Lavender Lodge Nursing Home

Lavender Lodge Nursing Home is residential care home providing accommodation and personal care for to up to 44 people. The service provides support to older people, some who are living with dementia. At the time of our inspection there were 40 people using the service. People had their own bedrooms within two inter-connected buildings, with communal lounges and dining areas. A small number of bedrooms were shared bedrooms. The care home is over two floors, with lifts between floors.

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

Storage arrangements and records for when staff administered people’s skin creams required improvement. Not all pre-employment checks had been completed when care staff started work. Not all staff consistently wore face masks in line with government guidance.

There were enough staff available to help promote people’s safety. The home environment was clean. Risks were identified, assessed and measures put in place to reduce risks where this was possible. Friends and relatives were able to visit their family members living at Lavender Lodge. Systems were in place so that local safeguarding procedures were followed when needed.

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 promoted people’s privacy, dignity and independence. People had positive relationships with staff and were treated well. People had their equality and diversity needs respected. People and their relatives when appropriate were involved in their care decisions.

Management and governance systems were in place to help check people received quality care. Plans were in place to continue to improve and refurbish Lavender Lodge. These plans included refurbishment and redecoration of people’s bedrooms and replacing the few remaining shared bedrooms with single occupancy rooms. The registered manager led with an open and approachable management style that created a positive and inclusive home environment for people, their relatives and staff.

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 1 June 2019).

Why we inspected

The 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 have found evidence that the provider needs to make improvements. Please see the safe section of this full report. The provider told us what action they had taken to the concerns we raised with them as part of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lavender Lodge Nursing Home is a care and nursing home in the city centre of Derby. It has 44 beds and specialises in catering for older people, some of whom are living with dementia or a physical disability. On the day of our inspection visit there were 44 people living at the home.

Following our last inspection, we asked the provider to complete regular action plans to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-led to at least Good.

At this inspection we found that improvements had been made. A comprehensive and effective audit system was in place. Medicines were managed safely. Risk was well-managed and staff knew how to keep people safe. Medical records were clear, up-to-date and accurate. Improvements had been made to the premises although further improvements were needed to ensure they were suitable for people living with dementia and others. The complaints procedure had been re-written and updated.

People’s experience of using this service

People and relatives said the home was a safe place. Staffing levels were good and trained staff available to support people in all areas of the home. Staff were safely recruited. All areas of the home were clean and tidy and staff followed the home’s infection control procedures to reduce the risks of infection.

People told us they liked the food served. Their nutritional needs were assessed and met and they had the support they needed when dining. The cooks knew people’s likes and dislikes and how to prepare and present their food in a way that was safe and appetising.

People said they had good access to healthcare professionals when they needed them. Staff supported people to making decisions about their care and support and ensured their rights were protected.

People were well treated and supported. A relative said, “The staff do an excellent job. [family member] is well-looked after and settled. The staff are very caring.” Staff knew how to build trusting relationships with people and took an interest in them. Relatives were made welcome at the home. Staff respected people’s privacy, dignity and independence.

People received personalised care. Staff met the needs of people from a range of different cultural backgrounds. Some people and relatives thought there should be more activities at the home. The registered manager said a new activities coordinator was being appointed to improve the activities programme.

People, relatives and staff said the registered manager was approachable and ensured the home was well-run. A staff member told us, “We feel safe with [registered manager] in change. He listens to staff and residents and will find a solution to any problem.”

Managers and staff provided personalised care and support. People, relatives and staff were involved in the running of the home and their views listened to. The registered manager produced regular action plans and worked with CQC and the local authority to make ongoing improvements to the home.

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

Rating at last inspection

At the last inspection we rated this service Requires Improvement (report published on 12/10/2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Lavender Lodge Nursing Home is a care and nursing home in the city centre of Derby. It has 44 beds and specialises in catering for older people, some of whom are living with dementia or a physical disability. On the day of our inspection there were 42 people living at the home.

At our last inspection of this home on 17 and 18 January 2018 we found two breaches of the regulations because the home was not always safe or well-led. We issued a requirement notice and a warning notice in response to these. Following our inspection the provider submitted an action plan stating how they intended to achieve compliance.

At this inspection we found that although some improvements had been made the home was still not fully compliant with the regulations.

The service had a registered 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.

We found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. Although some audits had been put in place these were not always effective. There was no comprehensive audit or other monitoring system in place to ensure quality performance, risks and regulatory requirements were understood and managed.

We also found a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment. This was because improvements were needed to the way medicines were managed to ensure they were administered safely.

People were assessed prior to them moving into the home to ensure the staff could meet their needs. Risks to people were assessed and their safety monitored. Staff had been trained in moving and handling and new, safer wheelchairs purchased.

Staff recruitment files were missing some essential documentation to show people were suitable to work in care. Most staff had completed all their essential training courses and those that hadn’t were booked to attend forthcoming courses.

People medical needs were met and a GP visited the home weekly to provide a surgery. One person’s medical records needed improvement.

Staff understood their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and sought people’s consent before providing them with care and support.

Improvements were needed to the adaptation, design and decoration of the premises to ensure people’s individual needs were met, particularly the needs of people living with dementia. The home was clean and tidy on the day of our inspection. There was an abundance of flowers in the garden and courtyard areas which people and relatives commented positively on.

People were supported to eat and drink enough and maintain a balanced diet. Staff knew people’s dietary preferences. If people needed one-to-one assistance with their meals this was provided. People were encouraged to choose what they ate. The food was well-presented, nutritious and varied. People’s cultural dietary needs were considered when meals were planned. English, Russia and Polish dishes were served.

