The Lawns Care Home

We found the following examples of good practice.

Staff were following current infection prevention and control guidance to help people to stay safe. We saw personal protective equipment was readily available and accessible, such as surgical face masks, disposable gloves and aprons, and staff used these appropriately during the inspection.

Staff received training in the management of infection control and using personal protective equipment appropriately.

The provider had implemented a programme of testing for both people using the service and staff, which all parties participated in.

The premises looked clean and hygienic. Additional cleaning processes had been put in place and there was a clear audit trail. The registered manager carried out regular infection control audits, and worked with the staff team to ensure infection prevention and control measures were followed to ensure people stayed safe.

People were supported to stay in regular contact with their families. The service had a clear process and booking system in place for visitors. Visitors were expected to undertake a screening process, decontaminate their hands, wear facemasks and ensure they socially distanced at all times during their visit.

The garden area had been arranged for socially distanced visits. The provider had recently refurbished a large summer house so that people could meet with their visitors comfortably during the colder weather. Staff also helped people stay in touch with family and friends through phone and video calls.

Information to help people understand the pandemic, including explaining why staff wore masks, had been used and displayed around the service in a variety of formats including easy read and pictorial formats.

Further information is in the detailed findings below.

The Lawns Care Home is a residential care home providing personal care to 12 people over the age of 18 who have a diagnosis of a learning disability. At the time of the inspection 12 people were living at the service.

The service had been open for some years and therefore had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. However, the service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control and inclusion. People's support focused on them having as many opportunities as possible to make choices about their care and lifestyle.

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

People continued to receive exceptional care and lived in a nurturing environment where their individual needs, personalities and wishes were at the centre. One relative said, “The care is second to none and the staff go above and beyond. It’s an amazing place, there should be more services like them.”

The ethos of the service as being one big happy family who support each other during difficult times and celebrated with each other on happy occasions, was clearly evident.

Staff continued to demonstrate an exceptionally caring nature and a passion for providing high quality care which was visible throughout the service. Staff showed genuine interest and concern in people's lives and their health and wellbeing and empowered people to achieve their goals, dreams and aspirations. Staff frequently went above and beyond the required expectations, to support people to enjoy their individual interests and hobbies. Staff recognised equality and diversity and understood how to protect people’s human rights and lifestyle choices.

People were empowered to make life choices and decisions about the care they received. People told us they chose what they wanted to do, where they spent their time and with whom.

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.

Robust recruitment practices were in place to ensure the suitability of new staff. People were supported by a stable and consistent staff team who knew people well and, as such, had an excellent understanding of their needs and wishes.

People's needs were assessed, recorded and met. Each person had a care plan which gave staff guidance about how people preferred to be cared for.

People were encouraged and supported to take positive risks and be as independent as they could be. Staff and relatives told us staff always tried hard to promote people’s independence.

The provider worked with other health and social care professionals to make sure people received the care and treatment they required. This included meeting changing health care needs.

Robust quality assurance systems were in place to monitor the safety and quality of the service and improvement was driven by engagement with people, whose views were listened to and acted upon.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism.

Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the operations director at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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 4 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Lawns provides accommodation with personal care for up to 12 people over the age of 18 who have a diagnosis of a learning disability. People had a range of care needs and some had communication difficulties associated with their learning disability. The home is staffed 24 hours a day. At the time of the inspection, eleven people had lived at the home for a number of years. The home is a large three storey house which also has a separate self-contained two bedroomed flat in an annexe. All bedrooms were for single occupancy, two rooms on the second floor of the main house were en-suite and had a small kitchenette and sitting room. These two rooms as well as the two in the annexe allowed people to live semi-independently. At the time of inspection, 10 people were living in the main house and one person was living in the annexe.

The service was previously inspected in October 2013 when the service was found compliant with all the regulations inspected.

The home was well-run by a registered manager, who had worked in the service since it had started in 1992. They described their passion and commitment to the people at The Lawns Care Home, which was evident throughout the inspection. In October 2016, they had registered with the CQC as the manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider also worked at the home most days of the week. People, their families and staff were all very complimentary about the provider, the registered manager and the home. Comments included “fantastic people” and “Both of them are so wonderful.” Staff were also described really positively, for example “always supporting [my relative] to get the most out of life.”

The provider and registered manager had a clear vision for the home and the people who lived there. They described how they, and the staff, were committed to ensuring people were supported to live as independently as possible. The home’s statement of purpose described how the main aim of the service was ‘‘to enable people with learning difficulties to lead a fulfilled life… encouraging and working with the Service User to be fully integrated into the community in which they live and to take part in its activities according to their individual needs, abilities and interests.’ Throughout the inspection we found evidence that these aims were lived up to. Staff followed these principles, treating people with kindness, friendliness and compassion. Staff made sure people had time to decide what they wanted to do both in the home and outside. People were then supported to do their choice of activity.

People were at the heart of the service and were involved in decisions about the home and the support they wanted. Activities were inclusive so everyone was supported to take part. People were happy and excited about what they were doing throughout the inspection. People were encouraged to be part of the local community. For example, people were involved in lots of local celebrations of festivities, including helping to make decorations for a Christmas tree as part of a local church Christmas Tree festival. The home also took an active part in the town’s Goose Fair which was held each year, having a stall to sell produce they had made. People also described how they were involved in drama sessions which led to a production, as well as planning a trip to a pantomime. People chatted to staff about these activities as well as describing other visits and trips they had done. These included holidays and day trips to local attractions. A recent newsletter which was sent to relatives had been partly written by people in the home and described how much they had enjoyed these activities. The home also arranged for entertainers and other visitors, such as Zoo lab to come to the home. People proudly showed us photos of them holding some of the animals that had been brought, including a snake and a very large snail.

