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Inspection carried out on 11 June 2018

During a routine inspection

This inspection took place on 11 and 15 June 2018 and was unannounced.

Lavender House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Lavender House Care Home accommodates up to 20 people in one adapted building. The service accommodated older people, some of whom were living with dementia. There were 19 people at the service at the time of inspection. The accommodation is over two floors, each floor is accessible via stairs or a stairlift.

The service was rated Requires Improvement at its last inspection in February 2017 and had breached one regulation in relation to not submitting notifications to CQC as required. Following the last inspection, we asked the provider to complete an action plan to show what they would do to meet the breach and improve the key questions of Well Led to at least Good. At this inspection, we found that the provider had made sustained improvements by ensuring that they had systems in place to ensure that all relevant notifications were sent to CQC in a timely manner.

The service had a registered manager in place 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 registered manager had an effective overview of the service and monitored the quality and safety of the service using a range of audits and checks. They were familiar with people’s needs and understood the challenges staff faced in providing effective care.

The provider had made links with healthcare services to take part in a scheme designed to promote the health and wellbeing of people living in care home settings. Staff had received training to take observations of people’s vital signs which healthcare professionals could use to make informed judgements about appropriate treatment plans.

The registered manager had established effective working relationships with a range of stakeholders included professionals and members of the community to provide resources, support and meaningful activities for people.

People and relatives told us staff were very caring and accommodating to their needs. People were treated with dignity and respect and staff were encouraged to spend quality time with people, offering comfort and reassurance where required.

People received personalised care and told us they were involved in making decisions about their care. People were encouraged to remain independent by carrying out domestic routines which they were familiar with and enjoyed. People’s needs were assessed to ensure that they had appropriate levels of care in place and that the service could meet their needs.

People were supported to take their medicines as prescribed and the provider had safe and effective systems in place to manage the ordering, storage, administration and disposal of medicines. People’s nutritional needs and preferences were met by staff who were flexible and patient in their approach when supporting people at mealtimes.

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 support this practice.

Risks associated with people’s health were assessed, monitored and mitigated. Where appropriate, the registered manager made referrals to other professionals to ensure people received timely care and treatment.

There were systems in place to help protect people from abuse and harm. There were systems in place to report concerns about people’s wellbeing and minimi

Inspection carried out on 27 February 2017

During a routine inspection

When we last inspected Lavender House Care Home on 10 and 15 December 2015 we found not all prescribed medicines were recorded when they were brought into the home which meant there was a lack of a robust audit trail for medicines. We also found there was a lack of a robust recruitment procedure to ensure people were supported by staff who were safe to do so.

During this inspection on 27 February 2017 we found the provider had made some improvements but we also identified new concerns. People received their medicines but not everyone had a care plan in place about medicines prescribed as “when required”. The recruitment procedures ensured the necessary checks were completed before new staff worked at the home.

Lavender House Care Home offers accommodation and care for up to 20 people who may be living with dementia. At the time of the inspection there were 18 people living there permanently and two who were staying short term. The home is over two floors and the second floor is accessed using a stair lift. The accommodation is provided in five shared rooms and 10 single rooms, four of which had en-suite facilities.

There was a registered manager at 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.

The registered manager had not notified the Care Quality Commission of relevant significant events.

People’s ability to make decisions was assessed in line with the Mental Capacity Act 2005 but this legislation had not been considered with regard to the use of sensor mats in bedrooms. We have made a recommendation in respect of this.

The need for some people to live at the home was legally authorised under the Deprivation of Liberty Safeguards. However, there was not a system in place to keep these under review and three had expired.

People were offered choices at mealtimes and were supported to eat when necessary. However, some people were not able to understand the choices due to the way the choices were presented.

Some areas of the home were in need of redecoration.

Care plans included information about people’s personal histories, routines, preferences and medical history. However, we observed that one person did not have all of their needs met as detailed in their care plan whilst we were sat near them. Activities were available which people enjoyed but some people living with dementia would benefit from more person-centred activities to engage them in a more meaningful way.

