The Lawn Residential Care Home

The Lawn Residential Care Home is a residential care home providing personal care to up to 31 people. The service provides support to both older people and younger adults. People may be living with dementia. At the time of our inspection there were 18 people using the service.

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

People were happy with the care they received. Feedback included, “I think it is very good” and, “It’s very friendly it always has been, it’s nice.”

The service had made improvements in relation to the medicines issues identified following the previous inspections. There was evidence of ongoing progress. However, not all of the required medicines information for people was yet fully embedded into their medicines care planning and assessments.

People were safeguarded from the risk of abuse. Staff ensured potential risks to people were identified, and mitigated. Staff reported incidents and any learning was shared. There were sufficient staff to provide people’s care safely. Staff were recruited safely. People were protected from the risk of acquiring an infection.

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’s needs were assessed. People’s care was delivered by appropriately trained staff. People were supported to eat and drink enough for their needs. Staff worked with professionals to ensure people’s healthcare needs were identified and met. People had sufficient space and the decoration of the service was under review.

Processes were in place at location and provider level to ensure potential risks and areas for improvement were identified, assessed, addressed and monitored. The registered manager reviewed the culture of the service and led it effectively. Staff worked openly and collaboratively with relevant external stakeholders and agencies.

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 requires improvement (published 22 July 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 10 June 2022. Six breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when to improve safeguarding and person centred care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also checked whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. In relation to specific concerns we had about governance. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

The 3 warning notices served in relation to safe care, equipment safety and nutrition were followed up and found to have been met at a targeted inspection completed on 22 August 2022.

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 changed from requires improvement to 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 The Lawn Residential Care Home 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.

The Lawn Residential Care Home is a residential care home providing personal care to up to 31 people. The service provides support to both older people and younger adults. People may be living with dementia. At the time of our inspection there were 20 people using the service.

The care home accommodates people across two floors. There are communal facilities for people to socialise and an accessible garden.

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

People told us they were happy living at the home and felt well cared for by staff who understood how to manage risks to them.

The provider and the registered manager had taken actions to ensure people’s environment was safe for their use and potential risks to people had been identified and assessed. Measures were in place to manage them.

There had been significant improvements to the safe management of people’s medicines. There was still some further work to do. For example, to ensure people’s allergies were recorded and protocols for ‘as required’ medicines were sufficiently detailed.

Staff ensured any potential risks to people associated with their eating and drinking were assessed and managed.

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 requires improvement (published 22 July 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulations 12, 14 and 15.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12, 14 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. In relation to specific concerns we had about people’s safety, medicines management and the safety of the environment. We did not review whether the Warning Notice for Regulation 17 in relation to governance had been met as the provider and the registered manager still have further time to meet the requirements of this regulation. Regulation 17 will be reviewed at the next inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

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

The Lawn Residential Care Home is a residential care home providing personal care and accommodation to up to 31 people. The service provides support to older people, younger adults and people living with dementia. At the time of our inspection there were 21 people using the service.

The care home accommodates people across two floors. There are communal facilities for socialising and activities and a garden.

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

Risks to people associated either with their care, their medicines or from their environment were not always recognised, assessed or adequately managed. The provider’s safeguarding processes had not been operated effectively to ensure people’s safety. It was not always clear if staff had escalated potential incidents, or if they had, what action had been taken. This placed people at risk of harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice. Where people were subject to restrictions on their freedoms, legal requirements had not always been met.

Potential risks to people from choking or weight loss had not always been assessed. People’s care needs had not always been fully assessed. Not all staff were up to date with the provider’s training or supervision requirements.

Governance was ineffective at both the registered manager and provider level. The provider’s processes were not always used effectively to identify and address issues for people's safety or to drive required improvements in a timely manner. Although people and relatives were happy with the service, there was not a clear strategy to ensure people’s safety and to drive improvements.

People and relatives we spoke with were very happy with the service, they felt safe and liked the care, the staff and the registered manager. Their feedback included, “Staff are all super and very nice” and “It’s very friendly, the communication is good and the staff care about the residents.”

There were enough staff overall, apart from some nights. The provider had safe recruitment practices. Processes were in place overall to prevent and manage the risk of infection.

Staff worked across the team and with external agencies to access healthcare services for people. People had plenty of spaces to relax and socialise. As more people accommodated were now living with dementia, additional, appropriate signage, may benefit them.

The provider had systems in place to seek the views of people and staff. Relatives reported they felt their views were acted upon. Staff worked with relevant external stakeholders and agencies to deliver people's care.

