The Lawn Residential Care Home provides personal care and accommodation for up to 31 older people. The service does not provide nursing care. At the time of the inspection there were 31 people accommodated.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good overall, however we have revised the rating for the safe domain to requires improvement, as staffing and records require improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service overall remained good.

There were sufficient staff rostered. However, there had been issues with high levels of staff sickness which were being addressed for people. Action had been taken to fill staff vacancies and to increase senior staff presence at the weekends. Not all people’s written care plans had been reviewed monthly as required by the provider. The registered manager was aware and had taken relevant action. Following the inspection, the provider submitted evidence which demonstrated this work had now been completed, but it still needs to be sustained over time.

Risks to people had been identified and managed safely. People’s health, dietary and fluid needs were identified and met. Processes were in place to safeguard people from the risk of abuse. People were protected from the risk of acquiring an infection. The environment was suitable and safe for people. Learning took place following incidents and improvements were made. Medicines were safely managed. The registered manager took swift action to complete three outstanding annual staff medicines competencies during the inspection.

People’s care delivery took account of national and local guidance. Staff undertook relevant training and were supported in their role.

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.

Overall people told us staff were caring. Staff were seen to be polite and respectful to people. Some people said they would like more interaction from some staff and this has been fedback to the registered manager to address. People were supported to maintain their independence. People’s dignity was upheld during the provision of their care.

People and or their representatives were involved in planning their care. Although some people told us they would have liked better activities, a range of both internal and external opportunities were provided. People’s end of life care needs were met at the service.

Most people and staff felt the service was well-led. The new registered manager had a good understanding of the challenges facing the service through the quality assurance processes and was taking the correct actions to address them for people. They actively engaged people, staff and the community. Processes were in place to share information both within the service and with external organisations. Staff worked with other agencies to ensure people received joined up care.

Care service description

The Lawn Residential Care Home provides accommodation for up to 31 older people, some of whom may also be living with dementia. The home is situated in the village of Holybourne and is a period house which has been altered and extended for use as a care home. There is access to landscaped gardens and grounds. At the time of our inspection 29 people were using the service.

Rating at last inspection

At the last inspection, the service was rated good overall and Requires Improvement in the ‘Effective’ domain.

Why we inspected

We previously carried out an unannounced comprehensive inspection of this service on 12 and 13 July 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 14 of the Health and Social Care Act (Regulated Activities) Regulations 2014, Meeting nutritional and hydration needs.

We undertook this focussed 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 The Lawn Residential Care Home on our website at www.cqc.org.uk.

At this inspection we found the service had improved, there were no breaches of regulations and therefor the rating for the ‘Effective’ domain has been changed to Good.

Why the service is rated Good in the ‘Effective’ domain

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

At the last inspection we found care plans did not always address the risk in relation to malnutrition or match with the actual care that was being delivered. Some people were choosing not to eat but it was not clear that the provider had considered and addressed all the risks in relation to this. At this inspection, we found that care plans had been updated and accurately reflected people’s care. Care plans recorded all measures which had been taken to protect people from the risk of malnutrition.

People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. For lunch a main meal was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.

People were supported to maintain good health through access to ongoing health support. Records showed that district nurses, psychiatric nurses and the GP had been involved in people’s care and referrals were made where appropriate.

The inspection took place on 12 and 13 July 2016 and was unannounced.

The Lawn Residential Care Home provides accommodation for up to 31 older people, some of whom may also be living with dementia. The home is situated in the village of Holybourne and is a period house which has been altered and extended for use as a care home. There is access to landscaped gardens and grounds. At the time of our inspection 23 people were using the service.

The Lawn does not have 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. A new manager had been recruited by the provider and was due to start in post following the inspection therefore they had not yet applied to register with CQC.

At the last inspection on 12, 17 and 18 November 2015 we found six breaches in regulations. We asked the provider to take action to make improvements to safeguarding, safe care and treatment and the implementation of the principles of the Mental Capacity Act 2005. We took enforcement action to require the provider to make improvements to person centred care planning, staffing and governance. This action has been completed. Following this inspection the service had not been rated as inadequate for any of the five key questions and has therefore been taken out of special measures.

People said they felt safe. Staff had received safeguarding training and were able to explain how to protect people from abuse and how to report suspected abuse.

People’s individual risks were appropriately assessed and care plans were in place to mitigate against known risks. Staff were knowledgeable about risks to people and what actions needed to be taken to keep people safe.

There were sufficient staff on duty. People’s needs were met whether they were in communal areas or being cared for in bed.

Staff recruitment and induction practices were safe. Relevant checks were carried out to ensure that suitable staff were recruited.

Medicines were stored and administered safely. Records in relation to medicines were accurate and staff had received training in medicines administration, and had their competency checked regularly.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

The provider did not always take appropriate action if people were not eating in line with their assessed needs. Some people were choosing not to eat but it was not clear that the provider had considered all options available.

Most people were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. For lunch a main meal was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.

