Lavender Court is a ‘care home’ without nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lavender Court provides adapted accommodation and care for up to seven people with learning disabilities. At the time of our inspection there were seven people using the service, supported in the home by 17 permanent staff. Some of these staff were allocated to the home from another service which was closed for refurbishment. At the time of the inspection there were plans to rota the staff across the two services when it re-opened in the new year.

The property is a large bungalow with seven bedrooms, communal spaces, a rear garden and is close to local amenities. The home was closed between January to July 2018 for a refurbishment project which adapted the premises for people with mobility needs and to provide en-suite facilities.

This inspection took place on the 17, 18 and 22 October 2018. We returned on the 30 October 2018 to provide feedback to the registered manager and operations manager who were both on annual leave during our inspection on the 22 October 2018. The inspection was unannounced on the first day of inspection which means we did not provide the service with warning of our visit. Subsequent days were announced.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a manager registered with us.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we found breaches of Regulation 12 (Schedule 3), 15 and 18 of the Registration Regulations 2009 and Regulations 9, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service received an overall rating of requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) safe, effective, responsive and well led to at least good. At this inspection we found there were repeated breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have satisfactory arrangements to manage individual’s risks and safety. Records were not suitably maintained, accurate and up to date and the governance of the service failed to bring about the improvements required for them to become compliant.

Systems did not always ensure that vulnerable adults were protected from foreseeable risks. People’s risk assessments were completed but were not always clear or accurate and did not contain sufficient information to identify or mitigate risks. The service did not use an effective method to calculate staffing deployment.

The governance of the service was unsatisfactory. A quality assurance tool had recently been developed but was not comprehensive, and not always acted on promptly or sufficiently. Records were not always up to date or appropriately filed. There was not sufficient day-to-day management oversight of the home or enough time allocated to senior staff to achieve delegated management duties.

The service had made improvements to staffing levels whic

Lavender Court is one of two care home services the provider is currently registered for.

The service provides accommodation and residential care for up to eight adults with moderate to severe learning disabilities. Lavender Court is situated in residential area of Slough, Berkshire. The building is a large, detached bungalow on one level. There are eight single bedrooms with a lounge area, a separate dining room, kitchen, office and communal bathrooms. There a large patio and garden at the rear of the premises. Although not registered with us, there is also a separate day services building adjacent to the service, which provides a base for activities such as IT, music, exercise, cooking or arts and crafts. People who lived at Lavender Court attended the day centre at various times from Monday to Friday.

At the time of the inspection, there was no 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. Leading up to the inspection, we were required to complete an administrative cancellation of the former registered manager, as they have failed to cancel their own registration. The home manager at the time of our inspection had not applied to add Lavender Court to their existing registration.

Since registration under the Health and Social Care Act 2008 on 20 January 2011, Lavender Court was inspected four times. The most recent inspection was a routine planned visit on 19 December 2013. We inspected five outcomes which were compliant. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first rating under the Care Act 2014.

People who used the service were protected from abuse and neglect. Appropriate systems were in place to ensure that any allegations would be reported for assessment and investigation. The service was unable to tell us if any allegations were ever referred to the local authority. There were no records which showed allegations of abuse or neglect.

Some risks for people and the service were assessed, mitigated, documented and reviewed. Risk assessments related to people’s care required better oversight. We found that some risk assessments were missing. For example, one person who had routine falls and others who had epilepsy did not have specific risk assessments to prevent harm. Risks from the building were considered and managed, although records were not kept in an organised format.

We looked at two staff personnel files. The location’s home manager was responsible for ensuring fit and proper person checks were completed and recorded for new staff. We found the service had strong recruitment and selection procedures that ensured suitable, experienced applicants were offered and accepted employment. Personnel files contained all of the necessary information required by the regulations and no documents or checks were missing.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. The home manager explained there were no medicines incidents. However, even potential failures in practice that did not result in harm to people required reporting. We advised the provider to seek guidance and support to ensure any medicines incidents were always recorded and reviewed.

The deployment of staff was unsafe and inappropriate. Although organisational restructuring was evident, the safety of people was placed at risk due to inappropriate changes in the staffing levels and roles. People’s dependency levels and satisfactory risk assessment of staff numbers on day shifts were not considered. We observed numerous instances during the inspection where people were at

The people who lived at the home had complex support needs and were not always able to tell us their views using the spoken word. We saw the relationship and interactions between staff and people who use the service were positive and respectful. We spoke with relatives of one person using the service told us that they were happy with the service provided and that the care was of an excellent standard provided by friendly professional staff. These people also told us that staff communicated with them regularly about the care being provided to their relative and that staff had made them aware of the complaints procedure; but they had never had cause to use it.

We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal goals. We looked at a range of files that demonstrated the personalised approach in place to support the staff’s comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who use the service. We observed staff assessing people’s needs and ensured that care was provided in line with individual care plans. We saw that people were comfortable and that adequate numbers of staff were available to provide the individualised support needed.

During our inspection we used a number of different methods to help us understand the experiences of people who lived at the home because they had complex needs which meant they were not able to tell us their experiences

Care records provided clear guidance to staff about how to meet people’s needs and were personalised to the people they related to. There was evidence that people where possible were involved in their care and able to give consent. Where this was not possible, the appropriate meetings were held with those working on their behalf to ensure their rights were being upheld.

We observed people participating in a cookery activity, laughing and interacting positively with staff.

Staff we spoke with demonstrated a good understanding of people’s needs and how they could be met. They also ensured they were kept up to date on any changes to people’s needs through handover meetings, staff team meetings and email communications.

The Local Authority ensured that all appropriate recruitment checks were carried out prior to staff starting work. The provider’s arrangement for staff induction, training and development provided staff with the knowledge and skills required to meet the needs of people using the service.

Most care records were up to date and reviewed annually; there were some risk assessments that had recently passed their review dates.

The residents of Lavender Court had limited communication skills and so it was not possible to collect direct feed back from them. One person was happy to show us their room and one person was happy to share their person centred file with us. This contained photographs of them undertaking activities, on holiday and with family and friends. They were particularly happy when sharing the photographs of them horse riding. One room was being painted and the person whose room it was had chosen the colour using a paint chart. Another person had been supported by their uncle to purchase new furniture. People who use the service were involved in planning the menu.