The Lawns

The Lawns is a residential care home providing personal care and accommodation for up to nine adults living with a learning disability. Services for people with learning disabilities and or autism are supported. At the time of the inspection there were eight people living at The Lawns.

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

People and their families were positive about The Lawns and staff who supported them.

People were treated with kindness and compassion. People spent time in the community within COVID-19 guidelines and at the home, doing activities they enjoyed and had chosen. People's support focused on them having as many opportunities as possible for them to gain new skills and maintain independence.

Risks to people had been assessed and care plans reflected how to support people to keep people safe whilst maximising their independence.

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. Where there were restrictions on people, staff were working within the requirements of the Mental Capacity Act (2005).

There were enough staff to support people. Staff had been recruited safely and completed an induction when they first started. Staff updated training to ensure they were able to support people, following best practice guidance and seeking health professional support for particular medical conditions. For example, epilepsy and VNS systems (a magnet used to manage seizures).

Staff worked in a relaxed manner, ensuring that people had enough time to make decisions for themselves wherever possible in a way they understood.

People were kept safe by a registered manager and staff who were committed to their care and well-being.

Safeguarding issues were reported and investigated appropriately. Lessons were learnt when things went wrong, and actions was taken to reduce the risks of a reoccurrence. Staff had received up to date safeguarding training and knew how to make appropriate referrals.

The home was well-maintained and looked after. The home was clean and we were assured that staff were following COVID-19 national guidelines. There were policies and procedures to ensure the risks of infection was minimised with particular focus on COVID-19.

Medicines were well managed and organised.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. At the time of this inspection eight people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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 7 March 2018)

Why we inspected

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.

The inspection was prompted in part due to concerns received about the care of people with epilepsy. Concerns had also been raised about the registered manager. A decision was made to inspect and examine those risks. We have found evidence that the provider has made improvements to mitigate any risks. Please see the safe and well led sections of this report. We found no evidence during this inspection that people were at risk of harm from this concern. There was a whole home safeguarding process which is now closed and an individual safeguarding process which is ongoing. The provider has been fully co-operative with this process.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

At the last inspection in October 2015 the service was rated overall Good. At this inspection we found the service remained Good in all domains.

People, their families, staff as well as health and social care professionals were very positive about the home and the care provided. Comments from people included “I like it here.” “Care worker is nice.” People were relaxed and happy with staff, laughing and chatting with them.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were encouraged to do a range of activities both in the home and in the community. Staff worked with people to support them to choose what they wanted to do and who they wanted to do it with.

Staff knew people well and were kind and compassionate when working with people. Staff were knowledgeable about people’s communication methods. People were treated with dignity and people’s right to privacy was respected by staff. People’s diversity and wishes were understood by staff, including cultural and religious preferences. People were protected from the risks of abuse by staff who understood their responsibilities.

There was a registered manager in post. There was a quality assurance and governance framework which checked that the home was safe and well maintained. There were systems to ensure the home was kept clean and free of infection. There were also quality assurance systems which monitored the care provided to people. Where issues were identified, there were actions to address them. There were policies and procedures in place which ensured the smooth running of the service. The home had a complaints policy and process. People were supported to have an independent advocate where necessary.

There were sufficient staff who had the knowledge, skills and experience to support people with their care. Staff had been recruited safely. Staff were supported to undertake training when they first joined the home and to refresh their knowledge from time to time. Staff were also supported to do nationally recognised qualifications. Staff had regular one to one supervisions with a senior worker which gave them an opportunity to reflect on what was going well, what was not going so well and what support they needed to improve their work.

Care records contained risk assessments and care plans which described people’s personal background, risks, needs and preferences as well as how these should be met. Staff were able to describe how they worked with people to deliver the care in the care records.

People experienced effective care that promoted their health and wellbeing. People were encouraged to eat a healthy diet of their choice. Staff prepared meals to meet people’s special dietary needs. People were offered drinks throughout the day to ensure they remained well hydrated. People’s health needs were monitored and health professionals were involved where necessary. Medicines were stored and administered in a safe way. Staff recorded accurately when medicines were given. Checks were undertaken to monitor the medicine administration.

Further information is in the detailed findings below.