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

Rating at last inspection

The last rating for this service was good (published 12 July 2018).

Why we inspected

We received concerns in relation to the security of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We identified further concerns at the site visit in relation to the key question of effective, so we widened the inspection to include this key question.

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 good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

The provider provided CQC with an action plan based on CQC’s inspection feedback, which set out how the provider planned to address the issues found.

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

Enforcement and Recommendations

We have identified breaches in relation to person centred care, safe care, nutrition and choking risks, safeguarding, premises and governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good overall, however we have revised the rating for the safe domain to requires improvement, as staffing and records require improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service overall remained good.

There were sufficient staff rostered. However, there had been issues with high levels of staff sickness which were being addressed for people. Action had been taken to fill staff vacancies and to increase senior staff presence at the weekends. Not all people’s written care plans had been reviewed monthly as required by the provider. The registered manager was aware and had taken relevant action. Following the inspection, the provider submitted evidence which demonstrated this work had now been completed, but it still needs to be sustained over time.

Risks to people had been identified and managed safely. People’s health, dietary and fluid needs were identified and met. Processes were in place to safeguard people from the risk of abuse. People were protected from the risk of acquiring an infection. The environment was suitable and safe for people. Learning took place following incidents and improvements were made. Medicines were safely managed. The registered manager took swift action to complete three outstanding annual staff medicines competencies during the inspection.

People’s care delivery took account of national and local guidance. Staff undertook relevant training and were supported in their role.

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.

Overall people told us staff were caring. Staff were seen to be polite and respectful to people. Some people said they would like more interaction from some staff and this has been fedback to the registered manager to address. People were supported to maintain their independence. People’s dignity was upheld during the provision of their care.

People and or their representatives were involved in planning their care. Although some people told us they would have liked better activities, a range of both internal and external opportunities were provided. People’s end of life care needs were met at the service.

Most people and staff felt the service was well-led. The new registered manager had a good understanding of the challenges facing the service through the quality assurance processes and was taking the correct actions to address them for people. They actively engaged people, staff and the community. Processes were in place to share information both within the service and with external organisations. Staff worked with other agencies to ensure people received joined up care.

The Lawn Residential Care Home provides accommodation for up to 31 older people, some of whom may also be living with dementia. The home is situated in the village of Holybourne and is a period house which has been altered and extended for use as a care home. There is access to landscaped gardens and grounds. At the time of our inspection 29 people were using the service.

Rating at last inspection

At the last inspection, the service was rated good overall and Requires Improvement in the ‘Effective’ domain.

Why we inspected

We previously carried out an unannounced comprehensive inspection of this service on 12 and 13 July 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 14 of the Health and Social Care Act (Regulated Activities) Regulations 2014, Meeting nutritional and hydration needs.

We undertook this focussed 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 The Lawn Residential Care Home on our website at www.cqc.org.uk.

At this inspection we found the service had improved, there were no breaches of regulations and therefor the rating for the ‘Effective’ domain has been changed to Good.

Why the service is rated Good in the ‘Effective’ domain

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

At the last inspection we found care plans did not always address the risk in relation to malnutrition or match with the actual care that was being delivered. Some people were choosing not to eat but it was not clear that the provider had considered and addressed all the risks in relation to this. At this inspection, we found that care plans had been updated and accurately reflected people’s care. Care plans recorded all measures which had been taken to protect people from the risk of malnutrition.

People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. For lunch a main meal was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.

People were supported to maintain good health through access to ongoing health support. Records showed that district nurses, psychiatric nurses and the GP had been involved in people’s care and referrals were made where appropriate.

The Lawn Residential Care Home provides accommodation for up to 31 older people, some of whom may also be living with dementia. The home is situated in the village of Holybourne and is a period house which has been altered and extended for use as a care home. There is access to landscaped gardens and grounds. At the time of our inspection 23 people were using the service.

The Lawn does not have 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. A new manager had been recruited by the provider and was due to start in post following the inspection therefore they had not yet applied to register with CQC.

At the last inspection on 12, 17 and 18 November 2015 we found six breaches in regulations. We asked the provider to take action to make improvements to safeguarding, safe care and treatment and the implementation of the principles of the Mental Capacity Act 2005. We took enforcement action to require the provider to make improvements to person centred care planning, staffing and governance. This action has been completed. Following this inspection the service had not been rated as inadequate for any of the five key questions and has therefore been taken out of special measures.

People said they felt safe. Staff had received safeguarding training and were able to explain how to protect people from abuse and how to report suspected abuse.

