This inspection took place on 22 and 24 February 2017 and was unannounced. It was the first inspection of Lawnbrook Care Home since it was purchased by the current provider in April 2016 and was undertaken in response to concerns raised about the safety and quality of the service being delivered.The home provides accommodation for up to 30 people, including people living with dementia care needs. There were 29 people living at the home when we visited. The home is a large building based on three floors, connected by two stairways and a passenger lift. The bedrooms are all for single occupancy and have en-suite toilets and wash basins. There are four bathrooms, although only two of these were use; one was being used for storage and one was awaiting refurbishment to turn it into a shower room. The kitchen and laundry were based on the ground floor, as was a communal lounge/dining room. There were two smaller lounges that people could use on the upper floors of the building.
The home 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.
People’s safety was compromised in some areas. Infection control guidance was not always followed; some areas of the home smelt of urine and others were not clean; there was no clear process in place to prevent cross contamination in the laundry room; there had been three outbreaks of infection since April 2016; and appropriate ‘barrier techniques’ were not in place to prevent the spread of infection while staff were supporting a person with diarrhoea.
Medicines were not always managed or administered safely. Records did not confirm that people had received their medicines or topical creams as prescribed; there was no clear guidance for staff on when and how to administer ‘as required’ medicines; and the risks associated with blood-thinning medicines had not been assessed.
Individual risks to people were not always managed appropriately. People’s risk assessments were not reviewed when they experienced falls; people were not protected from the risk of pressure injuries; and there were no risk assessments in place for the environment. However, some risk management measures were in place, including appropriate fire safety systems.
The induction process was not structured and there was no process in place to monitor staff training. Although most staff said their training was up to date, we found some were not suitably skilled. Moving and repositioning techniques used were not always safe or appropriate and put people at risk. Staff said they felt supported in their work, but did not always receive one to one sessions of supervision to enable them to raise concerns or discuss their training needs.
A choice of meals was available to people, but choices were not offered in a meaningful way for people living with dementia. People who ate very little of their meals were not offered alternatives unless they had the capacity to request them. Charts used to monitor the amount people had eaten were not completed fully; although action was taken when people lost weight.
Staff did not follow legislation designed to protect people’s rights. They were not aware of people who had had restrictions placed on their freedom to keep them safe.
The premises were not maintained in a suitable condition. As a result, hot water was not available in all parts of the home and the passenger lift had experienced repeated failures. The décor did not support people to be able to navigate around the building, although the provider had recently employed a specialist to enhance the experience of people living with dementia.
New recruitment and selection procedures had been introduced as relevant pre-employment checks had not always conducted before staff started work. The new procedures were more robust and would help ensure only suitable staff were employed in the future.
People told us staff treated them with kindness and compassion. We observed positive interactions between people and staff. However, we also found that people and their families were not always treated with consideration. People’s privacy was protected in most cases, although some confidential information was visible in people’s rooms.
People said they received personalised care and staff demonstrated an understanding of people’s needs. However, care plans were not reviewed regularly and did not always contain sufficient information. Staff did not promote people’s continence effectively.
There was a lack of resilience in the management structure of the home and the registered manager undertook all management tasks without having anyone to delegate to. However, a deputy manager was being recruited to support them.
The registered manager was developing an appropriate quality assurance system and was aware of the strengths and weaknesses of the service. They acted as a role model for staff. Staff enjoyed working at the home and described the registered manager as approachable and supportive. They expressed a shared a commitment to improving the quality of care for the benefit of people.
People told us they felt safe living at the home. Staff were aware of their safeguarding responsibilities and had been trained to identify, prevent and report incidents of abuse. There were enough staff available to meet people’s needs.
People who could communicate verbally told us they enjoyed their meals. They were supported to access healthcare services when needed.
People were encouraged to remain as independent as possible and were involved in planning the care and support they received. They had access to a range of activities designed to meet their individual interests.
There was an open and transparent culture. The provider sought and acted on feedback from people. People knew how to make a complaint, although the complaints procedure was still being developed.
We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.