We carried out this unannounced inspection of The Lawns on 18 October 2016. The last inspection of The Lawns took place on 7 January 2014. The service was meeting the requirements of the regulations at that time. The Lawns provides nursing and residential care for up to 31 people some of whom are living with dementia. Bedrooms were situated on the ground and first floor and there was a stair lift and passenger lift available. The home is situated in the small town of Brixton on a main road on the outskirts of Plymouth and close to public transport networks. At the time of the inspection there were 29 people living at the 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.

We looked at how medicines were managed and administered. We found people were receiving their medicine as prescribed. However, the first administration round was observed to take most of the morning to complete. This was because some people needed more time and support to take their medicines. The nurse responsible told us “Some days are quicker than others”. The registered manager had made arrangements for pain relief and other essential medicines requiring administration in the morning to be administered at 7am. This meant people were having their medicines when they needed it. Records showed these medicines had been administered at the times prescribed. Regular medicine audits took place to identify they were being administered as prescribed and were safe.

At the time of the inspection work was taking place to repair a boiler which had affected the supply of hot water in parts of the home. Staff were managing to work around this and there was limited disruption. Staff were able to use alternative measures to heat water and the contractor confirmed the repairs would be completed in the next few days.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices.

Staff were visible in all areas of the service throughout the day. There were enough staff to spend time with people in addition to providing personal care. People told us “Never have to wait long before someone comes” and “They look after me well.”

Some people had complex needs and were not able to tell us about their experiences, but other’s told us they were very satisfied with the care and support they received living at The Lawns. Relatives told us, “They (people using the service) are being looked after very well” and “They (people using the service) are being amazingly well looked after.”

People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure people’s safety. Care records included details of people’s choices, personal preferences and dislikes.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

Staff were supported by a system of induction training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training, support and development.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisio

Our inspection of 23 June 2013 found that staff were not being appropriately supported and trained. We requested a date when they would have put this right. They told us that they would have achieved this on the 30 December 2013. We visited again on 7 January 2014 to ensure this was the case.

We also reviewed the staffing of the home as we had received information that there was not always enough staff on duty to meet people’s needs.

We spoke with four people and one visitor when we visited. We also spoke with the registered manager and six members of staff.

We found that there was enough staff to meet people’s needs and the staff were being supported and trained in their role. This meant people were being supported by enough trained and qualified staff.

We inspected the home on a Sunday. We spoke with eleven of the twenty seven people who were resident at The Lawns on the day of the inspection. Some of the other people were not able to speak with us due to their health needs. We were also able to speak privately with some people’s relatives.

Everyone we spoke with was very impressed with the care they received at the home. Everyone made positive comments regarding their support and the staff. Comments included “I could not wish for a better place…it is very comfortable here,” and “We are very well looked after, the staff are exceptional.” We observed the staff on duty as polite and friendly. People said the food was good, and they were provided with drinks throughout the day. People said if they had a complaint the management would respond to these appropriately.

Accommodation was furnished, decorated and maintained to a good standard and the home was very clean and odour free. The medication system, health and safety standards and quality assurance systems were maintained satisfactorily.

Staff recruitment checks were satisfactory. We received some minor concerns from people who used the service that at times staff were over stretched and there “could be a few more staff,” however overall we judged staffing levels as satisfactory. Improvement was required to staff training and staff supervision arrangements.

We (the Care Quality Commission) carried out this inspection as part of our scheduled inspection programme.

We talked with eight people who lived at the home. All of the people we spoke with said that they felt safe; they told us they were treated with dignity and respect by all of the staff. People were all very complementary about the staff at the home and the care they received. Comments included “it’s very nice here, the staff are very kind, I could complain if I needed to , but I don’t need to”, ”we have everything we could want” and “they (the staff) are a lovely lot of girls”.

Everybody we spoke with, were happy with the standard and choice of food served.

We looked at the care records for three people, we met with them and observed staff providing care. The care records were an accurate reflection of the care we saw being provided.

People using the service and staff told us that they felt there were sufficient staff on duty to meet people’s needs. Staff told us they felt sufficient staff were on each shift. We spoke with five staff who all told us they enjoyed working at the home.

Systems were in place and efforts had been made by the registered manager to monitor the service and address any problem found.

People said they were happy with the care they receive at The Lawns; they said the staff were "very good"," very kind" and when asked they said they felt safe.