People and relatives told us they were satisfied with the service provided at the home. The provider had carried out a survey of people’s and relatives’ views and organised coffee morning with a view to involving them in the running of the home.

We saw that relationships between people and staff were good and staff interacted with people at every opportunity. The staff were kind and caring. They supported people to express their views and be actively involved in making decisions about their daily lives and how they wanted to be supported. Care plans had been made more personalised and included details about people’s preferences and cultural needs.

The home’s part time activity coordinator, ran a music session during our inspection. This was hugely successful with people enjoying the music and the physical activity that went with it. Some people said they would like more activities at the home and the opportunity to get out into the wider community.

The provider’s complaints procedure needed amending to make it clear that it is the local authority, not CQC, who is responsible for investigating complaints. The acting manager said this issue would be addressed.

At the time of our inspection the provider was working with the local authority and the health service to address some of the issues at the home with a view to improving the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 17 and 18 January 2018. The first day of the inspection was unannounced.

At our last inspection we identified a regulatory breach which related to safe care and treatment. At this inspection we found the registered provider had not made sufficient improvements in this area and we found a further breach of regulation 17 good governance. Following our inspection the representative of the registered provider sent us an action plan which showed how some of our immediate concerns would be addressed.

The home provides personal care and accommodation for older people, people with dementia, and people with a physical disability.

A registered manager was in post. This is a condition of the registration of 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 and associated Regulations about how the service is run.

People and their relatives told us they were safe living at this service. However, we found the registered provider had identified safeguarding concerns in February and August 2017 which they had not reported to the Care Quality Commission (CQC).

During our inspection, we found there were still concerns regarding people’s safety. We found medicines were not managed safely as not all staff responsible for the administration of medicines had made sure that a person’s medicine was not accessible to other people.

People's risk assessments provided staff with information on how to support people safely, though some assessments were not fully in place. Lessons to prevent incidents occurring had not comprehensively learnt from past events. People were not fully protected from the risks of infection.

Staff had been trained in safeguarding (protecting people from abuse) and, in the main understood their responsibilities in this area, though staff needed more training in which relevant outside agencies to contact.

People using the service and the relatives we spoke with, except one person, said they thought the home was safe.

Staff support through a programme of training, was not up to date. Most recruitment checks had been carried out safely to ensure staff were suitable to work with vulnerable adults.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs, though they were unsure what this meant in practice. Staff understood their main responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, although they were of all their responsibilities under this law.

People did not always have the opportunity to have sufficient quantities to eat and drink. Everyone told us they liked the food served. People's health care needs had been protected by referrals to health care professionals when necessary.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way, though one person reported there had been occasions where staff had not shown respect. People and their representatives were not always involved in making decisions about their care, treatment and support.

Care plans were individual to the people and covered their health and social care needs. Some activities had been organised to provide stimulation for people, though stimulation which suited people was not always available.

People and relatives, except two relatives, told us they were confident any concerns they expressed would be followed up.

People and relatives, except two relatives, and staff were satisfied with how the home was run by the registered manager.

Management had not carried out audits and checks to ensure the home was running properly to meet people's needs. Essential issues had not been comprehensively audited.

Lavender Lodge Nursing Home is registered to provide nursing care for up to 44 older people living with dementia and or a physical disability. At the time of this inspection there were 41 people using the service. The service is located close to Derby city centre. The home is divided into two units which are referred to by the provider as the ‘traditional side’ and the ‘new side’. Communal living areas were located on both sides of the service.. Lifts were in place to access the first floors.

There was a registered manager in post; they were also the service provider. 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. There was a nursing manager who was responsible for the day to day management of the service.

The provider did not have thorough systems to monitor staff training to ensure staff could do their job effectively. This included the frequency of any training updates, training completed and waiting to be completed.

Risk assessments and behaviour support plans were not always in place to ensure people received safe care.

The staff team were knowledgeable about safeguarding issues and protected people

from coming to harm. They knew what to do if concerns were raised about a person's welfare and who to report those concerns to. People’s medicine were not always administered as prescribed. For example two medicines were given on a continuous basis rather than when required.

There were sufficient staff deployed to ensure people’s care and support needs were met. There were two qualified nurses on duty at all times along with care staff. In addition to this catering, domestic staff, laundry staff and maintenance staff supported the running of the service.

The provider was clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Some people were subject to restrictions and the provider had identified where their support needed to be reviewed. We observed staff sought people’s consent before they provided care and support.

People enjoyed the food and drink they were served. People were supported at mealtimes if they required this. Arrangements were made for people to see the GP and other healthcare professionals as and when they needed to.

People were supported by staff that were generally kind and caring. Staff respected people’s privacy and dignity. Staff interactions with people were mixed. We saw some staff always spoke with people when assisting them or when passing people. However two staff did not interact with people whilst supporting them with their meal.

The provider had systems in place to monitor the quality of the service to enable them to drive improvement. The appropriate checks to maintain the premises and facilities were completed on a regular basis.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We were told that people's cultural and religious needs were met and that people were encouraged to be independent were possible. We saw that care plans and risk assessments were updated regularly and staff found them helpful. One person told us 'they are very helpful, if anything changes the care plan is updated'.

People told us they felt safe at Lavender Lodge and had never seen anything of concern. One person told us 'I know my relative is safe when I leave, I have no worries.'

Staff we spoke with told us they had enough training to carry out their duties and felt supported by the provider and senior staff. People told us they had the opportunity to give their opinion about the service to the provider and were confident any concerns would be addressed. We found that records were not always easily accessible however this has improved since our previous inspection.