Lavender Hills Care Home

We found the following examples of good practice.

A range of policies and guidance was available to manage the COVID-19 pandemic. This had been updated in line with changes in the guidance, and links to a range of further information was available to the staff team. Contingency plans and risk assessments had been completed.

Arrangements were in place to ensure people were admitted to the service safely. A regular testing programme was in place for people who used the service, staff and visitors. Relatives of people confirmed the appropriate visiting arrangements to enable them to spend time with their family members. All staff had been fully vaccinated in line with the current government guidance.

The service was clean and tidy and cleaning schedules had been completed. Dedicated housekeeping staff undertook cleaning duties. Audits of the service was taking place and records had been completed to confirm the findings from these.

A range of personal protective equipment, (PPE) was available throughout the service. Staff confirmed enough supplies of PPE was available for them. Information and guidance was on display throughout the service to guide and support people and staff. Staff were observed wearing PPE appropriately at all times during the inspection. Relatives who visited the service confirmed the staff wore PPE when they visited. Staff told us, and records confirmed they had undertaken relevant training in infection control and donning and doffing of PPE. The registered manager told us they undertook observed checks of staff donning and doffing and handwashing to ensure this was being undertaken in line with guidance.

There was sufficient staff in the service. Staff told us there was enough staff to undertake their role. Relatives said, “There is always plenty of staff around” and, “There is enough staff, they answer buzzers promptly when we buzz.” Systems were in place to ensure sufficient staff were in place in the event of a COVID-19 outbreak. The registered manager discussed how they had managed the recent outbreak in the service.

We found the following examples of good practice.

The provider had a clear visiting policy and procedures in place in relation to relatives and friends, staff and visiting professionals. There was a separate area for visitors to put on and take off personal protective equipment (PPE). There was a good stock of PPE available for everyone.

The provider had updated visiting procedures and policies in relation to the most recent government guidance which allowed for each person living in the home to have a nominated visitor. The home had provided each nominated visitor with a supply of lateral flow tests (LFT) which detect Covid 19.

Staff movement around the home had been managed to minimise the number of contacts they had and to support social distancing.

Staff had received regular training about the pandemic and use of PPE. The home worked with the local authority infection prevention control nurses to ensure they were following guidance appropriately. Some vacant bedrooms had been designated as storage for PPE.

Easy read information about the pandemic and use of PPE had been provided for people living in the home. This helped people understand and reduced potential anxiety.

People’s experience of using this service:

People told us they felt safe at the service. There were enough staff available to provide care and support; staffing arrangements were kept under review. Staff had received training on safeguarding and protection matters. They were aware of the signs and indicators of abuse and they knew what to do if they had any concerns.

The provider had arrangements to promote the safety of the premises, this included maintenance, servicing and checking systems. People were protected by the prevention and control of infection.

Staff followed some good processes to manage people's medicines safely. Some improvements were made during our visit and the provider confirmed further action was in progress, including the medicines management checking systems.

People's needs were assessed, planned for and reviewed. Each person had a care plan which was designed to ensure their needs and choices were met. People were supported with their healthcare needs. Changes in people's health and well-being were monitored and responded to. Where necessary, people received appropriate medical attention.

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

People made positive comments about the caring, sociable attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.

There were numerous opportunities for people to engage in a wide range of group and individual activities. Visiting arrangements were flexible, relatives and friends were made welcome at the service.

There was a good standard of décor and furnishings to provide for people's comfort and well-being.

People said they were satisfied with the variety and quality of the meals provided at the service. Their individual needs and preferences were catered for. People were supported to enjoy the mealtime experience.

People had an awareness of the service's complaints procedure and processes. They indicated they would be confident in raising concerns. Some complaints records were unclear and didn’t properly show how they were investigated and managed. The provider confirmed to us, action had been taken to make improvements.

The provider had arrangements to encourage people to express their views and be consulted about Lavender Hills Care Home. They had opportunities to give feedback on their experience of the service and suggest improvements.

The provider used a variety of systems and processes, to regularly monitor and improve the service. Management and leadership arrangements supported the effective day to day running of the service.

Rating at last inspection: At the last inspection the service was rated good (published 5 October 2016).

