We inspected this service on 11 May 2017; this was an unannounced comprehensive inspection visit. Our last unannounced comprehensive inspection visit took place on 5 February 2016 and breaches of legal requirements were found including the cleanliness and maintenance of the home, the number of staff available to care for people and concerns that staff did not recognise the requirements for legal consent. After this inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to those requirements. We undertook a focused unannounced inspection on 29 September 2016 and found the provider had made the improvements needed to meet the legal requirements, however further improvements were needed. This was because applications to deprive people of their liberty had been made before some people’s ability to make decisions and consent to care had been assessed. At this inspection we found improvements had been made in these areas.

Lawnswood Avenue is registered to provide accommodation and personal care for up to eight people with learning disabilities. On the day of this inspection there were eight people using the service, with seven people in residence on the day of our inspection visit. There was a registered manager in post but they were on long term leave at the time of our visit. An acting manager was in post to oversee the management of the service during the registered manager’s absence. 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.

Staff were aware of the signs to look out for that might mean a person was at risk of harm. Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Although there was enough staff available to meet people’s personal care needs, we found that this impacted on staff availability to provide some people with the support they needed to access the community on a regular basis. The management team were monitoring the support time people needed to enable them to liaise with funding authorities regarding this.

People felt safe with the staff that supported them. Identified risks were managed in a way that ensured risks to people were minimised whilst promoting their rights and choices. People were supported to take their medicine when needed and this was done in a safe way. Checks were made before employment to confirm staff were of good character and suitable to work in a care environment.

Staff received training to support the people they worked with and supervision, to support and develop their skills. The staff team included people and their representatives in the planning of care. People were supported by a consistent staff team that knew them well. Staff understood people’s preferred communication method and the support they needed to make their own decisions. When people were unable to consent to specific decisions they were supported in their best interest.

People’s needs were assessed and support plans where developed with people to enable them to be supported in their preferred way. People were supported to maintain a diet that met their dietary requirements and preferences and to use healthcare services. People were treated with respect and supported to maintain their dignity. The staff knew people’s likes and dislikes and preferences. People were supported to maintain relationships that were important to them.

There were processes in place for people to raise any complaints and express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the provider to drive improvement.

We carried out an unannounced comprehensive inspection of this service on 25 February 2016. Breaches of legal requirements were found including the cleanliness and maintenance of the home, the number of staff available to care for people and concerns that staff did not recognise the requirements for legal consent. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lawnswood Avenue on our website at www.cqc.org.uk

Lawnswood Avenue is registered to provide accommodation and personal care for up to eight people with varying learning disabilities. On the day of our inspection, there were seven people living in the home. There was a registered manager in post. 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.

There was a programme of on-going improvements being undertaken. A deep clean had been completed and repairs had been made to provide a safe and clean environment for people living in the home. The communal areas of the home were being decorated to improve the wellbeing of people and staff.

The number of staff available to care for people had been reviewed and amended to ensure they received the level of support they required when they were in the home and taking part in outdoor activities. Staff morale had improved and the level of staff support had increased.

People’s ability to make their own decisions had been re-assessed. Capacity assessments which considered people’s ability to consent to all aspects of their care and safety had been completed for most people.

We could not improve the rating for safe from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.”

This inspection took place on 25 February 2016 and was unannounced. At our last inspection on 5 March 2014 the provider was meeting the legal requirements we inspected.

Lawnswood Avenue is registered to provide accommodation and personal care for up to eight people with varying learning disabilities. On the day of our inspection, there were eight people living in the home. There was a registered manager in post but they had been seconded to another service. 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 number of staff available to care for people had not been planned around their level of need by the provider. Some people’s support was adversely affected by the staffing levels. The environment was not clean and well maintained to ensure people were safe and not at risk of cross infection.

The provider was not working within the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Some people were being deprived of their liberty to keep them safe. The provider had not applied for authorisation to do this as is required under the DoLS legislation. Staff did not feel supported by the provider to care adequately for people and protect their own well-being.

There were arrangements in place to recruit staff who were suitable to work with people in a caring environment. Staff understood their responsibility to protect people from avoidable harm and potential abuse and knew how to report concerns. Staff received training to improve their knowledge and skills to care for people effectively. People had a choice of food and drinks provided to meet their individual needs. The opinions and support of health care professionals was sought to maintain people’s physical, mental and psychological health.

People received care from staff who treated them with kindness and compassion. Staff knew people well and understood how they wanted to be supported because they knew their likes, dislikes and preferences for care. People received support to maintain the relationships that were important for them. Relatives were able to visit whenever they wanted to.

People received support to spend time in and out of the home. People were able to choose holiday destinations and were supported by staff to have a break from their normal routine. Relatives felt empowered to raise concerns or complaints directly with the staff or the provider.

People were given opportunities to discuss the care and support they needed. The provider asked relatives and healthcare professionals for their opinions of the service. The provider was monitoring the quality of the service and using some audit information to identify if there were any trends or patterns in incidents which occurred in the home.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection to check on the progress the service had made to address the concerns we raised at our last inspection visit. We saw that further improvements had been made to the gardens to ensure that people had access to a safe and suitably maintained garden area that they could use at all times. Staff told us that these improvements were ongoing.

We were not able to speak indepth with all the people who used the service because of their complex needs which meant they were not all able to tell us their experiences. We observed positive interactions between people living at the home and the staff that looked after them. Staff knew the best way to communicate effectively with individual people.

We saw that people had their care needs assessed and had been involved with planning the support they wanted from staff. At this visit there were sufficient staff to support people to lead full active daily lives both within the home and the community. Audits were carried out to make sure that people received their medicines safely.

We saw that people’s bedrooms and communal areas within the home were decorated and presented in a way that promoted their individuality and age group. One person we spoke with told us “I love my bedroom, it’s comfortable”. We saw that improvements had been made to the gardens, however more could be done to ensure that people had access to a safe and suitably maintained garden area that they could use at all times.

At our visit to the home we found that there were sufficient staff working in the home to support people to lead active daily lives and access the community in a way that maintained their safety.

People’s care files were safely stored and people’s confidentiality was respected by staff.

At the time of our visit four of the people who lived in the home were away on holiday. We were not able to speak indepth with all the people who used the service because of their complex needs which meant they were not able to tell us their experiences. We saw that staff treated people kindly and respectfully. One person we spoke with told us “I like living here, yes the staff are okay”. We talked with staff who demonstrated they were aware of people's care and support needs.

We saw that people’s bedrooms and communal areas were decorated and presented in a way that promoted their individuality and age group. One person we spoke with told us “I love my bedroom I go in there whenever I want”. “X (name of staff) helps me to keep it tidy”. We saw that work was needed in some areas of the home and grounds to make sure that people lived in a safe and clean environment.

We had received an anonymous concern about the level of staffing in the home. At our visit to the home we found that there were areas where staffing levels needed to be reviewed. For example sufficient staff were needed to make sure people were supported to access the community in a way that maintained their safety at all times.

The manager shared information with us that showed that the provider regularly checked the quality of the service people received at Lawnswood Avenue.