The Lawns Nursing and Residential Care

The service is on two floors, with access to upper floors via a shaft lift or stair lifts. Bedrooms have either an ensuite or washing facilities. There is a secure outside patio area.

We found the following examples of good practice.

The registered manager and staff had been working hard and were dedicated to keeping people safe. Staff had received infection, prevention and control training and they wore PPE correctly.

Government guidance was being followed to ensure people were protected from the spread of infection, for example seating arrangements in the lounges and dining rooms enabled people to socially distance.

People remained connected with their friends and families via the use of technology. A new dedicated telephone line had been installed so that day to day operational phone calls did not affect people’s ability to speak with their loved ones. The Wi-Fi system had been improved throughout the service to ensure access for all, regardless of where their bedroom was positioned.

Visitors to the service were prevented from catching and spreading the infection because safe and effective measures were in place. This included people’s temperatures being checked on entry and the wearing of PPE. Visit times were staggered, and a newly created visiting booth enabled people to visit their loved ones safely. The visiting booth had been decorated in a way which provided people and their families with a homely and comfortable feeling.

Families were enabled to visit their loved ones, who were at the end of life and were treated with respect and compassion by staff. At the time of the inspection, the provider was in the process of communicating with people and families about the new government visiting guidance. They were keen to start arranging face to face visits as soon as possible to help reduce ongoing social isolation.

People were safely admitted to the service from hospital and/or the community in line with current guidance.

A new laundry area had been created on the top floor which had been done to improve the handling of contaminated laundry, should there be an outbreak at the service. The laundry areas were safely managed, with systems in place to handle laundry in line with guidelines. Cleaning routines at the service included high touch areas, such as door handles and light switches.

Regular testing of people and staff was taking place, and the vaccine had been rolled out to people and staff. Risk assessments were in place as required and measures were being taken to protect people and staff who were assessed as being in a vulnerable category.

Staff's overall wellbeing was important to the registered manager, and steps had been taken to offer support through team meetings, one to one sessions. The registered manager had taken time to display personal messages of thanks and appreciation of the staff, in helping to sustain staff morale and personal resilience.

The registered manager had a good understanding of infection, prevention and control guidance and was confident in their decision-making processes and knew how to access local support.

Should an outbreak occur the registered manager had a contingency plan in place.

People’s experience of using this service:

Without exception all the people and relatives we spoke with praised the home. Prior to and during the inspection, relatives contacted us to tell us about the exceptional care at the home.

People told us they felt safe and well cared for. People’s preferences were respected, and staff were sensitive and attentive to people’s needs. Staff were seen to be kind, caring and friendly: we heard staff engaging people in conversation and heard laughter between them. It was clear staff knew people and their relatives well.

The home was well-led by an experienced manager who had managed the home for many years and who was willing to seek advice and act on suggestions. Relatives and staff praised them for their dedication and support.

There were sufficient numbers of care staff and nursing staff employed to ensure people’s needs were met. Staff had time to sit and engage people in conversation and to support people’s involvement in social activities. Recruitment practices were safe, and staff received the training they required for their role. This included specialist training for nursing staff to maintain their registration with the Nursing and Midwifery Council.

Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible. Although not all care plans gave as detailed a description of people’s needs as staff described to us, changes had been made, and were ongoing, to update the care plans and risk assessments. People’s daily care notes also needed more detail to record the care provided by staff and to demonstrate people received the care they needed to keep them safe. Staff were aware of their responsibilities to safeguard people. The registered manager was committed to improving the records to reflect the good care we observed.

People and their relatives were involved in making decisions about their care.

People received their medicines safely and as prescribed. Medicine management practices were safe.

The home was spacious and well furnished. The environment was safe, and equipment regularly serviced to ensure it remained in safe working order.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided.

Rating at last inspection: The home was previously inspected in October 2016 and was rated ‘Good’ in all five key questions. The report was published in December 2016.

At this inspection, the home continued to meet the characteristics for ‘Good’, and the rating for the home remains unchanged.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

There was 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.

