action was taken to reduce reoccurrences. Staff were recruited safely and there were sufficient amounts of staff to meet people’s care needs.

People’s medicines were managed safely. There were effective systems in place to ensure people had their oral medicines as prescribed and improvements were made to the documentation of topical medicines following feedback.

People were protected from the risk of infection. The building was appropriately maintained and plans were in plan to help people evacuate in the event of an emergency arising. The building was also appropriately adapted to cater for the needs of the people living there.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) to ensure people’s rights were protected. Decision-specific assessments were carried out with best interest decision being recorded and appropriate referrals were made to the Deprivation of Liberty Safeguards (DoLS) authority.

People enjoyed the food and had a choice of food and drinks which we saw staff catering for.

People were supported to access other health professionals where necessary and health professionals felt referrals were appropriate. The service carried out assessments to ensure they could effectively support people.

Staff had appropriate training and support to be able to care for people well.

People felt they were treated with dignity and respect. Where possible people were supported to retain their independence and make decisions about their care. Staff supported people in a way that suited the person.

Staff knew people well and plans reflected people’s needs. People’s diverse needs and end of life choices had been considered. Activities were arranged for people to partake in.

People and relatives were able to complain and feedback was acted upon and responded to, overall.

Effective systems were in place to help identify improvements required and taken was taken to resolve any concerns identified. Further improvements were planned with the introduction of an electronic system. People, relatives and staff felt the acting manager was approachable and they could feedback their opinions of care. Notifications were submitted to the CQC as required and the previous rating was being displayed.

We carried out an unannounced comprehensive inspection of this service on 31 January 2017 and breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk. We found that improvements had been made in relation to all four previous breaches, so those regulations were no longer being breached.

The inspection took place on 10 May 2017 and was unannounced. Ladydale Care Home is a residential home for up to 54 people who have a variety of support needs, such as people with a physical disability, those with dementia or people who have a learning difficulty. There were 34 people living at the service at the time of the inspection.

There was a Registered Manager in post at the time of our 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.

The principles of the Mental Capacity Act 2005 (MCA) were not always followed. Conditions for Deprivation of Liberty Safeguards (DoLS) were not always being followed. Mental capacity assessments were not always carried out to help determine if people had capacity to make decisions and evidence of Lasting Power of Attorney (LPOA) was not always in place.

Audits were now being carried out and whilst some had been effective, some actions had not yet been completed and further work was required to ensure the improvements continued and that all plans were updated to reflect that people had care and support that protected their wellbeing.

People told us they felt safe and their relatives confirmed they felt their loved ones were safe in the home. We found staff understood risks to peoples safety. For example, there were detailed plans in place to help people who needed support of they became agitated so that staff could effectively support them and action was taken to ensure people’s health and wellbeing was being protected. Medicines were being managed safely, however further improvements were required to staff training for topical medicine administration and guidance for staff on as required medicines. People, relatives and staff told they felt there were enough staff and our observations confirmed this. Safe recruitment practices were in place and staff had appropriate checks prior to starting work to ensure they were suitable to work with people who use the service.

Plans were also in place for people who needed support to maintain their skin integrity and for those at risk of falls. We could see appropriate analysis and action had been taken following a person falling to try and reduce the risk of another fall occurring.

Up to date plans were in place for staff to follow in the event of an emergency evacuation of the home.

People were protected from abuse by staff who understood the different types of abuse, how to recognise it and to report it if they suspected someone was being abused. We saw appropriate safeguarding referrals had been made.

People were complimentary about the food and were supported to have food and drinks of their choice that were appropriate for their needs. People had access to other health professionals in order to maintain their health and wellbeing.

Staff and relatives knew who the registered manager was and felt able to go to them with queries. The manager was proactive in seeking and enco

This inspection was unannounced and took place on 31 January 2017. At the last inspection in September 2016, we found the provider was not meeting fundamental standards and we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked them to make improvements regarding management of risks, medicines management, protecting people from abuse, staffing levels, staff skills and knowledge, meeting people’s healthcare needs, maintaining people’s privacy and dignity, person centred care, managing complaints, quality assurance and the reporting of incidents to CQC. Following the last inspection the service was rated as inadequate and placed in to special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We undertook this unannounced comprehensive inspection on 31 January 2017 to check that the required immediate improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk. At this inspection, we found some of the required improvements had been made. However, two of the breaches of Regulations we identified at our three previous inspections were still present.

Ladydale Care Home is registered to provide accommodation with personal care for up to 54 people including people with dementia and people with physical and learning disabilities. On the day of the inspection there were 38 people living at the home. Although there was no registered manager in post a new manager had been recruited shortly after the last inspection and had submitted an application to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 found people were not always kept safe as risks were not consistently assessed or reviewed. People who presented behaviours that may challenge others were not always supported appropriately and guidance for staff was not available to ensure they received safe, consistent support. Improvement had been made to the systems used to manage medicines; however some people’s medicines were out of stock on the day of the inspection.

The provider had not always ensured that risks posed by potentially unsuitable staff were effectively managed to protect people. There were sufficient numbers of staff to respond to people’s care and support needs. People told us the presence of care staff enabled them to feel safe.

People were not always appropriately supported to make decisions for themselves. Assessments of people’s capacity to make certain decision about their care had not always been fully carried out. This put people at risk of having decisions made on their behalf without their consent. Improvements had been made in the way people were supported to access specialist healthcare supported when required, however improvements in how staff followed the advice given were required.