People’s individual risks were appropriately assessed and care plans were in place to mitigate against known risks. Staff were knowledgeable about risks to people and what actions needed to be taken to keep people safe.

There were sufficient staff on duty. People’s needs were met whether they were in communal areas or being cared for in bed.

Staff recruitment and induction practices were safe. Relevant checks were carried out to ensure that suitable staff were recruited.

Medicines were stored and administered safely. Records in relation to medicines were accurate and staff had received training in medicines administration, and had their competency checked regularly.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

The provider did not always take appropriate action if people were not eating in line with their assessed needs. Some people were choosing not to eat but it was not clear that the provider had considered all options available.

Most people were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. For lunch a main meal was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.

People were supported to maintain good health through access to on-going health support. Records showed that district nurses, psychiatric nurses and the GP had been involved in people’s care and referrals were made where appropriate.

Staff were kind and patient with people, using gentle persuasion and encouragement to support them. They took time to listen to people and understand how they were feeling. People’s dignity was respected. People were supported to be as independent as possible.

People were involved in decisions about their care and were offered choices in all aspects of their daily life. Where they had capacity, people had signed their care plans showing that they agreed with the plan of care.

Staff were able to respond appropriately to people’s needs because they knew them well and understood their care needs. Staff got to know people personally so they could respond to their preferences, likes and dislikes providing personalised care. Care plans were reviewed monthly and updated where necessary to ensure that staff were always aware of people’s needs.

People were able to engage in different activities, such as playing scrabble, watching films or playing indoor skittles. People being cared for in bed were visited in their room by staff for one to chats.

The provider had a complaints procedure which detailed how complaints should be dealt with. There were a small number of complaints and all had been dealt with appropriately.

The atmosphere in the home was friendly and easy going. The manager was passionate about the home and proud of the improvements made. There was a family feeling amongst staff who were keen to ensure people were happy and well cared for. Staff felt valued and involved in decision-making and this reflected in the care delivered.

Feedback was sought regularly from people, staff and relatives and was responded to, ensuring continuous improvement to the home.

The manager demonstrated good management and leadership. She ensured she was visible ‘on the floor’ on a daily basis. People knew and trusted her.

Policies and management arrangements meant there was a clear structure within the home which ensured the service was effectively run and closely monitored.

The quality of the service was closely monitored through a series of audits. Provider level quality assurance was in place and appropriate actions had been taken in response to this.

During this inspection we found one breach of regulation. You can see what action we asked the provider to take at the back of the full version of this report.

The Lawn Residential Care Home provides accommodation for up to 31 older people, some of whom may also be living with dementia. The home is situated in the village of Holybourne and is a period house which has been altered and extended for use as a care home. There is access to landscaped gardens and grounds. At the time of our inspection 31 people were using the service.

The Lawn Residential Care Home had 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 (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.

There were not enough staff on duty to meet the needs of people using the service. When we arrived for our inspection three staff instead of five were providing care and people were distressed and upset at having to wait for breakfast and personal care. Recent changes in staff employment contracts had unsettled staff causing some staff to leave and leading to a rise in the use of agency staff. People told us they did not like agency staff providing their care because they did not know their individual needs. There was no formal method of ensuring that agency staff were informed about people's individual care needs.

There was an atmosphere of uncertainty in the home. People told us they were unsettled and distressed about recent changes and the numbers of staff leaving the home, which had impacted on their care and welfare. There was a general feeling from people of unrest. They felt that too many changes were happening too quickly and that the home didn’t feel like a community.

A range of tools were used to assess and review people’s risk of poor nutrition or skin damage such as Malnutrition Universal Screening Tool (MUST) and Waterlow. However, the provider did not always identify risks or take actions to mitigate risks, for people. The provider had not assessed the risks associated with ongoing building work in the home.

There was a risk that records in relation to medicines administration were not accurate. People were left medicines to take and staff did not check if they were taken or record which member of staff left the medicines with the person. One person did not receive a blood test in a timely manner. The blood test was required to ensure they were receiving the correct dose of their medicine. There was a risk they did not receive the correct dose.

People were not always safe. Not all staff had received safeguarding training or knew how to report safeguarding. One person was living under Deprivation of Liberty Safeguards (DoLS) was not kept safe.

People were asked for their consent before care and treatment was provided. A member of staff gave examples of how they sought permission to provide care. However, where people lacked capacity to make specific decisions, the provider did not act in accordance with the principles of the Mental Capacity Act 2005 (MCA), by ensuring that people gave valid consent for care and treatment. Appropriate DoLS applications may not have been made. There was a risk that people were deprived of their liberty without the relevant authority.

