We inspected this service on 9 January 2018. Ladymead Care Home is registered to provide personal or nursing care and accommodation for up to 40 people. On the day of our inspection 31 people were living at the service.

Ladymead Care Home is a residential setting. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service comprises of two floors.

At the last inspection in November 2015 the service was rated requires improvement in responsiveness and rated Good overall.

At this inspection we found the service was rated good in all areas and remained Good overall.

There was a registered manager running 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.

At our previous inspection we found people’s care plans did not always reflect people's individual care needs. At this inspection we found improvements had been made and people’s care plans were up to date and reflected support people required.

Ladymead Care Home had a clear management structure, with an established long term committed team of staff. People were encouraged to raise any concerns, they were listened to and people’s feedback was acted upon. The senior team was highly regarded. The service continued to provide a good quality of care and the registered manager had systems to monitor the service delivery, to review and improve if necessary. Complaints were managed appropriately and people knew how to raise concerns.

People remained safe. Staff knew how to report safeguarding concerns and they were aware of safeguarding and whistle blowing procedures. People’s care files contained detailed risk assessments that covered areas, such as mobility, nutrition, skin integrity or falls. Where people had been identified as being at risk, their records outlined management plans on how to keep the person safe. People were supported by sufficient number of suitable skilled staff and received support without any unnecessary delay. Staff complimented the support and development opportunities they received.

The service continued to be caring. The dedicated and stable staff team supported people with kindness and respect. People’s equality and diversity needs were respected. People were provided with a variety of activities, according to their needs, choices and preferences.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. 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. People’s rights to make their own decisions were respected.

People’s health and well-being needs were met and staff responded effectively to people’s changing needs. The team worked with health and other professionals where required. People were supported to meet their nutritional needs and encouraged to maintain a good diet. People were supported to take their medicines safely by trained and competent staff.

This inspection took place on 12 November 2015 and was unannounced. Ladymead Care Home provides care for up to 40 older people requiring nursing or personal care. On the day of our inspection 33 people were living at the service.

There was a manager in post who was in the process of applying to be the registered manager with Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People told us they felt safe. People were cared for by staff that were knowledgeable about their responsibilities to keep them safe. People were protected by appropriate risk assessments that promoted their independence. Management plans were in place to reduce and manage the risks and to ensure people’s safety.

Medicines were stored and administered in a safe way. People received their medicines as prescribed and in line with the organisation’s medicines policy.

Staffing levels were sufficient to meet the needs of the people who used the service. Staff received regular training. People were cared for by staff that were knowledgeable about their roles and responsibilities and had the skills, knowledge and experience required to meet people’s needs.There were effective recruitment processes in place so that people were supported by staff of a suitable character.

People were supported to eat and drink enough and maintain a balanced diet. The chef was knowledgeable about people’s individual nutritional needs. People who required assistance with their meals were supported in a caring and professional manner. People told us the food was good and that they had a choice of meals.

On the day of the inspection we saw staff supported people in a caring, professional and friendly manner. People’s privacy and dignity was promoted. People we spoke with told us they were happy with the service and well cared for.

People had care plans in place to address their individual health and social care needs. The provider had identified that the care plans needed to be more person centred and individualised. We saw that the provider was in the process of implementing a new format for care planning documentation.

The manager and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The MCA is the legal framework that protects people’s right to make their own choices. DoLS are in place to ensure that people liberty is not unlawfully restricted and where it is, that it is the least restrictive practise.

The people we spoke with said they had no complaints, but would feel comfortable speaking to staff if they had any concerns. Manager ensured when concerns had been raised these had been investigated and resolved promptly.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. External professionals were complimentary of the manager and of the care provided at the service. They told us, any advice they gave was followed.

The service had systems and processes in place to ensure people received a high quality of care and people’s needs were being met. There were opportunities for people and their relatives to provide feedback about the service.

Ladymead Care Home is a purpose-built home in the village of Wroughton, on the outskirts of Swindon. The home provides accommodation on two floors and has single and double rooms, with en-suite facilities. The home is registered to accommodate up to 40 people requiring nursing or personal care.

One inspector visited the home and answered our five questions, Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Safeguarding procedures were robust and staff had a clear understanding of their responsibilities with regard to protecting the people in their care. There had been no safeguarding referrals made in 2013 or 2014. People told us they felt very safe. Relatives told us that their family members felt and were safer in the care home than they had been in their own homes.

Mental Capacity Act assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS). The home had not made any Deprivation of Liberty Safeguards referrals in 2013 or 2014.

There were enough staff to ensure people were safe and comfortable. The manager or her deputy were able to make decisions about staffing numbers on a day-to-day basis. They regularly reviewed staffing levels and had the authority to make any adjustments that were necessary to ensure people’s comfort or safety.

