We carried out an unannounced inspection of Lawwood on 12 and 13 November 2018.

Lawwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Accommodation is provided on two floors. All bedrooms had a shower ensuite facility. At the time of the inspection, there were 11 people accommodated in the home.

At the last inspection on 27 and 28 July 2016, the service was rated as ‘Good’. During this inspection, we found the service remained ‘Good’.

People using the service said they felt safe and staff treated them well. Appropriate recruitment checks took place before staff started work. There were enough staff on duty and deployed throughout the service to meet people's care and support needs. Safeguarding adults’ procedures were robust and staff understood how to safeguard the people they supported from abuse. People's medicines were managed appropriately and safely.

Staff had completed an induction when they started work and completed regular refresher training. The registered manager and staff understood the principles associated with the Mental Capacity Act 2005 (MCA) and acted according to this legislation. 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 in the service supported this practice. There were appropriate arrangements in place to ensure people were supported to follow a healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. We observed staff had a good relationship with people and supported them in a kind and caring manner. People living in the home, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to meet people’s needs. People were supported to participate in activities that were personalised and meaningful to them. We noted people participated in a wide range of activities and had a weekly activity planner to help them structure their time.

People were aware of how they could raise a complaint or concern if they needed to and had access to a complaints procedure.

All people and staff told us the service was well managed and operated smoothly. The registered manager provided leadership and took into account the views of people, their relatives and staff about the quality of care provided. The registered manager used the feedback to make improvements to the service.

We carried out an inspection of Lawwood on 27 and 28 July 2016. The first day was unannounced.

Lawwood is registered to provide accommodation and personal care for up to 11 people. It specialises in the care and support of people with mental ill health and does not provide nursing care. At the time of the inspection there were 11 people accommodated at the service. All people were provided with a single room with an ensuite shower facility.

The service was managed by 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.

At the last inspection on 27 and 28 April 2015, we asked the provider to make improvements to the arrangements in place to manage medicines. Following the inspection the provider sent us an action plan which set out what action they intended to take to improve the service. During this inspection, we found the necessary improvements had been made in order to meet the regulations.

People living in the home said they felt safe and staff treated them well. There were enough staff on duty and deployed in the home to meet people's care and support needs. Safeguarding adults’ procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to support people to have a healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care and support needs and had been involved in the care planning process. Care plans and risk assessments provided guidance for staff on how to meet people’s needs. People were supported to participate in a variety of activities. People knew about the home's complaints procedure and said they were confident any complaints would be fully investigated and action taken if necessary.

All people and staff told us the home was well managed and operated smoothly. The registered manager took into account the views of people about the quality of care provided through consultation, meetings and surveys. The registered manager used the feedback to make improvements.

We carried out this inspection to follow up progress on compliance actions identified at our last inspection on 17 July 2013. The provider sent us a detailed action plan and stated the service would be compliant by 31 October 2013. On this inspection we found the necessary improvements had been made.

We spoke to nine people living in the home and all expressed their satisfaction with the service provided. One person told us, “I really like it here” and another person commented, “It’s a very comfortable and caring home”.

People’s care and support was planned and delivered in accordance with their needs. People had individual support plans which were underpinned by a series of risk assessments. People told us they discussed their needs with staff and had been fully involved in the development and review of their plans.

We found suitable arrangements were in place for the management of medication.

People were satisfied with the service provided, one person told us, “It’s very nice here I like it” and another person commented, “It’s great, we’re all well looked after and they care about you”. People told us their rights to privacy, dignity and independence were upheld and respected.

People’s care was delivered in accordance with their needs. However, we found one person did not have an individual care plan which reflected their current needs. This is important to ensure the person is supported in a safe way in line with their current needs and preferences.

Whilst there were suitable policies and procedures in place to manage medication, we found some improvements were needed in respect of record keeping and the assessment of risks associated with the self-administration of medication.

