The Lawns

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider worked with people and those close to them to establish their plan of care and comprehensive individual transition plans, prior to the person moving between services. This meant any potential risk were mitigated and people received continuity of care. Pre-assessment paperwork was always completed involving people, relatives and partners prior to people moving into the service and shared with staff. Assessments of needs were communicated with staff when people moved into the service or returned from a hospital stay through care plans, handovers and day-to-day communication, helping to ensure care remained consistent and responsive.

The provider worked effectively with healthcare professionals and implemented recommendations from external agencies, supporting people to receive care that reflected their changing needs and circumstances. Staff recognised when people's needs changed and sought advice and support to help ensure continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider established effective safeguarding systems, policies and procedures and managed safeguarding concerns promptly, using local safeguarding procedures whenever necessary. There was a consistent approach to safeguarding and matters were always dealt with in an open, transparent and objective way. Where required, investigations were thorough.
All staff had received safeguarding training and demonstrated a comprehensive awareness and understanding of their roles and responsibilities. Staff knew how to recognise the signs and symptoms of abuse and who they would report concerns to both internally and externally. They told us they felt confident management would listen and act if they raised concerns.

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. People had the necessary assessments in place to ensure their rights had been fully respected. The provider followed the principles and requirements of the Mental Capacity Act (MCA) where people were deprived of their liberty, under the Deprivation of Liberty Safeguards (DoLS) or through an order by the Court of Protection. Staff had a clear understanding of DoLS, they were used appropriately and only when it was in the best interest of the person. The provider continued to strengthen monitoring processes. The registered manager explained, “A review of internal processes has been completed, with clearer accountability established for receiving, recording, and actioning DoLS authorisations. Additional management oversight and tracking systems have also been implemented to ensure future authorisations, conditions, and statutory notifications are managed within the required timescales.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people’s health, safety and welfare were identified for example, risks associated with people’s mobility, swallowing difficulties and malnutrition. These risks were assessed before people started to use the service and assessments were amended as needed. Risk assessments were created and maintained within the provider electronic recording system, updated regularly and as things changed. Relevant health and safety concerns were included in people’s care plans.

Staff understood the risks associated with people's care and could describe how these were managed in practice. People and, where appropriate, their relatives were involved in discussions about care and support, helping to ensure decisions reflected what mattered to them. Comments from relatives included, “They phone me regularly to keep me informed. They have a resident of the day system when they will ring you and give an update of things” and “They talk to us a lot and let us know how [our loved one] is doing.”

Risk management was responsive to people's changing needs. Staff acted on concerns, sought advice from healthcare professionals when required and updated care arrangements to help keep people safe while maintaining as much independence as possible.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider took all possible action to assess and reduce the risk of injury caused by people’s living environment and liaised with other organisations when needed. Effective arrangements were in place to monitor the safety and upkeep of the premises, engaging professionally qualified professionals to complete environmental and equipment checks. This helped ensure people lived in an environment that supported their safety, comfort and independence.

Environmental checks, audits and risk assessments were completed, with issues identified and addressed through management oversight processes. Equipment and technology, such as sensor mats and monitoring systems, were used to support people's safety and wellbeing. Staff understood environmental risks and their responsibilities for maintaining a safe environment, and recommendations from external professionals were acted upon where required. We observed staff using equipment correctly and supporting people to stay safe.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People expressed they were happy with staff supporting them. People felt there were sufficient staff on duty. Comments included, “There are plenty of staff about. When we are there, they are always popping into the room to check everything is ok” and “I think there are enough staff. [My loved one] stays in their room most of the time, but staff go in regularly and take drinks etc.”

There were enough competent staff on duty when we visited. Staff had the right mix of skills to make sure that practice was safe, and they were able to respond to unforeseen events. The provider regularly reviewed staffing levels using a dependency tool which calculated the number of staff needed and adapted them to people’s changing needs.

Staff told us they received appropriate training and supervisions to enable them to fulfil their roles. However, we received mixed feedback from staff about staffing levels. Some staff told us at times there were not enough staff working at The Lawns to ensure people’s needs were met and to enable staff to take their allocated break. Comments included, “Staff feel overstretched around morning personal care. There are many high dependent people needing 2 carers to fully support their personal care and often there are only 2 carers assigned to each floor” and a “Few times it happened we only work with 3 carers, unable to have our lunch break or drink throughout the shift.” Another staff member told us, “I feel there are enough staff working at The Lawns. They work hard to give the residents the care and respect they deserve.”

The registered manager told us they had several vacant posts and were actively recruiting new staff. They used the same reliable agency staff who were familiar with the service and people to cover absences. They told us there had been increased level of sickness absences recently. This resulted in shifts not being fully staffed some days due to short notice and lack of agency staff availability. This had been discussed with staff at the team meeting held on the day we visited.

Healthcare professionals told us they noticed recent improvements in staffing levels and there were agency staff on most shifts. Comments included, “Over the past 6 months the care has improved with fewer residents. I hope this does not decline with increasing resident numbers and use of agency staff evident on most of my visits.”

Appropriate recruitment checks were carried out as standard practice. Recruitment processes were robust, and staff were recruited safely. Appropriate Disclosure and Barring Service (DBS) checks and other recruitment checks were carried out as standard practice. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Significant improvements were made to the way people’s medicines were managed and to ensure people’s involvement since our previous assessment. However, shortfalls remained and further improvements were needed.

Medicines were stored safely and securely. Suitable systems were in place for ordering, storing and disposing of medicines, and records were kept for medicines requiring extra security. However, staff had not always accurately recorded the opening and expiry dates of some medicines in line with the provider's procedures. This increased the risk of medicines being used beyond their recommended in-use period.

Some people were prescribed high-risk medicines; however, risk assessments were not always in place. For example, 2 people prescribed anticoagulants did not have a corresponding risk assessment. This meant staff did not have clear guidance on the risks associated with these medicines or how to respond to potential complications. The ‘Managing Medication’ part of people’s care plans were person-centred. However, these did not always include enough guidance for staff about peoples’ medicines. For example, 1 person was prescribed 2 laxatives with variable doses, but the care plan did not explain when doses should be increased or reduced. This meant staff did not have all the information needed to support the safe administration of these medicines.

A review of medicines administration records (MARs) showed that people received their medicines as prescribed. Clear guidance was in place for medicines prescribed as required (PRN) and for topical medicines, including body maps to support correct application.

We spoke with 1 resident, who said their medicines were managed well and that they were involved in decisions about their medicines.