Lavender Lodge

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

People’s prescribed medicines had not always been stored within recommended temperature limits, in the refrigerator, or in the medicines trolley. Risks to people were not always safely managed to prevent them from harm.

People did not always receive personalised care that met their individualised needs; care was task-based. Information within some care plans was not always reflective of people’s changing needs. The premises had not been adapted to provide a dementia-friendly environment. Auditing systems were not sufficiently robust to identify the issues found at this inspection.

People’s consent to care and support was gained in line with the requirements of the Mental Capacity Act 2005. 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.

People felt safe living at Lavender Lodge. A relative said, “It’s a nice home, nicely run and the home feels caring. The manager is lovely and chats with people. My mother is well looked after, she’s smiling and happy. I get the impression that staff know people well”. There were sufficient staff on duty to ensure people’s needs were met promptly.

People were supported to have a nutritious diet and healthy lifestyle. They had access to healthcare professionals when this was required.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 July 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We carried out an unannounced focused inspection of this service on 17 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to medicines management, how people’s risks were managed, and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lavender Lodge is a residential care home providing accommodation and personal care for up to 20 people. At the time of our inspection 20 people were using the service, the majority of whom were living with dementia.

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

People told us they felt safe living at the home. There was no dedicated housekeeping staff employed at the time of the inspection, and care staff could work additional hours to undertake cleaning. A relative observed that when they visited some parts of the home required vacuuming, and toilets were not cleaned thoroughly. Medicines were not always managed safely. Some medicines which should have been discarded were still being stored. Medicines that were required to be stored securely were not managed safely. A small lounge was cluttered with cardboard boxes, PPE, and a hoover. People were prevented from using the room to its full extent.

Auditing systems were not sufficiently robust to identify areas in need of improvement. Care plans lacked detail about people’s support needs and guidance for staff. The rating of requires improvement awarded at the last inspection undertaken in September 2021 was not on display at the home. The provider’s website showed the rating of good from an inspection undertaken in February 2018 which was not current. Information was inaccurate and misleading. No formal feedback had been obtained from people or their relatives about their views of the home.

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.

Staff were caring and kind with people. People were treated with dignity and respect. There were sufficient staff to meet people’s needs.

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

Rating at last inspection and update and update

The last rating for this service was requires improvement, report published 22 November 2021. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 September 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, caring and well led.

The inspection was prompted in part due to information we had received about the service, including cleanliness of the home, and management arrangements. A decision was made for us to inspect and examine those risks.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, risks to people, care planning, auditing systems, and display of ratings. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lavender Lodge is a residential care home providing personal care to 20 people at the time of the inspection. The majority of people are living with dementia. The service can support up to 20 people.

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

Systems were not always effective in ensuring people were protected from the risk of infection. Some parts of the home were not cleaned to a high standard.

Care was not always delivered in a person-centred way, although staff were observed to be kind and patient with people. A housekeeper was on duty mainly during the morning. In addition to their caring duties, staff were expected to undertake cleaning and laundry tasks, as well as planning activities with people. Two people told us they had nothing to do during the day except watch television. After the inspection, the registered manager informed us that there were planned activities, usually in the afternoons.

Medicines were managed safely. There were sufficient staff on duty to meet people’s support needs. People were protected from the risk of potential abuse and harm.

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.

Audits were effective in monitoring and measuring the service and identified areas for improvement.

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

Rating at last inspection and update

The last rating for this service was Good (published 2 February 2018).

Why we inspected

The inspection was prompted in part due to concerns we had received about the service with regard to staffing levels, and cleanliness of the home. A decision was made for us to inspect and examine those risks. We were also informed that people were got up very early in the morning by night staff, therefore, inspectors arrived at the home soon after 6.00am on the day of inspection, to see whether this was the case. When we arrived at the home, people were still in bed with their curtains drawn.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. 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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We discussed the issues that were of concern during the inspection, and the provider has taken steps to address these. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took into account the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to safe care and treatment.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This is the first inspection of the service since there was a change of provider.

There was a registered manager for 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 told us the service had been through a significant period of change since the change of ownership in 2015, with a new registered manager and deputy manager, and a number of changes to the staff. There was an ongoing plan being followed to improve the environment in which people lived. Improvements already made had included redecoration, new floorings, new furnishings, a review of security with new locks and keypads, a new call bell system, setting up a new sensory room and the provision of two new wet rooms. There was a maintenance programme in place which ensured repairs were carried out in a timely way, and checks were completed on equipment and services. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

People and their relatives told us they felt people were safe. They felt it was somewhere where they could raise concerns and they would be listened to. A relative told us, “Nothing is cosmetic, it is all functional, it happens. With security comes contentment in spite of the dementia.” Another relative told us, “I bought my mother here for safety now I have peace of mind. She can walk downstairs alone but she is well supervised. She can wash herself but they supervise her bathing.” Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. Medicines were stored correctly and there were systems to manage medicine safely. Audits and stock checks were completed to ensure people received their medicines as prescribed.

People's individual care and support needs were assessed before they moved into the service. Relatives told us where possible people had been involved in making decisions about their care and treatment and they had also felt listened to. Care and support provided was personalised and based on the identified needs of each individual. Personalisation and person centred care focused on people having choice and control in their life, and was at the forefront of the care delivered. People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. People’s healthcare needs were monitored and they had access to health care professionals when they needed to.

Consent was sought from people with regard to the care that was delivered. All staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation. Staff told us they always asked for people’s consent before they provided any care and support.

People, relatives and staff told us staffing levels were sufficient. The registered manager monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. People were cared for by staff who had been recruited through safe procedures. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff. Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They had received supervision and appraisal. They felt they knew people’s care and support needs and were kept informed of any changes. They confirmed that they felt valued and supported by the managers, who they described as very approachable. They told us the team worked well together.

People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner.

There was a positive culture in the service. Staff were involved and updated about changes at the service through meetings and at handovers each day. The registered manager had a good oversight of the service and knew where changes and improvements were needed. People and their representatives were asked to complete a satisfaction questionnaire. The registered manager told us feedback from this had been used to inform the refurbishment programme in the service. They also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have. One member of staff told us, “I love it here.” Another member of staff told us, “It’s a big family. (Registered manager’s name) is excellent.”