People felt safe living at the home and the registered manager and staff understood safeguarding procedures. There were plans in place to deal with foreseeable emergencies and risk assessments were in place to reduce the risks to people’s health and wellbeing. People had access to healthcare services when necessary.

People were supported by staff who had received an effective induction into their role, which enabled them to meet the needs of the people they were supporting. Staff were further supported through supervision, training and appraisal.

Staff developed caring relationships with people using the service. People were encouraged to express their views and be involved in making decisions about their care and support. Staff were mindful of respecting people’s privacy and dignity when supporting them with personal care.

The provider had a policy and arrangements in place to deal with complaints. People and their relatives were encouraged to provide feedback and were supported to raise concerns if they were dissatisfied with the service provided at the home. The registered manager also sought formal feedback through the use of quality assurance questionnaires sent to people, their families, professionals and staff.

There were systems in p

Inspection carried out on 10 December 2015

During a routine inspection

This inspection took place on 10 and 15 December 2015 and was unannounced.

Lavender House Care Home offers accommodation and care for up to 20 people who may have dementia. The home is over two floors and the second floor is accessed using a stair lift. There were 16 people living at the home when we visited.

There was not a registered manager in place. 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 previous registered manager de-registered in September 2015.

The provider did not ensure people were protected through safe recruitment procedures. There were safe medication administration systems in place so that people received their medicines when required, however, some recording was not accurate.

People were being supported by staff who had did not have the opportunity to maintain their skills and knowledge. Staff did not have full access to formal induction, refresher training, formal supervision or appraisal of their work.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This legislation protects people’s rights and freedoms. We found the manager was meeting the requirements of the Deprivation of Liberty Safeguards. An application had been made to the local authority for the majority of people living in the home and they were waiting for the outcome. However, there was a lack of training regarding the Mental Capacity Act 2005 which had led to a particular situation being misunderstood.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting concerns. Staff had been trained in safeguarding adults and were aware what procedures to follow if there was a suspicion of abuse. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

People were supported to have a meal of their choice by organised and attentive staff. If they became unwell staff made a referral to their GP or other health care professionals as appropriate.

People appeared happy and contented and were treated with kindness and compassion in their day-to-day care. There was a relaxed atmosphere in the home. People were supported to be actively involved in making decisions in their daily lives, such as what clothes to wear. People’s privacy and dignity was respected by staff.

People’s needs were assessed before they moved into the home to ensure staff could meet their needs. Care plans were personalised and each file contained information about the person’s likes, dislikes and people important to them.

The provider had a complaints procedure in place which was displayed by both entrance doors and complaints were investigated.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home, although people and their relatives did not have formal opportunities to feed back their views about the home and quality of the service they received. The manager had notified CQC about significant events.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Inspection carried out on 1 May 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

Each person who used the service had a care plan in place which included various assessments, such as moving and handling and risk assessments. This meant risks were identified and staff were aware how to minimise the risks to people’s health and welfare.

Appropriate arrangements were in place in relation to the recording of medicine. There was a medication administration record, (MAR) in place for each person, which was completed only after people had taken their medication. Medicines were handled appropriately. Staff told us they could only administer medication after they had been trained to do so. They explained the process of administering medication and were aware of individual needs.

People were protected from unsafe or unsuitable equipment because the provider ensured equipment was properly maintained. There was a range of equipment in the home such as stair lifts and hoists. We saw up to date certificates were in place which showed when equipment was last serviced and when it was due again.

Is the service effective?

We spent time sitting in the lounge area and saw people were engaged in conversation or activity with each other and staff. Music was being played in one area of the lounge and three people were tapping their feet in time. We saw staff talking with people and one undertook a reminiscence activity which involved three people. Staff used a book with local photographs as a prompt and were knowledgeable about the local area. This meant conversation was not limited to photographs alone and branched out into other areas.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We spoke with a person who used the service who said “the food is good” and that the staff member providing the food was a “good cook”. One visitor told us the food was “amazing, all homemade” and another one said the food “looked nice, they make things nice for tea, lots of homemade things”. We were also told how a person’s birthday was celebrated with a tea party in the conservatory and how an “afternoon tea” had been presented with tiered trays.