Systems were in place to make sure that managers and staff continually monitored the quality of care offered to people. Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People were given a Service User Guide which described, in detail the service that the home offered. It included what type of care the home offered and people’s responsibilities.

People told us that they were happy living in the home. Two people told us that they ‘‘couldn’t ask for better care’’, other people expressed the same sentiment. Relatives told us that they were very happy with the standard of care their family members received. They commented, ‘‘we’re involved in the care planning to make sure mum’s needs are met’’, ‘‘we are very, very pleased with the care’’ and ‘‘we can’t fault the care’’.

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. They were involved in developing their plans of care if they chose to be. Care plans clearly identified people’s needs and how they should be met. People and their relatives told us that their healthcare needs were very well met.

The home made sure that staff were well trained and there were enough staff on duty to meet people’s individual needs.

Is the service caring?

People were supported by well trained and knowledgeable kind and patient staff. We saw that care staff responded quickly and sensitively if people either asked for or indicated that they needed help.

People commented the staff were ‘‘absolutely wonderful’’, ‘‘kindness itself’’ and ‘‘very willing to help me at all times.’’ Relatives told us that staff were ‘‘excellent’’, ‘‘kind, caring and respectful’’ and ‘‘staff, especially the cook and activities co-ordinator will go over and above to make sure people are happy and comfortable’’.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Peoples’ individual interests were identified and used to enhance peoples’ lifestyle.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People commented that the activities co-ordinator was ‘‘brilliant’’, they said, ‘‘she is very, very, enthusiastic’’. They told us that she provided a variety of interesting activities for people to do. People told us that they very much enjoyed the activities.

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. Four minor complaints had been received in 2013 and 2014. These had been appropriately dealt with, to the complainant’s satisfaction. People told us that they were confident to approach staff or the manager with regard to concerns and said they were, ‘‘totally confident’’ that action would be taken promptly, as necessary.

Is the service well-led?

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was being maintained or improved.

Staff told us, ‘‘it is a good place to work’’ and that they had good training opportunities and were well supported by the management team. People who live in the home, their relatives and staff members told us that they felt ‘‘ very comfortable’’ to approach the manager at any time.

We spoke with three people who lived in the home who told us that they were well supported and the staff met their needs. One relative told us that they had visited several homes before deciding that they liked Ladymead best. They said that staff met all their relative’s needs. Another relative told us that the staff could not take better care of their relative. They said that the staff were very caring and met all their relative’s nursing and care needs.

Before people received any care or treatment they were asked their consent and the provider acted in accordance with their wishes. We saw staff asking people throughout the day what they wanted to do and what support they needed. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People's needs were assessed and they had care plans to make sure their needs were met. People experienced care, treatment and support that met their needs and protected their rights. There were suitable arrangements for obtaining, administering, recording and storing medicines so that people received the right medicines at the right time.

There were enough staff on duty to make sure people’s needs were met. We saw that staff were attentive to people’s needs and they were not rushed. There was a relaxed atmosphere. People knew how to make a complaint. Complaints were investigated and action was taken when needed.

One of the people we spoke with told us that their family had researched for a suitable care home via the internet. They had identified ‘Ladymead’ as suitable and the person said they had been received with “open arms” and was “made to feel they had been a friend for years”. They told us about the meal choices that were offered and that there was always fresh fruit available.

The person said that if they did have cause for compliant they would speak to the manager or a senior nurse and that they felt confident that the home would “respond appropriately”.

We spoke with the relative of one person who said the home had looked after their family member “admirably” that “nothing was too much trouble” and the “staff were very kind”. They also said they were very happy and their family member’s needs were “incredibly well catered for”.

Another relative said the “staff are wonderful” and that they take time to explain things to people. They added that they had seen an improvement in their relative’s well being since their admission to the home.

One person’s relative told us that they had noticed a quick response time when calls bells were sounded.

We spoke with four people who lived at Ladymead. One person told us "it is very nice here." Another person said "the staff would do anything for you." Three people told us that the food was very good. The fourth said it was not as good as they used to make it. All four people said there were a lot of activities and they could join in if they chose. They all said that the staff were very polite and respectful.

Before people received any care or treatment they were asked their consent and the provider acted in accordance with their wishes. We saw staff asking people throughout the day what they wanted to do and what support they needed. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People's needs were assessed and they had care plans to make sure their needs were met. People experienced care, treatment and support that met their needs and protected their rights. There was enough equipment to meet people’s needs for example hoists and wheelchairs. These were well maintained to keep people safe.

Staff had proper recruitment checks before they started to work with people so that people were protected from unsuitable staff. There was a range of training for staff and they had opportunities to take further qualifications. Staff had the right skills to support people. All the people we spoke with said that staff were very helpful and kind and they got the help and support they needed.