Lavender Court

Lavender Court is a care home. It is registered to provide accommodation and nursing care to up to 85 people. Lavender Court specialises in the care of older people including people living with dementia.

The home was divided into four distinct areas. Orchid provided personal care to people, Poppies cared for people with nursing needs and Sunflower cared for people living with dementia. The fourth area, Rose, provided rehabilitation in partnership with the NHS, for people leaving hospital.

At the time of our inspection there were 78 people using the service.

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

People were generally happy with the care and support they received. However, a number of people raised concerns about the high numbers of agency staff at the home. Some people told us they did not always know staff names and agency staff were not always clear about their needs. Improvements were needed to make sure people knew who staff were and felt comfortable with them.

The registered manager and provider were committed to recruiting more permanent staff but at the time of the inspection were relying on agency staff to keep people safe.

We have recommended that the provider keeps the deployment of agency staff under review.

People’s medicines were not always managed safely, and improvements were needed.

We have recommended that the provider puts further checks in place for some medicine management.

There was a friendly relaxed atmosphere and people were able to have personal and professional visitors at any-time. People said they felt safe at the home despite the staffing issues. One person told us, “The staff make you feel safe.” Another person commented, “No one has been unkind to me since I have been here.”

Staff were following good infection prevention and control practices which helped to minimise risks to people.

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 said they were able to make choices about their day to day lives. We observed, people who were able, followed their own routines.

People had care plans which identified their physical needs and also gave some information about their likes and dislikes. The provider was in the process of changing the care plan system. The registered manager told us they hoped the new system would further enhance person-centred care.

People had access to a range of organised activities and the home had good links with local groups such as church groups and schools.

People lived in a home where the registered manager and provider monitored the quality of care provided and constantly looked at ways to make improvements. The registered manager listened and acted on feedback received.

Most people were happy with the support they received. One person said, “It is unbelievably better than I expected. Staff are excellent – they do what you would like them to do.” Another person commented, “Quite happy with everything. Nowhere is perfect but this is as close as you could get.”

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 Good (Published 9 April 2018) A targeted inspection looking at infection prevention and control practices was carried out in August 2020 and no concerns were identified.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We received concerns in relation to cleanliness, staffing, management and general standards of care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We found no evidence that people were at risk of significant harm from the concerns raised but have identified some areas for improvement. Please see the Safe section of this full report.

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.

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 not changed from Good based on the findings of this inspection.

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

Follow up

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

We found the following examples of good practice.

Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people.

There were systems in place to carry out checks on everyone who visited. This included making space available for visitors to put on and take off the appropriate personal protective equipment (PPE).

Staff assisted people to keep in touch with family and friends through phone and video calls. Visitors could also book appointments to visit people in a safe way. One visitor commented how good communication had been throughout this difficult time.

Furniture in communal areas had been re-arranged to enable people to socialise and take part in activities in a socially distanced way.

Staff felt well supported by the registered manager and the provider. Staff said the registered manager kept them all up to date with guidance which helped them to feel safe and reassured. The registered manager told us how proud they were of the staff team and their commitment to doing “The right thing to keep people safe.”

Further information is in the detailed findings below.

The service is divided into three units, residential care on the first floor, general nursing care on the second floor and the third floor accommodates people who have a dementia. All bedrooms are for single occupancy and are fitted with en-suite facilities. The service is staffed 24 hours a day and registered nurses are available on the nursing unit.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good

There was 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 told us they felt safe. Staff understood how to recognise and report signs of abuse or mistreatment. Staff had received training on how to recognise the various forms of abuse, which was regularly updated and refreshed. The provider carried out risk assessments to identify any risks to people using the service and to the staff supporting them. Safe recruitment processes were completed. There was enough staff to meet the needs of the people living at the home.

The provider had systems in place to manage medicines safely. There were suitable arrangements for storing and recording medicines that required extra security. Staff recorded room and fridge temperatures.

Staff followed good infection control practice. Staff knew the reporting process for any accidents or incidents. Records showed that the provider had taken appropriate action where necessary, and made changes to reduce the risk of a re-occurrence of an incident. The service had suitable processes to assess people’s needs and choices, the registered manager assessed people prior to a moving in to the service to check the service could meet the person’s needs.

Staff had appropriate skills, knowledge, and experience to deliver effective care and support. All new staff completed an induction. Records showed staff received comprehensive training, which enabled them to carry out their roles effectively. Staff received regular supervision and appraisals. Staff completed food hygiene training, they knew about good practice when it came to nutrition and hydration.

Staff asked people for their consent before delivering care or support and they respected people’s choice to refuse care. Care records showed that people gave their consent to the care and support provided. Most people we spoke with said they had been included in some of their care planning. All the relatives we spoke with said they had good communication with staff and were involved in their relative’s care.

The provider worked with health and social care professionals to ensure each person received a support package tailored to meet their individual needs. We spoke with professionals, who told us they could contact the provider by phone or email and they got a response straight away.

The provider sought people’s feedback and took action to address issues raised. There was a system in place to manage and investigate any complaints. People had information about how to make a complaint. The provider recorded incidents and accidents. They used this information to consider any changes to a person’s support needs and how staff could meet those needs.