Staff had completed an induction and a probationary period of employment, to ensure they knew how to provide effective care for people. However, fire safety training was out of date and staff had not received appropriate support through supervision meetings and appraisals. Staff did not receive appropriate support from the provider to ensure they effectively carried out their role.

Menus demonstrated that a balanced diet was offered and people were supported to eat and drink sufficiently. People were served food which met their assessed dietary needs.

People were supported to maintain good health through access to ongoing health support. A GP surgery was held in the home once a week and access to other health professionals was evident from records, such as district nurse, an optician and a chiropodist.

People told us the standard of care in the home had slipped. There was a general feeling from people of unrest. They felt that too many changes were happening too quickly and that the home didn’t feel like a community. People told us they did not like agency staff, providing their care because they felt such staff did not know them and did not know their needs. People’s dignity was not always respected.

Staff encouraged people to be involved in day to day decisions about their care. However, there was no evidence, within care plans, of people’s involvement in determining their plan of care. Care plans did not demonstrate that people had been involved. Relatives said they would like to be more involved.

Care planning in response to people’s needs required improvement. Care plans did not provide staff with guidance to manage people’s specific conditions, illnesses or behaviours, such as diabetes. Care provided was not responsive to people’s needs.

It was not possible to determine how staff were made aware of people’s specific needs and how they were updated about people’s changing needs. There was no handover sheet or documented handover process which would have provided staff with specific information about people’s needs.

The provider was responsive to concerns from people and staff in terms of holding meetings to discuss concerns raised about the proposed restructuring programme which was affecting all staff. The complaints policy was displayed on the notice board to ensure people and relatives knew how to complain.

People were supported to take part in social activities. There was an activities co-ordinator, and a variety of social activities were available.

The provider had a quality monitoring system in place; however this had not been effective. Issues we identified during our inspection had not been found as a result of the provider's quality monitoring processes. There was no evidence that actions had been taken as a result of quality monitoring audits.

There was an atmosphere of uncertainty in the home. People were unsettled and distressed about recent changes and staff were unhappy they were leaving in significant numbers. The reaction from staff has impacted directly on people’s care and welfare.

The registered manager told us that the goals of the home were to provide a good standard of care in an environment similar to people’s homes where they have choices and the service is personalised to them. Our inspection has demonstrated that these goals were not being achieved in the home. The registered manager acknowledged that the home was struggling to provide this level of service.

Staff told us the registered manager was approachable however this view was not replicated by people who said they hardly saw the registered manager.

The registered manager and the operations manager were clear that the changes were positive and would secure the future of the home for people and staff. Whilst they recognised that the home was going through a difficult time they were confident that things would improve in time.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service 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.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

We found the service to be safe, caring, responsive and well led, however we found that training and supervision was not up to date.The provider sent us an action plan to demonstrate how they would address the issues found. On 5 February 2015 we re-inspected The Lawn Residential Care Home to assess whether compliance had been achieved.

This is a summary of what we found-

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

We reported on only one of the five questions.

Is the service effective?

We found there were effective systems in place to ensure that staff received regular training updates and had regular supervision meetings and annual appraisals. Staff told us they felt supported in their role.

We spoke to people about their medicines, they told us that they were happy with how their medicines were handled.

Below is a summary of what we found. The summary is based on our observations during the inspection, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe? We found that people's medicines were handled safely.

On the day of the inspection there were 28 people using the service. As part of this inspection we spoke with four people, two healthcare professionals who were visiting the service, the registered manager, and five staff. We also reviewed records relating to the management of the home which included, three people's care plans and daily care records.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service to be safe as there were arrangements in place to ensure that it had been cleaned properly. People told us 'Oh yes, it is well cleaned.' Guidance and appropriate equipment was available to staff to ensure that a good level of cleanliness was maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People who used the service all had capacity to decide where they wanted to live and there were no restrictions on them leaving the service as they wished. While no applications have needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People had a positive dining experience. There was a range of choices available to people and the food was presented in a way that supported people's independence as they could choose the amounts they wanted to serve themselves. Lunchtime was a sociable time with people chatting to each other. People told us that the meals were not as good as they had been due to the temporary absence of the new chef. However, the chef was due to return to the service imminently.

The service had met people's care needs effectively. One person told us 'Yes, staff understand my care needs.' People had care plans in place to address their identified needs and they had been involved in planning how they wanted their care to be provided. Where risks had been identified for people measures had been taken by the service to manage these.