People

The inspection took place on 12, 17 and 18 November 2015 and was unannounced.

The Lawn Residential Care Home provides accommodation for up to 31 older people, some of whom may also be living with dementia. The home is situated in the village of Holybourne and is a period house which has been altered and extended for use as a care home. There is access to landscaped gardens and grounds. At the time of our inspection 31 people were using the service.

The Lawn Residential Care Home had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were not enough staff on duty to meet the needs of people using the service. When we arrived for our inspection three staff instead of five were providing care and people were distressed and upset at having to wait for breakfast and personal care. Recent changes in staff employment contracts had unsettled staff causing some staff to leave and leading to a rise in the use of agency staff. People told us they did not like agency staff providing their care because they did not know their individual needs. There was no formal method of ensuring that agency staff were informed about people's individual care needs.

There was an atmosphere of uncertainty in the home. People told us they were unsettled and distressed about recent changes and the numbers of staff leaving the home, which had impacted on their care and welfare. There was a general feeling from people of unrest. They felt that too many changes were happening too quickly and that the home didn’t feel like a community.

A range of tools were used to assess and review people’s risk of poor nutrition or skin damage such as Malnutrition Universal Screening Tool (MUST) and Waterlow. However, the provider did not always identify risks or take actions to mitigate risks, for people. The provider had not assessed the risks associated with ongoing building work in the home.

There was a risk that records in relation to medicines administration were not accurate. People were left medicines to take and staff did not check if they were taken or record which member of staff left the medicines with the person. One person did not receive a blood test in a timely manner. The blood test was required to ensure they were receiving the correct dose of their medicine. There was a risk they did not receive the correct dose.

People were not always safe. Not all staff had received safeguarding training or knew how to report safeguarding. One person was living under Deprivation of Liberty Safeguards (DoLS) was not kept safe.

People were asked for their consent before care and treatment was provided. A member of staff gave examples of how they sought permission to provide care. However, where people lacked capacity to make specific decisions, the provider did not act in accordance with the principles of the Mental Capacity Act 2005 (MCA), by ensuring that people gave valid consent for care and treatment. Appropriate DoLS applications may not have been made. There was a risk that people were deprived of their liberty without the relevant authority.

Staff had completed an induction and a probationary period of employment, to ensure they knew how to provide effective care for people. However, fire safety training was out of date and staff had not received appropriate support through supervision meetings and appraisals. Staff did not receive appropriate support from the provider to ensure they effectively carried out their role.

Menus demonstrated that a balanced diet was offered and people were supported to eat and drink sufficiently. People were served food which met their assessed dietary needs.

People w

We inspected The Lawn Residential Care Home on 22 July 2014. During that inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

We found the service to be safe, caring, responsive and well led, however we found that training and supervision was not up to date.The provider sent us an action plan to demonstrate how they would address the issues found. On 5 February 2015 we re-inspected The Lawn Residential Care Home to assess whether compliance had been achieved.

This is a summary of what we found-

If you want to see the evidence supporting our summary please read the full report.

We reported on only one of the five questions.

Is the service effective?

We found there were effective systems in place to ensure that staff received regular training updates and had regular supervision meetings and annual appraisals. Staff told us they felt supported in their role.

We visited this service to check medicine management systems.

We spoke to people about their medicines, they told us that they were happy with how their medicines were handled.

Below is a summary of what we found. The summary is based on our observations during the inspection, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

Is the service safe? We found that people's medicines were handled safely.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of the inspection there were 28 people using the service. As part of this inspection we spoke with four people, two healthcare professionals who were visiting the service, the registered manager, and five staff. We also reviewed records relating to the management of the home which included, three people’s care plans and daily care records.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service to be safe as there were arrangements in place to ensure that it had been cleaned properly. People told us “Oh yes, it is well cleaned.” Guidance and appropriate equipment was available to staff to ensure that a good level of cleanliness was maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People who used the service all had capacity to decide where they wanted to live and there were no restrictions on them leaving the service as they wished. While no applications have needed to be submitted, proper policies and procedures were in place.

Is the service effective?

People had a positive dining experience. There was a range of choices available to people and the food was presented in a way that supported people’s independence as they could choose the amounts they wanted to serve themselves. Lunchtime was a sociable time with people chatting to each other. People told us that the meals were not as good as they had been due to the temporary absence of the new chef. However, the chef was due to return to the service imminently.

The service had met people’s care needs effectively. One person told us “Yes, staff understand my care needs.” People had care plans in place to address their identified needs and they had been involved in planning how they wanted their care to be provided. Where risks had been identified for people measures had been taken by the service to manage these.

However, we were not fully assured of the effectiveness of the service in relation to the completion of appropriate training to enable all staff to deliver care and treatment safely and to an appropriate standard. The registered manager told us that all staff had completed their e-learning induction and were up to date with the providers required e-learning. However, the provider had experienced issues with their e-learning training provision. It had not always captured what training staff had completed. As a result we were unable to establish what training staff had actually completed and if staff had any training outstanding. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting workers.