We looked at how medicines were managed and administered. We found people were receiving their medicine as prescribed. However, the first administration round was observed to take most of the morning to complete. This was because some people needed more time and support to take their medicines. The nurse responsible told us “Some days are quicker than others”. The registered manager had made arrangements for pain relief and other essential medicines requiring administration in the morning to be administered at 7am. This meant people were having their medicines when they needed it. Records showed these medicines had been administered at the times prescribed. Regular medicine audits took place to identify they were being administered as prescribed and were safe.

At the time of the inspection work was taking place to repair a boiler which had affected the supply of hot water in parts of the home. Staff were managing to work around this and there was limited disruption. Staff were able to use alternative measures to heat water and the contractor confirmed the repairs would be completed in the next few days.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices.

Staff were visible in all areas of the service throughout the day. There were enough staff to spend time with people in addition to providing personal care. People told us “Never have to wait long before someone comes” and “They look after me well.”

Some people had complex needs and were not able to tell us about their experiences, but other’s told us they were very satisfied with the care and support they received living at The Lawns. Relatives told us, “They (people using the service) are being looked after very well” and “They (people using the service) are being amazingly well looked after.”

People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure people’s safety. Care records included details of people’s choices, personal preferences and dislikes.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

Staff were supported by a system of induction training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training, support and development.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People were offered a choice of healthy and nutritious meals. Staff made sure people's dietary and fluid intake was sufficient for good nutrition. People had a choice of meals and relatives said they often had snacks and drinks outside of meal times. The cook had information about people’s dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ensure they stayed healthy.

People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Families and staff felt they could raise any concerns or issues they may have with the manager, who they said was approachable. People told us they felt their views and experiences were listened to.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits and meetings with all stakeholders of the service. Response from this monitoring showed that there was overall satisfaction with the service.

Our inspection of 23 June 2013 found that staff were not being appropriately supported and trained. We requested a date when they would have put this right. They told us that they would have achieved this on the 30 December 2013. We visited again on 7 January 2014 to ensure this was the case.

We also reviewed the staffing of the home as we had received information that there was not always enough staff on duty to meet people's needs.

We spoke with four people and one visitor when we visited. We also spoke with the registered manager and six members of staff.

We found that there was enough staff to meet people's needs and the staff were being supported and trained in their role. This meant people were being supported by enough trained and qualified staff.

Everyone we spoke with was very impressed with the care they received at the home. Everyone made positive comments regarding their support and the staff. Comments included 'I could not wish for a better place'it is very comfortable here,' and 'We are very well looked after, the staff are exceptional.' We observed the staff on duty as polite and friendly. People said the food was good, and they were provided with drinks throughout the day. People said if they had a complaint the management would respond to these appropriately.

Accommodation was furnished, decorated and maintained to a good standard and the home was very clean and odour free. The medication system, health and safety standards and quality assurance systems were maintained satisfactorily.

Staff recruitment checks were satisfactory. We received some minor concerns from people who used the service that at times staff were over stretched and there 'could be a few more staff,' however overall we judged staffing levels as satisfactory. Improvement was required to staff training and staff supervision arrangements.

We talked with eight people who lived at the home. All of the people we spoke with said that they felt safe; they told us they were treated with dignity and respect by all of the staff. People were all very complementary about the staff at the home and the care they received. Comments included 'it's very nice here, the staff are very kind, I could complain if I needed to , but I don't need to', 'we have everything we could want' and 'they (the staff) are a lovely lot of girls'.

Everybody we spoke with, were happy with the standard and choice of food served.

We looked at the care records for three people, we met with them and observed staff providing care. The care records were an accurate reflection of the care we saw being provided.

People using the service and staff told us that they felt there were sufficient staff on duty to meet people's needs. Staff told us they felt sufficient staff were on each shift. We spoke with five staff who all told us they enjoyed working at the home.

Systems were in place and efforts had been made by the registered manager to monitor the service and address any problem found.