Why we inspected: This was a planned inspection in line with the previous rating.

Follow up: We will plan a follow up inspection as per our inspection programme. We will continue to monitor the service and if we receive any concerning information we may bring the inspection forward.

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

Lavender Hills care home is owned by GHS Care Ltd and provides care and accommodation for to up to 45 people with residential care needs. Nursing care is not provided. The premises are an older type large house in its own grounds on the outskirts of Ramsbottom. It is some distance from a main road, the town's facilities, and not on a bus route. The original house has undergone extensive renovations, and the facilities and accommodation are of a high standard.

At the time of this inspection there was a registered manager who had been in post since August 2014. 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 was supported in her role by the home’s assistant manager.

The service was last inspected in August 2014. We found it was meeting all legal requirements applicable at that time.

During this inspection, we found the service was meeting the current regulations.

People told us they felt safe living at Lavender Hills care home and felt the care received was delivered in a professional, caring and compassionate way.

The provider ensured processes were in place to maintain a protected and suitable environment for all people using the service and their visitors. Suitable training was offered to staff to ensure they were competent in recognising the signs of abuse and could appropriately and confidently respond to any safeguarding concerns and notify the relevant authorities when required.

The service conformed to the requirements of fire safety by ensuring fire audits were up to date and relevant checks were carried out on a weekly basis to fire equipment and lighting. People using the service had personal evacuation risk assessments in place and the provider had an additional contingency plan which provided direction about what to do in the case of an emergency or failure in utility services or equipment.

The service had satisfactory staffing levels to support the operation of the service and provide people with safe and personalised care. People told us they never felt rushed and staff were responsive to their needs. We noted the service offered a variety of training to its staff which ensured the staff team were skilled and experienced in safely and effectively supporting all people using the service.

Appropriate steps were taken to verify new employee’s character and fitness to work. Following successful appointment to the role the provider ensured a robust induction plan was carried out which ensured staff were equipped with the correct skills and knowledge to effectively support people in an informed, confident and self-assured manner.

Processes were in place to take immediate action against staff in the event of any misconduct or failure to follow company policies and procedures. The provider also took appropriate action to ensure safeguards had been implemented following a recent incident.

Appropriate processes were in place for the safe administration of medicines in line with best practice guidance from the National Institute for Health and Care Excellence. Staff had received training in medicines management and all medicines were stored securely and safely. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

Staff displayed an awareness of the Mental Capacity Act 2005 and had completed appropriate training. Appropriate referrals had been submitted to the local authority by the home’s manager and a good audit trail was seen.

The provider had considered and implemented adequate documentation to support the development of the care planning process and support the delivery of care. Each plan was individual to the person’s needs. Effective systems were implemented to maintain independence, by providing a detailed plan covering essential information care staff needed to follow. These ensured clear information about people’s needs wishes, feelings and health conditions and were kept under regular review.

Positive staff interaction and engagement with people was observed. Staff were caring, respectful and understanding in their approach and treated people as individuals. Staff promoted privacy and dignity and supported people to maintain control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted upon by means of questionnaires enabling them to influence the service they received. Comments were received from people during the inspection which supported these observations.

People who used the service along with their relatives/visitors were complimentary about the management structure. People described the registered and deputy manager as helpful and professional. Staff informed us they felt well supported and that they could approach either manager with any concerns.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with eight people using the service, looked at care records of three people in detail and a selection of other records in relation to other people's care. We also spoke to four care staff, the cook, the deputy manager and the operations manager.

This is a summary of what we found:

Is the service safe?

Before people were admitted to the home they had an assessment carried out to make sure they would be safe in the environment and there was enough skilled and qualified staff to meet their needs.

The deputy manager understood their obligation to apply the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). This is a legal framework designed to protect the best interests of people who are unable to make their own decisions.

People told us they were treated very well by the staff. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Each person had an individual care plan which was underpinned with a series of risk assessments. Risk assessments identified and informed staff who may be at risk of falling, developing pressure ulcers or may not eat enough and how to manage this.

People told us they felt safe and never had any cause for concern. One person said, 'We have always been told to tell them if anything is not right. The staff are very good with everyone.' Another person told us, 'We're on first names here, all equal. I think the staff are very respectful. They treat me well and it's just nice knowing they are around.'