Is the service caring?

We spoke with two people who used the service and five visitors. One person told us the staff were “lovely, very nice people” who were “very kind” and did anything for them. One visitor told us their relative was “happy” living there and they were “well looked after”. Another visitor said the staff were “professional and kind”.

We saw staff cared about the people they were supporting. One person had returned from hospital and was receiving palliative care. During our inspection we heard off duty staff who were visiting the home, or telephoning the home, asking how the person was. We saw a person who used the service had started to walk around the home in a state of undress after lunch. The staff immediately worked as a team and took action to support this person and ensure they were safe and their dignity was maintained.

Is the service responsive?

The manager ensured people’s individual needs were met. A visitor told us their relative had initially been unsettled in their bedroom and a change had been suggested and implemented which had been successful and meant the person was now happy. One person had a bedroom upstairs, but following an incident, staff suggested a move downstairs which meant the person was safer in their room. A visitor told us staff ensured they washed their relative’s favourite item of clothing overnight as the person liked to wear the item all the time. This visitor also said staff were “immediately there” if [their relative] needed anything.

Is the service well-led?

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. A ‘residents’ meeting was held and minutes were made available to people. People had expressed the view that they did not like a meal which featured on the menu and this was removed, unless anyone specifically asked for it. Ideas had been discussed for activities over the Christmas period. The provider had a complaints procedure and the manager said they were generally able to deal with complaints face to face. A complaint had been made to the manager who had responded appropriately.

The provider had systems in place which ensured audits were undertaken regularly by the manager. Monthly audits included monitoring medication administration, kitchen equipment and practice, cleaning and maintenance. There was a named person in the management team who undertook a monthly review of the monthly audits. All audits noted any required improvements and action was taken to ensure the improvements were made. The manager also undertook daily visual checks around the home and spent time talking with staff.

Inspection carried out on 4 April 2013

During a routine inspection

We were told staff were respectful when they spoke to people and also confirmed people were called by their preferred name. Visitors told us their relatives could make choices, such as "whether to see the hairdresser or not" and what time they got up and went to bed. We spoke with one person who lived in the home and they told us they "liked the food" and that staff knew what they liked to drink. They also said they could get anything they wanted. Visitors told us their relatives were "happy" there. One visitor told us how the staff ensured their relative received the appropriate medical care and always informed them about their health. Staff responded to their relative’s needs in an individual way, meaning that they got the support which suited them. Visitors told us they could always find staff when they needed to and they were “brilliant” and “friendly” and “always willing” to talk to them. They also said there was “good” and “fantastic” communication from the staff about any changes in people’s wellbeing.

We found people's wishes and choices were respected and their care needs were met. People had up to date care plans which were used by staff to ensure they met people's needs. Policies and procedures were in place to safeguard vulnerable adults and the manager was aware of the local authority procedures and how to use them effectively. Suitable numbers of staff were available throughout the day and night. Quality assurance systems were in place.

Inspection carried out on 9 August 2012

During a routine inspection

We spoke with four people using the service and four visitors. Feedback about the care received by people living in the home was positive. They said that they had the help and support they needed. One person said that they were happy “they had no complaints”. Another person said that staff were “very nice” and “treat you all right”. Relative’s comments about the care provided by the home were positive and they felt that they were informed if issues arose. There were mixed levels of knowledge about care plans and involvement in planning of care. We saw that people were able to make choices such as about staying in their rooms or sitting outside for a cigarette. Comments were received about the range and suitability of activities and mental stimulation in the home. Two relatives questioned whether the provision was enough to meet individual needs.

We observed interactions between staff and people using the service and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. This was used due to a high number of people with dementia living in the home. We saw friendly and supportive interactions between staff and people using the service but noted some patronising approaches, such as the use of terms such as “darling “ and “sweetheart” potentially affecting people’s dignity and respect.

Inspection carried out on 1 March 2012

During a routine inspection

People that live at Lavender House had dementia so not everyone was able to tell us accurately about their experiences. We spent a long time in the lounge observing people and the interactions of staff with people. Where able we have included the views of people who are living at Lavender House.