Is the service caring?

We spoke with people who told us “Staff are kind” and “Staff are very good they look after me.” We found that the service was caring as we observed that staff were warm in their interactions with people. They did not rush people and were sensitive to their needs. Staff spoke with people respectfully and used their preferred terms of address.

Is the service responsive?

We found the service to be responsive. In people’s care plans and records we saw the service had made referrals to outside age ncies promptly in response to people’s changing needs. One person told us “Oh yes, staff are very good” and “If my needs change staff are responsive.” We spoke with visiting health professionals who told us that the service was “Responsive in reporting issues.”

Is the service well-led?

We spoke with people who told us that they felt that the registered manager was approachable. One person told us “Yes, we can make comments.” We found that people’s views on the service had been sought both through formal surveys and meetings and through regular informal feedback. Their feedback had been noted and action taken in response to their comments.

Audits of the service had been completed. There were regular provider visits to ensure that the provider had an overview of the quality of the service provided.

There were not enough qualified, skilled and experienced staff to meet people’s needs. We identified an issue within the home relating to long term sickness and staff taking sick leave at short notice. The provider was often unable to cover sickness as they were operating with three care staff vacancies and they did not use agency staff. The registered manager often worked care shifts to cover sickness which meant she didn't have time to carry out her management responsibilities.

People were not protected against the risks of unsafe premises because the risk of legionella and asbestos had not been managed within the building. The Health and Safety Inspector from East Hampshire District council has issued Improvement notices in relation to the management of legionella and asbestos and has placed a prohibition order on a lift due to insufficient emergency lighting.

People were not protected against the risk of unsafe care because there was not an effective system in place to manage risks. The provider had identified risks in relation to legionella and asbestos but had not taken appropriate actions to mitigate those risks.

When we visited there were 27 people using the service. We spoke with the registered manager, two members of staff and two people who used the service. We observed interactions between staff and people living in the home. We also reviewed three care plans, two daily records and two staff personnel files.

People were asked for their consent before care was given. People told us that staff always asked for their consent and respected their wishes.

People’s needs were assessed and care was delivered to support people’s safety and welfare. Staff had a good understanding of people’s needs and people’s care was reviewed and updated regularly. We spoke with two people who used the service. They were both happy with the service and felt that the service met their needs with comments such as “Couldn’t be better,” “they are so good, you only have to ask.”

We found that medicines were stored safely and that arrangements were in place to ensure they were administered safely. We reviewed the medication administration procedure and the medicines records.

We found that appropriate checks were carried out before staff were able to start work. We spoke with two staff who told us that a criminal records check was carried out before they commenced employment. We saw records of this.

The service had several effective systems in place to monitor and improve the service being provided.

During this visit we spoke with five people who used the service, three members of staff, the deputy manager and the registered manager.

The people we spoke with confirmed that they received the care and support that they needed, in the way that they wanted it to be provided. They told us they were involved in the reviews of their care plan and were asked their views by staff. One person told us the service had been “a great help to me”. Another person told us that their health had improved since coming to live at the home.

People we spoke with were confident that staff had the appropriate knowledge and skills to meet their needs and made positive comments about the professionalism of the staff. For example, one person remarked “always a smile and a cheery word, never heard one of them ever grumble”. People told us that they felt safe and that staff treated them well.

People were asked for their views about their care and support and they were acted on. One person told us about regular meetings with the management where “as a rule they have answers to the things that were raised at the meeting before”. The person said that these meetings were a “regular opportunity to express your views if you wish”.

During our inspection on 13 August 2013 we found that people were not protected against the risks of unsafe premises and were not protected against the risks of unsafe care because there was not an effective system in place to manage risks. We found that the provider was not able to respond to changing circumstances such as sickness which meant that there were not enough staff to meet people's needs.

As a result of our inspection we issued the provider with two warning notices and a compliance action. There was a requirement to be compliant by 4 October 2013. The provider responded with an action plan telling us what actions they were taking to address the non compliance. On 17 and 28 October 2013 we carried out further inspections of the home to assess whether the home was compliant.

The risk in relation to unsafe premises had been reduced because the provider had engaged contractors to carry out remedial work and actions identified in the 21 June 2013 legionella risk assessment. We spoke with the contractors during our inspection on 17 October. They were able to provide documentary evidence in relation to all the improvements that had been made to the water system since our last inspection on 13 August 2013.

We found that there were enough staff to meet people's needs even though we found that an unsatisfactory sickness culture still remained within the home. This was because the registered manager had worked hard to ensure that all shifts were covered. This meant that people who use the service were not affected by the staffing difficulties. We spoke with six people who use the service. They all said that staff were meeting their care needs and always came promptly whenever they used the call bell.

The provider had made improvements to their systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. A water management policy and procedure had been produced and circulated. Further risk assessments in relation to legionella and asbestos had been commissioned and actions taken to address the identified risks.