Staff were trained in emergency procedures such as fire and first aid. All staff had been trained in the safe moving and handling of people. Staff used safe ways of working, for example, when they used a hoist to assist them move people.

Staff had also been trained in safeguarding vulnerable adults. Care had been taken to make sure people were kept safe by good recruitment procedures being followed. Staff contractual arrangements prevented them from gaining financially from people they cared for.

Systems were in place to make sure the provider continually checked the service was safe. Guidance was being followed such as health and safety in the work place, infection control, fire regulations and control of hazardous substances. This reduced the risks to people and helped the service to continually improve.

Is the service caring?

People told us they were happy with the care they received and the staff team. They said, 'They are good carers and know their responsibilities looking after us 'elderly folk'. I like them all and the male carer they have is a nice fellow, he would get you anything. I have no complaints.' And, 'I've nothing but praise for the service we get. All the staff are very helpful and good. They have time to have a chat with me. When I had a bad chest infection they got my GP out straight away.'

Daily records showed staff responded to people's needs as required day and night. Staff gave a good account of, and showed an understanding of, the varying needs of different people we had discussed with them.

People were able to make choices regarding their lifestyle. They had the opportunity and scope to express their wishes for daily living and social activity, and this was respected. This supported people to be cared for in a way that did not inappropriately restrict their freedom.

People were provided with a choice of food and special diets were catered for. We noted people were offered a glass of wine with their evening meal.

Is the service responsive?

People were given plenty of opportunities to say what they wanted. People's assessment of needs and care plans were reviewed regularly and professional help and support was sought from health and social care professionals when needed.

Good practice was followed to make sure people were admitted properly. A continuing assessment of need was on-going for people, including mental capacity assessment to support continuing care needs being addressed appropriately.

Staff had relevant training to support them in their role.

Arrangements were in place to deal with emergency situations such as fire evacuation, loss of electricity, and disruption to catering, flooding, accommodation, gas, heating, staff, water and severe weather.

People using the service and their relatives had the opportunity to complete a satisfaction survey. A system was in place for receiving comments, compliments and complaints. People told us that they would know how to make a complaint, should they need to do so.

A relative we spoke with said, 'It's a lovely home and they have certainly thrown money at the place. Everything's being replaced or upgraded and not done cheaply either. I think the new water feature being built at the front is beautiful and will give people a lot of pleasure. It's like being in a stately home.'

Is the service effective?

People told us they were happy with their care. They had their own preferred routines, likes and dislikes. There were no unnecessary rules to follow and no rigid routines.

A relative told us, 'The biggest thing to measure how well they care for her is in her health. Since she has been here she looks healthier, her skin is looking better and she is more relaxed.'

People's health and well-being was monitored. Appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Staff considered they had time to spend with people. They said 'Team work is very good,' and 'We do practical training as well as refresher training and we are competency checked.' We saw there was sufficient staff on each shift with a range of skills and experience. This meant people were being cared for by a staff team with the knowledge to meet their needs.

Is the service well led?

Staff and relatives told us there was an open culture with opportunities for them to share their views and make suggestions. Staff told us they were supported to develop their skills and given opportunity to attend training.

The quality assessment and monitoring systems promoted the effective management of risks relating to health, welfare and safety of those living at the home.

Staff were clear about their responsibilities and duty of care and were able to raise their views and discuss work issues at staff meetings and in one to one supervision. The operations manager visited the home on a daily basis and provided management support for the registered manager.

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. We saw evidence the service knew when to consult with health and social care professionals when required. This meant any decision about people's care and support was made by the appropriate staff at the appropriate level.

At this inspection in December we found the management of medicines in the home was much improved in all the areas we assessed and that had previously been of concern. Staff were following correct procedures for the ordering, recording and the administration of medicines, and we saw people living in the home were being given their medicines safely.

We saw at this inspection that people's personal records had improved. All the people living in the home had an assessment of their needs and a care plan which included information about how staff should look after them. The risks associated with some aspects of their care had also been assessed, such as the risk of pressure sores, malnutrition and moving and handling. This should help ensure people were looked after safely. The records of medicines administered were also much improved and accurately showed what had been given to people.