However, we were not fully assured of the effectiveness of the service in relation to the completion of appropriate training to enable all staff to deliver care and treatment safely and to an appropriate standard. The registered manager told us that all staff had completed their e-learning induction and were up to date with the providers required e-learning. However, the provider had experienced issues with their e-learning training provision. It had not always captured what training staff had completed. As a result we were unable to establish what training staff had actually completed and if staff had any training outstanding. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting workers.

Is the service caring?

We spoke with people who told us 'Staff are kind' and 'Staff are very good they look after me.' We found that the service was caring as we observed that staff were warm in their interactions with people. They did not rush people and were sensitive to their needs. Staff spoke with people respectfully and used their preferred terms of address.

Is the service responsive?

We found the service to be responsive. In people's care plans and records we saw the service had made referrals to outside age ncies promptly in response to people's changing needs. One person told us 'Oh yes, staff are very good' and 'If my needs change staff are responsive.' We spoke with visiting health professionals who told us that the service was 'Responsive in reporting issues.'

Is the service well-led?

We spoke with people who told us that they felt that the registered manager was approachable. One person told us 'Yes, we can make comments.' We found that people's views on the service had been sought both through formal surveys and meetings and through regular informal feedback. Their feedback had been noted and action taken in response to their comments.

Audits of the service had been completed. There were regular provider visits to ensure that the provider had an overview of the quality of the service provided.

As a result of our inspection we issued the provider with two warning notices and a compliance action. There was a requirement to be compliant by 4 October 2013. The provider responded with an action plan telling us what actions they were taking to address the non compliance. On 17 and 28 October 2013 we carried out further inspections of the home to assess whether the home was compliant.

The risk in relation to unsafe premises had been reduced because the provider had engaged contractors to carry out remedial work and actions identified in the 21 June 2013 legionella risk assessment. We spoke with the contractors during our inspection on 17 October. They were able to provide documentary evidence in relation to all the improvements that had been made to the water system since our last inspection on 13 August 2013.

We found that there were enough staff to meet people's needs even though we found that an unsatisfactory sickness culture still remained within the home. This was because the registered manager had worked hard to ensure that all shifts were covered. This meant that people who use the service were not affected by the staffing difficulties. We spoke with six people who use the service. They all said that staff were meeting their care needs and always came promptly whenever they used the call bell.

The provider had made improvements to their systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. A water management policy and procedure had been produced and circulated. Further risk assessments in relation to legionella and asbestos had been commissioned and actions taken to address the identified risks.

People were not protected against the risks of unsafe premises because the risk of legionella and asbestos had not been managed within the building. The Health and Safety Inspector from East Hampshire District council has issued Improvement notices in relation to the management of legionella and asbestos and has placed a prohibition order on a lift due to insufficient emergency lighting.

People were not protected against the risk of unsafe care because there was not an effective system in place to manage risks. The provider had identified risks in relation to legionella and asbestos but had not taken appropriate actions to mitigate those risks.

People were asked for their consent before care was given. People told us that staff always asked for their consent and respected their wishes.

People's needs were assessed and care was delivered to support people's safety and welfare. Staff had a good understanding of people's needs and people's care was reviewed and updated regularly. We spoke with two people who used the service. They were both happy with the service and felt that the service met their needs with comments such as 'Couldn't be better,' 'they are so good, you only have to ask.'

We found that medicines were stored safely and that arrangements were in place to ensure they were administered safely. We reviewed the medication administration procedure and the medicines records.

We found that appropriate checks were carried out before staff were able to start work. We spoke with two staff who told us that a criminal records check was carried out before they commenced employment. We saw records of this.

The service had several effective systems in place to monitor and improve the service being provided.

The people we spoke with confirmed that they received the care and support that they needed, in the way that they wanted it to be provided. They told us they were involved in the reviews of their care plan and were asked their views by staff. One person told us the service had been 'a great help to me'. Another person told us that their health had improved since coming to live at the home.

People we spoke with were confident that staff had the appropriate knowledge and skills to meet their needs and made positive comments about the professionalism of the staff. For example, one person remarked 'always a smile and a cheery word, never heard one of them ever grumble'. People told us that they felt safe and that staff treated them well.

People were asked for their views about their care and support and they were acted on. One person told us about regular meetings with the management where 'as a rule they have answers to the things that were raised at the meeting before'. The person said that these meetings were a 'regular opportunity to express your views if you wish'.