The Lawns Care Home

The Lawns Care Home is a residential care home providing accommodation and personal care to up to 62 people. The service provides support to older people and people living with a dementia type illness. The Lawns Care Home accommodates people in one adapted building across two floors, with several communal areas and an outdoor garden space. At the time of our inspection there were 46 people using the service.

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

The management of people’s medicines had improved. However, further guidance was needed for medicines to be taken on a ‘when required’ basis and medicines with a variable dose. Records for the application of creams and lotions were not always complete. We have made a recommendation about the recording of medicines.

The provider’s oversight of the service had improved. More robust systems and processes had been implemented. However, systems and processes needed to become further embedded and maintained. We have made a recommendation about this.

Risks to people were assessed, monitored and managed. Some care plans provided staff with good information and guidance to keep people safe. Some care plans contained inconsistent information and lacked clarity, but staff confirmed they received all relevant up to date information in daily handovers and meetings.

People’s nutrition and hydration needs were appropriately assessed and people who required modified diets received these. Some staff did not have a clear understanding around high calorie drinks, and this was addressed by the manager immediately.

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.

There were enough staff to provide safe care to people. Safe recruitment procedures were in place. The service was clean, tidy and well maintained. Lessons were learnt when things went wrong, and good improvements had been made since our previous inspection. People told us they felt safe and were well supported.

The culture and atmosphere in the service was much more positive than our previous inspection and staff told us they were happy. Staff, relatives, professionals and people spoke extremely positively about the manager and the improvements made.

The manager had built good relationships with professionals and made timely and appropriate referrals. People were involved in the service and relatives were kept up to date. The provider and the manager were welcoming, open and honest throughout the inspection process.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 14 April 2022) and there were four breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulation.

This service has been in Special Measures since 14 April 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

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.

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

Recommendations

We have made a recommendation in the safe key question in relation to the management of medicines. We have made a recommendation in the well-led key question in relation to audits. Please see these sections for further details.

Follow up

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

The Lawns Care Home is a residential care home providing accommodation and personal care to up to 62 people. The service provides support to older people and people living with a dementia, in one adapted building across two floors. At the time of our inspection there were 45 people using the service.

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

People’s medicines were not managed safely, and people did not receive their medicines as prescribed. Risks to people were not always appropriately assessed, monitored and managed. People’s nutrition and hydration needs were not adequately recorded or known by staff. No action was taken if people at risk did not have enough to drink. Staff were not always deployed throughout the service appropriately, and staff consistently told us there were not enough care workers. Pre-employment recruitment checks for agency staff were not always fully in place. The service was not clean. Lessons were not always learnt when things went wrong.

Leadership, governance and culture within the service did not ensure high quality care was delivered. Care records were not always person-centred and up to date. We received mixed feedback about the atmosphere within the home. Quality assurance was ineffective, and the service had deteriorated since our previous inspection. The provider did not have appropriate or effective oversight of the service. People were not always referred to healthcare professionals in a timely manner.

People told us they felt safe and they liked the staff. Immediately after our inspection the provider implemented an action plan to address the concerns identified around medicines, the environment, risk assessments and people’s nutrition and hydration needs. Visitors to the service were appropriately screened for COVID-19 and visiting arrangements were in line with government guidance. The service had enough PPE and staff took part in a regular COVID-19 testing programme.

Following our feedback, the provider ensured that appropriate support was provided to the service. The provider understood their regulatory requirements and their duty to be open and honest when things go wrong. Relatives generally told us they were kept up to date. The provider and acting manager were receptive and responsive to feedback and worked with CQC to implement action plans to resolve the issues identified.

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 26 February 2020).

A targeted inspection took place in November 2020 (published 25 November 2020). The service was inspected but not rated and therefore this did not change the last rating for the service.

At our last comprehensive inspection, we recommended that the provider consider current guidance on medicines management and take action to update their practice. At this inspection we found the provider had not acted upon this recommendation and had not made the necessary improvements.

Why we inspected

The inspection was prompted in part due to concerns received about management of medicines, cleanliness of the service, and safeguarding concerns. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

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

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

During the inspection we fed back our concerns to the provider. We also liaised with the local authority and relevant stakeholders.

The provider and the acting manager were very responsive to our feedback. The provider immediately prepared and implemented a robust action plan. The provider and the acting manager prioritised the concerns which posed the highest level of risk to people. Steps were taken to address our concerns, minimise risk, and ensure the safety of people using the service. The provider arranged for the acting manager to have ongoing support from the senior management team, who visited the service regularly to support with improving the quality of the service. We have had positive feedback from professionals following the implementation of the provider’s action plan.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lawns Care Home 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 safe care and treatment, nutrition and hydration, staffing and good governance at this inspection.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

We found the following examples of good practice

¿ The home was following good practice to prevent staff and visitors from catching and spreading infections. Visitors to the home were asked to complete a checklist and declare they were not experiencing any of the potential symptoms of COVID-19 and had their temperatures taken.