We spoke to eight residents, two relatives, five members of staff, the acting manager and the owner. All the residents spoke highly of the staff and said they were well cared for. They made the following comments: "Staff are very good; they know what they are doing", "I can't find any fault here at all,and that's my honest opinion" and "I'm looked after properly and I get on with all the staff". A relative said, "The staff are very kind and any problems are dealt with properly". Residents told us they had baths and/or showers when they wanted and needed, and that staff answered buzzers in a timely way. Sometimes there was a wait, but not for an unacceptable time. We observed people looked clean and well cared for. The bedrooms we saw were clean, and all but one was free from unpleasant odours.

Staff told us they were unsettled by all the management changes but were optimistic of improvement. They told us they felt supported by the owner and the new (acting) manager. They said both were accessible, and listened to and responded to, their worries and concerns about the constant changes. However we found there was a problem with short notice staff absenteeism and shifts not always filled.

At this visit in September we saw, through records and discussion with staff, there had been considerable improvements in staff training and supervision and support. An extensive programme of staff training was in progress and most staff had received supervision and appraisals. New members of staff were also undertaking a suitable and timely induction.

However we found the medication practices were not in accordance with correct procedures and some people were not receiving all their medicines at the right time.

We spoke to four people living in the home, and a relative. They told us the care was good and that people had the care they needed. Their comments included: "It feels right here", "They treat you very well" and "The carers are nice, very helpful". However the records did not sufficiently document the care people needed. There was no written information about the care of one person, including for pressure sores, and for others the risks associated with some aspects of care had not been assessed.

We asked the provider to provide an action plan telling us when and how the home would become compliant with this regulation. Though we were told of the appointment of a new manager we did not receive an action plan. Social Services undertook a monitoring exercise, after our inspection in April, and had concerns there had been no improvement in the areas identified. We visited the home again in June to check if any progress had been made. The new manager was in post, but through talking to staff and looking at records we found there had been little progress in the areas of concern.

Most people felt sufficiently involved in their care and support, and one person said, "The staff talk to me about the care I need". However one person didn't feel they had been involved in planning some aspects of the support they needed.

We saw people received the medication they needed at lunch time and one person told us, "I always get my medication (for diabetes) when needed.

Staff said they felt supported and the morale of the team had improved considerably in recent weeks due to management changes.They said staff absenteeism had decreased and that staffing levels and continuity of the staff team had improved. However through talking to staff and looking at records we found there were still significant shortfalls in the training people had undertaken since the inspection in October 2012.

Senior staff told us there was a new service quality monitoring system in place. This should help ensure any necessary improvements are made.

We judged the action plan to be satisfactory, and at our recent inspection we checked to see whether or not the action had been completed according to the plan. We spoke to the registered manager, three members of staff, and looked at the relevant records. We found the service had taken sufficient action to comply with the regulation concerned. A resident told us the staff were very good and that she always had the care and support she needed though 'sometimes staff were rushed'.

Staff told us there had been an improvement in the organisation and the consistency of the staff team, and that gaps in shifts were filled by (mainly) permanent staff and more rarely, agency staff. They also said that there was a designated team of staff working in the dementia unit who had the right skills, attitude and interest to support the people living there. The records we saw confirmed there had been these improvements, and also improvements in staff training.

We spoke with four people living in the home, a visitor and three members of staff. In general the view of all these people was the home had been through difficulties but were hopeful 'things would settle down' under the new management.

People living in the home we spoke with told us they had enough choices in their routines. They said they could go to bed and get up whenever they liked and could spend time in their rooms. People said staff treated them respectfully and kindly and were mindful of some of their preferences. One person said, "I am able to get up late and go to bed late". Another person said there was a good choice of food and told us, "The food is very good actually". We observed staff caring for people and supporting them in a patient and respectful way. A visitor said, "Staff are always very kind".

People living in the home were generally satisfied with the care they received. One person said, "I like being here; I don't want to live anywhere else". Another said, "Everything's perfect". However two people and a visitor felt the home was sometimes short of staff and at these times people had to wait for attention. Staff we spoke with agreed with this view.