Staff were provided with appropriate training opportunities and were invited to attend regular meetings.

There were effective systems in place to monitor and assess the quality of the service, which included gathering the views of people living in the home.

People using the service told us they were mostly satisfied with the support they received at Lawwood. They told us, “Things are alright I have no complaints” and “I feel safe living at Lawwood”.

People told us they were mostly satisfied with the way staff treated them. We were told of times when people had not always been happy with their support; these matters were being followed up by the manager.

People were being involved as far as possible in planning their support and were enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills.

People were supported to access resources and activities within the community and keep in touch with friends and relatives.

People were getting support with healthcare needs and they had access to ongoing attention from health care professionals.

We found people using the service were supported by trained, capable staff.

People were being consulted about their experience of service. We found that some checks on practices and systems were being carried out and action taken to improve and develop the service.

People spoken with during the inspection indicated they were satisfied with the care and support provided at Lawwood. They said “I like it here”.“I love it here its brilliant”.

People were being involved in planning their support and were enabled to make choices and decisions about matters which affected them. However, we found some improvements were needed with care plans to promote a more personalised service.

People said staff treated them well, that they were enabled to develop independence skills and were being supported to experience learning opportunities.

They also said they were supported to access resources and activities within the community and keep in touch with families and friends.

Everyone spoken with was satisfied with the catering arrangements and how they were supported with food choices, meal preparation and cooking.

People said they were getting support with healthcare needs, with regular check ups being arranged.

They described the staff as, “Friendly”. We found progress was needed with staff training and development to make sure the team had the right skills, knowledge and abilities.

People were being consulted about the service and we found that some checks on practices were being carried out. However, we found some improvements were needed with monitoring and developing the quality of service people receive.

We carried out an inspection of Lawwood on 27 and 28 April 2015. The first day of the inspection was unannounced.

We last inspected this home 7 February 2014 and found the service was meeting the regulations in force at that time.

Lawwood is registered to provide accommodation and personal care for up to 11 people. It specialises in the care and support of people with mental ill health and does not provide nursing care. At the time of the inspection there were 11 people accommodated at the service. All people were provided with a single room with an ensuite shower facility.

During the inspection we found the provider was required to make improvements to the management of medication. This was because medication was not managed in a safe and appropriate way and people’s well being was placed at risk. We have also made recommendations in respect to the development of staff training, the care planning processes and the quality monitoring systems.

At the time of the visit the registered manager was not working in the home. 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 home was being operated by a temporary manager and one of the owners of Lawwood Ltd.

People told us they felt safe and were well cared for in the home. However, they raised a number of concerns which related to the last few months. We raised the issues with the local authority under safeguarding procedures. The local authority is the lead organisation for the investigation of safeguarding alerts. Although staff had completed training on safeguarding procedures we found two staff were unsure where to report safeguarding concerns and the role of the local authority.

We noted from looking at training records that staff had completed a level three diploma in health and social care. However, the staff spoken with were unsure about the principles associated with the Mental Capacity Act 2005 and had not received specialist training on nutrition in order to support people with a healthy diet. The staff also told us they had not had an individual supervision for some time. Supervision is important to enable staff to discuss the operation of the home and future training needs. There were enough staff at the service to provide people with support and changes to staffing levels could be made if needed.

People told us they liked the food provided and confirmed they were offered choices at every mealtime.

People made complimentary comments about the current staff team and told us their rights to privacy and dignity were recognised and upheld. We observed staff were kind and sensitive in all their interactions with people living in the home.

Each person had an individual care plan which was supported by series of risk assessments. However, people told us they were unfamiliar with their plan and staff said the plans were difficult to follow and access information.

People were provided with opportunity to participate in a variety of activities both inside and outside the home. People were also supported to build their independence skills.

Whilst feedback was sought from people and staff about the quality of the service, we found the quality monitoring systems had not been fully implemented.

Our findings demonstrated a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.