People were encouraged to be independent and make decisions wherever possible. One person had been supported to achieve a personal goal of showering independently. Records showed this had been discussed with the person and monitored so that they were now able to do this with minimum staff support. People living in some areas of the home were able to live semi-independently, preparing some meals for themselves and undertaking housework such as cleaning their lounge and kitchen areas. They described how much they enjoyed having their independence whilst recognising the support was there when they needed it.

People were also supported to maintain and increase their independence outside their home. One person worked at a local hotel and some people were also able to go out on their own to the bank and shopping. People attended local clubs to enable them to maintain particular interests and hobbies as well as friendships. Although the atmosphere was lively, staff recognised that some people needed space, peace and a slower pace at times. When this happened, people were encouraged to use quieter areas of the home including the lounge and their bedrooms.

People did activities of their choice and were encouraged to try new things. Staff supported people to achieve their ambitions and potential. People undertook activities on their own and in groups, including work and social activities. These included sports, art, hobbies and social events.

The registered manager was committed to continuous improvement and had looked at ways to improve. This had included introducing a framework to support people with end of life care and bereavement. Staff had been trained to consider how to support people at their end of life with the aim to feel calm, pain-free and safe. The registered manager monitored that the changes had been effective by surveying people, their relatives, visitors and staff. Comments from everyone were very positive about the home and the staff.

People were consulted about how the home was run through regular meetings. Staff had worked with people to make these meetings meaningful and inclusive. Meetings were used to support people to choose the menus for the coming days as well as agree any group activities, for example where to go for holidays. People and staff were also involved when new people were being assessed to live in the home as well as recruitment of new staff. This meant they had the opportunity to choose who lived and worked in the home.

The body language and the conversations of people living at The Lawns showed they were happy and felt well-supported in a safe, comfortable and well-maintained environment. We saw people being treated with respect and dignity, with staff supporting them to have as much independence as possible doing activities they clearly enjoyed. People laughed and joked with staff who responded in a friendly, caring manner whilst maintaining professionalism. One person said “It’s my home”; another person said “I love it here.” Relatives commented that "Staff are amazing."

Relatives were very complimentary about how their family member was supported and cared for. They described the home as “fantastic” and said staff were “always supporting [my relative] to get the most out of life.”

People were encouraged to keep in touch with their family. Staff supported some people to visit their relatives regularly as well as contacting them by phone. Relatives described how they had also been supported by staff in the home and were welcomed as part of the “extended family.” People’s privacy was respected by staff.

Everyone we spoke with praised the home, the manager and staff for supporting people to meet their physical, health, social and domestic needs and aspiration. They described how staff involved them and asked their help and advice when needed. People described how they were involved in care reviews. Records confirmed that people had signed to show care reviews had been discussed with them and that they had agreed the information recorded.

Staff were recruited safely and were provided with a comprehensive induction before they started working with people on their own. Staff were supported, through supervision and appraisal, to reflect on their work with a manager. Staff were trained to deliver care to each person and received regular updates and opportunities to develop their skills further. All the staff were very positive about working at The Lawns and praised the provider and the registered manager.

People’s medicines were stored, administered and recorded safely. Staff had received training to support them in their role, both when they first started working at the home and in order to refresh their knowledge and skills.

Meals were important social occasions which people clearly enjoyed. Meals were prepared using fresh ingredients in a safe clean kitchen. People were supported to have a healthy diet of their choice. Where people prepared some meals for themselves, staff supported people to do this safely.

People had access to health and social care professionals to help them maintain good health. People’s capacity to make decisions about specific aspects of their care, for example their capacity to go out on their own, was assessed. Where they were deemed not to have capacity to make a particular decision the registered manager had recorded this and taken steps to ensure they worked within the Mental Capacity Act 2005. The registered manager confirmed they had discussed Deprivation of Liberty Safeguards (DoLS) authorisations

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

We spent time talking to people who lived at The Lawns and observing the interactions between them and staff. People's comments included: 'I love it here. We do lots of activities'; 'We are going out this afternoon, looking forward to it'; 'I go out when I want to, been shopping this morning' and 'The staff look after me well.'

Medicines were safely administered. We saw the medication records which were appropriately signed by staff when administering a person's medication.

Staff were able to speak confidently about the care practices they delivered and understood how they contributed to people's health and wellbeing.

Care plans and risk assessments demonstrated that they had been reviewed and updated on a regular basis or in response to changing needs.

The provider had assessed people's needs and put in place plans to meet people's needs. We found staff were following these plans. Individual risk assessments were in place to help people to develop independence. One person told us "I've learnt to get the bus on my own".

We found that all staff had been trained in safeguarding and the staff we spoke to were able to tell us what they would do if abuse was suspected, witnessed or alleged. One person told us "if I had any problems, I'd go to staff for them to sort it out".

The provider ensured there was sufficient staffing to meet people's needs and made additional staff available for activities when needed. We found that staff were appropriately skilled and experienced. People told us "staff look after us properly" and "staff are very nice".

We found the provider had systems in place to seek the views of people using the service and their family members and that they took account of these views to make changes. The provider also learnt from investigations carried out making changes as a result.