This inspection took place on 10 and 15 January 2019 and was unannounced.

At our last inspection of 24 February 2017, we found a breach of Regulation 12 of the Health and Social Care Act Regulated Activities Regulations 2014 because risk assessments were not in place for the balconies and sensor mats. We served a requirement notice and the provider sent us an action plan detailing what they would do to meet the regulations.

During this inspection we found the registered manager had completed their action plan and there was no longer a breach of this regulation.

Lawnbrook Care Home is a ‘care home’. 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.

Lawnbrook Care Home is a residential care for up to 30 people who may be living with dementia. The home is purpose built over three floors with communal sitting and dining areas are on the ground floor and the other floors are accessible by passenger lift. On the day of the inspection, twenty six people were living at Lawnbrook Care Home.

There was a registered manager in place. 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.

Risk assessments identified a range of environmental risks and plans were in place to minimise these risks. The provider had policies and procedures in place designed to protect people from abuse and staff had completed training in this. Regular safety checks were completed, for example, regarding gas and electrical items and lifting equipment.

People’s needs were met by suitable numbers of staff who knew people well. Effective recruitment procedures were in place which included a range of checks to ensure staff were safe to work with people living at Lawnbrook Care Home. Medicines were stored safely and accurate records were kept showing people received their medicines as prescribed. People were protected by the prevention and control of infection using risk assessments and maintaining the cleanliness of the home. Lessons were learned and improvements made when things went wrong.

Mental capacity assessments and best interests decisions were completed where necessary. People were supported by staff who were trained appropriately for their role. People were supported to eat and drink enough and were offered choices.

People were supported to access healthcare services and ongoing healthcare support when necessary. Staff supported people to take their medicines as prescribed. The environment was suitable to meet the needs of people living with dementia.

People were treated with kindness, respect and compassion and during the inspection we observed staff interacting positively with people. People were supported to express their views and be involved in making decisions about their care. People’s privacy and dignity was respected.

People received personalised care which was responsive to their needs. People had care plans in place which covered a range of information about people’s social histories, preferences and support needs. People enjoyed a range of activities. People were supported with end of life care where needed. The provider had a complaints procedure in place and it was displayed in the entrance hall.

The registered manager promoted a positive culture which was open and inclusive. There was a management system in place and individual responsibilities were clear. People and their relatives felt they were involved in how the service was run. The registered manager had put a range of audits in place to ensure they were able to monitor people’s changing needs. The registered manager

Lawnbrook Care Home provides accommodation for up to 30 people, including people living with dementia care needs. There were 25 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 washbasins. The kitchen and laundry were based on the ground floor, as was a communal lounge/dining room. People could use two smaller lounges on the upper floors of the building.

We previously inspected Lawnbrook Care Home in February and June 2017. During an unannounced, comprehensive inspection of the home in February 2017, we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that care and support were provided in a safe way; and they had failed to ensure good governance of the service. Following the inspection, we issued warning notices for the breaches of Regulations 12 and 17.

We required the provider to take action to meet these regulations by 30 June 2017. The provider sent us an action plan detailing what they would do to meet the regulations. We undertook an unannounced, focused, inspection on 18 July 2017 to check the provider had followed

their plan and to confirm that they now met legal requirements. We found improvements had been made to the quality and safety of the service and there was no longer a breach of regulations. However, further improvement was still required.

This inspection took place on 11 and 12 October 2017. The inspection team consisted of one inspector, one inspection manager and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

There was a registered manager in place. 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.

Risk assessments identified when people were at risk from every day activities, such as moving around the home and detailed what action was taken to minimise those risks and to deliver care and support which met people’s needs safely. However, risk assessments did not identify all risks at the home. Staff had completed Mental Capacity Act assessments but these were confusing and unclear about the decision making process. However, staff asked people for their consent before they supported them with personal care.

People told us staff supported them with their medicines. There were appropriate arrangements in place for obtaining, storing, administering and disposing of medicines. Medicines administration records (MAR) were completed fully, which showed people had received their oral medicines when needed. However, the MAR charts used to record the application of topical creams were not fully completed.

The registered manager had a system of audit in place to monitor the quality of service provided. However, we identified areas of concern which had not been identified through audits.

People and their relatives said they felt safe at the home. The provider had policies and procedures in place designed to protect people from abuse and staff had completed training in safeguarding people. People’s needs were met by suitable numbers of staff, who were trained appropriately for their role.

People told us they were satisfied with the cleanliness of the home and maintenance was completed as soon as possible.

People were supported to eat and drink enough and were offered choices. Some people required a specialist diet and staff ensured they were offered appropriate food.

People were supported to access healthcare services and ongoing healthcare support wh

We carried out an unannounced, comprehensive inspection of Lawnbrook Care Home in February 2017. We identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that care and support were provided in a safe way; and they had failed to ensure good governance of the service.

Following the inspection, we issued warning notices for the breaches of Regulations 12 and 17. We required the provider to take action to meet these regulations by 30 June 2017. The provider sent us an action plan detailing what they would do to meet the regulations.

We undertook this unannounced, focused, inspection on 18 July 2017 to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the issues cited in the two warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lawnbrook Care Home on our website at: www.cqc.org.uk.

Lawnbrook Care Home provides accommodation for up to 30 people, including people living with dementia care needs. There were 25 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. 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.

There was a registered manager in place. 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 improvements had been made to the quality and safety of the service, although further improvement was still required.

There were appropriate arrangements in place for obtaining, storing, administering and disposing of medicines. However, some stock recording errors were found and there was no process in place to ensure topical creams were not used beyond their ‘use by’ dates.

A new quality assurance system had been developed, based on an extensive range of audits. These were not yet fully effective and needed time to become embedded in practice. For example, they had not identified inconsistencies in the way consent was recorded in care plans. However, they had brought about some improvement; for example, they had led to enhancements to the environment.

A more robust management structure had been created. This allowed the registered manager more time to assess and monitor the overall running of the service.

Infection control arrangements had been significantly improved. The provider had appropriate policies and procedures in place to help ensure the home remained clean and to reduce the risk of cross infection.

Individual and environmental risks to people were managed effectively. For example, people were protected from the risk of falls, the risk of developing pressure injuries and the risk of malnutrition. Enhanced fire safety procedures were in place and fire safety systems were tested regularly.

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 h