The inspection took place on the 1 November 2016 and was unannounced.

Ladymead Care Home provides nursing care and accommodation for up to 27 people. On the day of our inspection there were 18 older people at the home, some of whom were living with dementia. The home is spread over two floors with a passenger lift, communal lounge and conservatory, dining room and gardens.

The home 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 2008 and associated Regulations about how the service is run.

People chose how to spend their day and they took part in activities in the home and the community. People told us they enjoyed the activities, which included bingo, interactive bowling and arts and crafts. However we found there was a lack of stimulation and interaction on a one to one basis for people and some people could be at risk of social isolation.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us “This is the safest place to be. I have lived in four different care homes and this is the best. Nobody is unkind and nobody shouts”. Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food and drink. One person told us “It is salmon for lunch today, I love salmon”.

People found staff to be kind, considerate and caring. Comments from people included “There is a core of long serving staff who are very good” and “Yes the staff are caring towards me and kind”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One member of staff told us “I haven’t been here long but feel confident and had a good induction with lots of training. Everyone is supportive and nice”.

There was a positive and open atmosphere at the home. People, staff and relatives found the registered manager approachable and professional. One person told us “The staff and manager work very hard they all seem happy and get on well together”.

The registered manager and provider carried out regular audits in order to monitor the quality of the home and plan improvements. There was a system in place to manage complaints and comments. People felt able to m

We carried out this inspection in response to information of concern we received in March 2014.

We spoke with five people who used the service, and one of their relatives. We also carried out a structured observation to help us understand the experience of people using the service. We spoke with a range of staff including the manager, administrator, nurse, and care and support staff. We checked care and administrative records to help us determine if national standards had been met.

We found that care in relation to tissue viability protected people’s welfare. Although we found some weaknesses in record keeping, the delivery of care in relation to the prevention and treatment of pressure damage was appropriate.

We saw that the home was clean and hygienic. A relative told us “They do a good job here and it always looks clean everywhere.”

We found there were appropriate numbers of nurses and care staff who were supported by a range of administrative and other staff. A person who used the service told us, "The staff are wonderful here, very kind and caring. They are always checking to see if I’m all right.”

At the last inspection in June 2013 we found Ladymead Care Home non-compliant with regulation 12 of the Health and Social Care Act because not all relevant government guidance had been followed and appropriate standards of cleanliness and hygiene had not been maintained.

At this inspection we found that the provider had taken the steps they needed to achieve compliance. We toured the building and examined sanitary ware. We spoke with a person’s relative, with the registered manager, administrator, head of housekeeping, a care worker and a cleaner.

We found that systems were now in place that meant people who used the service were protected from the risk of infection because guidance had been followed. We also found that appropriate standards of cleanliness and hygiene had been maintained.

A care worker said, “It’s much better than it was six months ago; it’s nice to have more cleaners around.” A cleaner told us, “It’s much better and we work more as a team. It smells a lot nicer now.”

We spoke with a range of staff including managers, care workers, a nurse, an activities co-ordinator, a maintenance person and a visiting GP. We talked with three residents and looked at the residents’ questionnaire to help us understand the experience of people who used the service.

We found that people’s needs were assessed, that each person had an individual care plan and that care was delivered in line with the plan. People’s choices and diversity were respected and their health was monitored.

People were happy with the service provided. One said, “They’re very kind and helpful, they’re caring staff and I’ve been very well looked after.”

We found that not all government guidance in relation to infection control had been followed. We also found that sanitary ware had not been maintained in a clean and hygienic state.

The home was undergoing renovation, but was safe, accessible and fit for purpose. One care worker said, “We’re having a lot of work done, it needed improvement and things are moving along.”

The home had lacked a permanent manager for over six months, but the provider had made all reasonable efforts to appoint a suitable leader. A manager felt it was a credit to the staff that they had, “Kept things together.”

Staff had access to suitable training. A care worker said, “We’re always updating our training, you can’t fault it.”

We found the provider had systems to gather feedback in order to assess the quality and safety of the service.

The people who lived at Ladymead Care Home told us that they received treatment and care from well trained, polite and knowledgeable staff in adequate and safe surroundings. We were told that the staff focus was on residents' comfort and great care was taken to respect their privacy and dignity at all times.

We found that comprehensive and well maintained care plans enabled care workers to meet residents’ assessed support needs in a structured and consistent manner.

During our visit we talked to staff and five residents who said the home supported residents to be independent wherever possible. Residents told us they had been consulted and felt involved about how they wished to have care and support delivered and were given clear information on a daily basis regarding their care and treatment. They told us their preferences were always accommodated and they described a relationship of trust with staff and felt they were being listened to. One person said “everyone works hard to look after the residents even when they are under a great deal of pressure”.

Residents told us that although the fabric of the building was tired in places, they felt safe living at the home and that they would speak to any member of staff if they had any concerns or complaints. They said that if they had reason to speak to someone they had confidence that their concerns would be addressed immediately.