There was a management structure in the service, which provided clear lines of responsibility and accountability. There were effective quality assurance arrangements at the service in order to raise standards and drive improvements. The service’s approach to quality assurance included completion of an annual survey. There were links with the community. Health and social care professionals told us the agency was well managed. The provider had ensured they complied with all relevant legal requirements, including registration and safety obligations, and the submission of

notifications.

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

Further information is in the detailed findings below

At the last inspection carried out on 11 December 2013 we did not identify any concerns.

Lavender Court can accommodate up to 69 people. The home is divided into two units and it provides general nursing care and residential care to older people. Within the building there are also 10 flats which are not currently occupied. Lavender Court is purpose built. All bedrooms are for single occupancy and are fitted with en-suite facilities. The home is staffed 24 hours a day and registered nurses are available on the nursing unit. The home is situated in a residential area close to the centre of Taunton.

There is a registered manager who is responsible for the home however they have submitted an application to cancel their registration for Lavender Court as they had moved to another of the provider’s homes. 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.

The home was being managed by an acting manager who had worked at the home for many years as a deputy manager. The acting manager had an excellent knowledge about the needs and preferences of the people who lived at the home. They had a clear vision for the home and they made sure this was understood and followed by the staff team. They were committed to ensuring people received the best possible care and they demonstrated a very good knowledge of the legal responsibilities which would be expected of a registered manager.

Staff morale was very good and there was a happy and relaxed atmosphere throughout the home. Staff interacted with people in a very kind and caring manner and people looked relaxed and content with the staff who supported them. One person told us “I’m treated like royalty; I really am. The staff help you in such a wonderful way. They are just so kind and caring.” Another person said “The staff are very pleasant, I’m treated with respect and dignity. They are all very caring and the manager is very good and comes to chat with me. The care is very good, I can make choices and I’m very well looked after you know.”

People told us they felt safe at the home and with the staff who supported them. One person told us “They know what I want I don’t have to worry. I feel safe here.” Another person told us “I feel very safe here. They take good care of me and I have nothing to worry about at all.” There were policies and procedures in place to minimise risks to people and to help keep them safe. These were understood and followed by the staff team.

People received care and support which was adjusted to meet their changing needs. People had access to appropriate healthcare professionals to make sure they received effective treatment when required. There were safe systems in place to make sure people received their medicines when they needed them. One person told us “They’ll always get the doctor if you need them. I was getting a lot of pain. I told the staff and the doctor came to see me. I have pain killers now which helps a lot.”

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences. Examples included soft or enriched diets. People who were at risk of malnutrition were weighed at least monthly to monitor their well-being. People told us they were provided with plenty to eat and drink. A choice of hot and cold drinks were offered regularly throughout the day and provided on request.

People were cared for by staff who were knowledgeable about their needs and preferences. Staff received regular training to keep their knowledge and skills up to date. A visitor told us “The care is good and [person’s name] is very happy. I’m happy with the care and the communications are very good. I have no concerns. The staff are good and I would tell you if they were not.” A person who lived at the home said “I think the staff are wonderful. They know what’s important to me. In fact; they know pretty much everything about me.” Another person told us “The staff seemed very skilled. They must get good training. They all know what they are doing.”

People and their visitors knew how to make a complaint. Everyone we spoke with said they felt confident any concerns would be addressed. One person told us “I’ve never had to report anything but if I had any complaints I would report them straight away. They would sort it out. Of that I am confident.”

There were systems to monitor the quality of the service and seek people’s views. People were able to give feedback in person, through comments and questionnaires and at resident’s meetings.

Staff knew how to make sure people’s rights were protected. They were up to date with current guidance about how to support people to make decisions and to keep them safe.

When we visited 55 people were using the service. The home was divided in to three units. One provided general nursing care, one provided residential care and the third provided care to people who had a dementia. We met with people on each unit, staff and two visitors. We also spent time observing how staff interacted with the people who lived at the home.

The people we spoke with were positive about the care and support they received. Comments included 'I am very happy living here. The staff are very kind indeed.' The home employed designated activity staff which meant that people were provided with opportunities for social stimulation every day. There were sufficient numbers of staff on duty to meet the needs of the people who lived at the home. We observed that staff were competent and professional in their interactions with people.

The home followed appropriate procedures for the management and administration of medicines.

We saw that people had been provided with equipment in line with their assessed needs.

People who used the service were provided with opportunities to express a view on the quality of the service they received.

People told us that they were able to make choices about their daily lives. Comments included 'It is very good and relaxed here. I like to stay in my room mostly and the staff know that' and 'I say what I want and the staff always respect what I say.'

We looked at three care plans. These contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure that they reflected people's current needs.

All staff spoken with were aware of indicators of abuse and knew how to report any worries or concerns. They said they felt confident that any reports would be fully investigated to ensure that people were protected.

Systems were in place which meant that staff had the skills, support and training needed to meet the needs of people who lived at the home.

The home had a complaints procedure which provided people who used the service and their representatives with clear information about how to raise any concerns and of how any concerns would be managed.