Improvements had been made to staff training, and people were now supported by staff who had received training relevant to their role, although there were still some gaps in staff knowledge, particularly in relation to supporting people to make decisions. Where the provider had taken action to deprive people of their liberty this had been done lawfully. People were happy with the food and drink they received and help was availa

We carried out unannounced inspections of this service on 23 June and 14 July 2016. At these inspections, we identified a number of Regulatory breaches and we told the provider that immediate improvements were needed to ensure people consistently received care that was safe, effective, caring, responsive and well-led. The service was rated as ‘inadequate’ and was placed into ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this unannounced comprehensive inspection on 23 September 2016 to check that the required immediate improvements had been made. You can read the report from our previous inspections, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk.

At this inspection, we found the required improvements had not been made. The breaches of Regulations we identified at our two previous inspections were still present and we identified an additional new Regulatory breach. The service was again rated as ‘inadequate’. As a result of this, the service will remain in special measures.

The service is registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or mental health needs, such as dementia. At the time of our inspection 43 people were using the service. Two of these people were residing in hospital, one of whom was being treated for a serious injury they sustained whilst living at Ladydale Care Home.

The home had a registered manager. However, they had recently left 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 and associated Regulations about how the service is run. An interim manager was in place during the registered manager’s absence and a new home manager had been recruited and was due to start working at Ladydale.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed

We carried out an unannounced comprehensive inspection of this service on 23 June 2016. At that inspection, we identified a number of Regulatory breaches and we told the provider that immediate improvements were needed to ensure people consistently received care that was safe, effective and well-led. The service was rated as ‘inadequate’ and was placed into ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this focused inspection on the 14 July 2016 to check that the required immediate improvements had been made. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ladydale Care Home on our website at www.cqc.org.uk.

At this inspection, we found the required improvements had not been made. Breaches of Regulations were still present and the service was again rated as ‘inadequate’. As a result of this, the service will remain in special measures.

The service is registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or mental health needs, such as dementia. At the time of our inspection 47 people were using the service.

The home had a registered manager. However, they were absent from the service at the time of this 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 and associated Regulations about how the service is run. An interim manager was in place during the registered manager’s absence. Staff told us they felt more supported in the absence of the registered manager.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely.

People were not always protected from the risk of abuse because suspected abuse was not always identified or reported as required.

Safety incidents were not always analys

We inspected this service on 23 June 2016. This was an unannounced inspection. Our last inspection took place in February 2015. At that time we found the provider was meeting the required Regulatory requirements.

The service is registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or mental health needs, such as dementia. At the time of our inspection 48 people were using the service. Three of these people were in receipt of temporary respite care.

There was a registered manager at the home. 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 this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely.

People were not always protected from the risk of abuse because suspected abuse was not always reported as required.

Most people told us they enjoyed the food. However, we found people’s risks of malnutrition and dehydration were not being effectively monitored or acted on.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. One person who was unable to make decisions about their care was being unlawfully deprived of their liberty.

We found staff did not always have the knowledge and skills requi

We inspected this service on 4 February 2015. This was an unannounced inspection. Our last inspection took place in April 2013 and at that time we found the home was meeting the regulations we looked at.

The service was registered to provide accommodation and personal care for up to 54 people. People who use the service may have a physical disability, a learning disability and/or a mental health needs, such as dementia. At the time of our inspection 49 people were using the service.

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 and associated Regulations about how the service is run.

People’s medicines were not always managed safely. The registered manager acknowledged that improvements were required with medicines management.

People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety.

Staff had completed training that enabled them to meet people’s needs effectively and the development needs of the staff were monitored by the registered manager.

Staff sought people’s consent before they provided care and support. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People were supported to access suitable amounts of food and drink of their choice and specialist diets such as diabetic diets were catered for.

People’s health and wellbeing needs were monitored and people were supported to attend health appointments as required.

People were encouraged to make choices about their care and the staff respected the choices people made. Staff treated people with kindness and compassion and people’s dignity and privacy was promoted.

People were involved in the assessment and review of their needs and care was delivered in accordance with people’s care preferences. People were encouraged and enabled to participate in activities that were important to them. These activities took place both within and outside the home environment.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive atmosphere within the home and the registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with us and they and the provider kept up to date with best practice guidance.

During the inspection we looked at four care records for people who used the service and spoke to people and their family members. We spoke with staff and the registered manager. We did this to help us to understand the outcomes and experiences of selected people who used the service.

People we spoke with told us that they had choices in their care and staff listened to what they wanted. We saw that people were treated with dignity and respect. One person told us, “The staff are great and they make me feel comfortable”.

The provider had a sysem in place to protect people from the risks associated with the unsafe handling of medicines.

We saw that the service was sufficiently staffed on the day of the inspection. People who used the service told us that there was always enough staff available when they needed support.

We viewed training records, which showed that staff had received training relevant to their role. Staff told us that they received appraisals and the registered manager was approachable if they had any concerns.

In this report the name of a registered manager, Deborah Johnson appears, who was not in post 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.

We visited this service to check upon progress being made following some safeguarding and complaints received about Ladydale in the past year. We had not visited for some time, although other agencies had been monitoring the changes being made. A new manager was appointed some months ago and had made good progress in making necessary improvements to the service.

Some staff had been suspended or dismissed. Some had not treated people living at Ladydale with dignity and respect, although some complaints had not been substantiated when investigated. We found that improvements had been made in the recording care planning information and further improvements were in process.

There were 47 people living at Ladydale when we visited. We spoke with ten of them. People told us that they were satisfied with the service provided. Some people had been resident for several years, others for a few months.

A person who had been at Ladydale for six months told us that they had settled well and liked the home, staff were good and the person had no complaints saying "I have been here for six months and they can't do enough for you. I like the food, there is a good choice and we are always asked what we would like".

We saw a relative of this person visiting later in the day. They told that us they were very happy with the care provided and said " (relative) was worried about coming here but settled well and likes the staff and the home."