¿ There was sufficient personal protective equipment (PPE) such as aprons, gloves and masks. Staff had undertaken training in putting on and taking off PPE and other Covid-19 related training.

¿ Steps had been taken to promote social distancing, such as frequent signage and seating being rearranged.

¿ Management had good processes for communicating changes in guidance with staff and to support staff with any anxieties about working during a pandemic.

¿ Management praised staff for the way they supported people who used the service emotionally and for maintaining a positive atmosphere in the home.

¿ Infection control audits and checks were carried out. The registered manager was continually reviewing and improving the checks being made to ensure good practice guidance was followed.

Further information is in the detailed findings below.

The Lawns Care Home is a care home providing accommodation and personal care for up to 63 people aged 65 and over. At the time of the inspection there were 53 people using the service.

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

The registered manager and the registered provider needed to improve medicines management practices to ensure medicines were handled and stored safely by competent staff. We made a recommendation about this.

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. Allegations of abuse had been dealt with in a robust manner to assure people about their safety. People and their relatives told us they were safe. Risk assessments had been developed to minimise the potential risk of avoidable harm to people during the delivery of their care. The registered manager had robust and safe recruitment procedures and monitored the safety of the premises.

People received person-centred care, which was responsive to their needs. Care records were well written and contained important details about people’s needs. Staff supported people with meaningful day time activities inside the home and in the local community. People's individual communication needs had been assessed and staff had tools to assist their interactions with people. The registered manager dealt with people's concerns and complaints appropriately.

People's care and support had been planned in partnership with them and their relatives. Staff had received regular training and supervision to support them in their roles. Improvements were required to ensure all staff were trained in the safe handling of medicines. 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 were positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The registered manager worked in partnership with people and their advocates.

The service was well-led. People, their relatives and staff spoke positively about the registered manager and management team. The registered manager regularly checked the quality of the care provided and people’s experiences. There was a positive culture throughout the service which focused on providing care that was individualised and promoted independence.

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 27 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had not been rated under the new registered provider of Burlington Care Limited so this was a first rated inspection for The Lawns Care Home.

The Lawns Care Home accommodates up to 62 older people, some of whom are living with dementia. There were 56 people living at the home at the time of the inspection.

A registered manager was in post. People, relatives and staff spoke positively about her leadership. A registered manager is a person who has registered with the CQC 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.

We saw issues addressed from an infection control nurses audit inspection on 3 March 2017 were being attended to in relation to a hand washing sink and window ledge on the day of the inspection visit. First thing in the morning we found the first floor bathroom contained clothes and continence products and was untidy. Staff were mainly using this bathroom as one other on this floor was temporarily out of use. We also found two fridges in the dining rooms on both floors contained ice and contained unlabelled food. It was acknowledged and the registered manager took immediate action on the day to rectify the fridges and sent us evidence they had met with night staff to review cleaning rotas and discussed bathroom tidiness.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected.

People were safe because risks had been identified and managed. All the staff in the home had completed training to give them the skills and knowledge to carry out their roles and to ensure people in the home were safe.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner.

People received on-going healthcare support from a range of external healthcare professionals and people’s health and nutrition needs were effectively monitored and responded to in line with nationally recognised practice. People were supported to eat a well-balanced diet and those who were at risk of malnutrition and/or dehydration had their food and fluid intake monitored. We found some records in relation to personal care were disorganised and the registered manager addressed this straight away.

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

There were sufficient staff deployed and we spoke with the registered manager to ensure staffing levels were reviewed in light of increasing numbers of people. Safe recruitment procedures were followed and staff had completed training in safe working practices and to meet the specific needs of people through face to face training. An effective induction process was in place which was linked to the Care Certificate for all new staff members.

There was an activities co-ordinator employed to help meet the social needs of people. A varied activities programme was in place although people fed back to us they would like more activities

The staff knew the people they were supporting well and treated them in a respectful and friendly way. We saw care plans identified people’s needs and wishes although some people we spoke with did not know about their plan of care.

The provider had a range of quality monitoring systems and had made improvements in response to people's feedback and audits. There was a commitment to deliver a good standard of personalised care and continued improvement based on the views of people who used the service and the enhancement of their lives. The staff team spoke positively about the support they received and were motivated and enthusiastic. Complaints, accidents, incidents and safeguarding events were taken seriously, thoroughly investigated and lessons learnt from them.

All staff informed us they were happy working at the service and morale was good. We observed that this positivity was reflected in the care and support which staff provided throughout the day.

The registered provider was meeting the conditions of their registration. They were submitting notifications in line with legal requirements.