This inspection took place on 28 March 2017 and was unannounced. This meant staff and the registered provider did not know that we would be visiting.

Lavender Court is a bungalow and provides care for up to 18 people. Bedrooms are single in nature and have en suite facilities which consist of a toilet and hand wash basin. There is one large lounge, a small part of which has been sectioned off to create a quieter area for people to sit and a dining room. The service is situated in Saltersgill and is close to shops, pubs, public transport and The James Cook University Hospital. At the time of the inspection 15 people were using the service.

At the last inspection on 2 and 21 January 2015 we rated the service as ‘Good’ overall but found improvements were required. Staff needed more training around the implementation of the Mental Capacity Act (MCA) 2005. We found the service in breach of regulations 18 (Consent to care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found that the team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

People and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring.

Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care settings. People’s medicines were managed safely. There were enough staff deployed to keep people safe. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received mandatory training in a number of areas, which assisted them to support people effectively, and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People were supported to be as independent as possible and had access to advocacy services where needed.

People and their relatives told us staff at the service provided personalised care. Care plans were person centred and regularly reviewed to ensure they reflected people’s current needs and preferences. People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

People and staff spoke positively about the registered manager, saying she supported them and included them in the running of the service. The registered manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

During the inspection we spoke with four people who used the service and two relatives. We also spoke with the unit leader and two of the care staff on duty.

The people we spoke with told us they were happy with care they receive. People told us they were involved in their care planning and able to make their own choices. One person told us, “I am quiet happy here, this is a new life here for me, and I can go out if and when I want to.” Another person said, “You get to know the staff, the home is small and friendly I like living here.” A relative we spoke with told us, “I am very impressed with everything here.”

We observed the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that staff interacted and communicated well with people. The staff were attentive and demonstrated knowledge and understanding of people’s needs.

We saw that people had their needs assessed and that care plans were in place.

We found that people were safeguarded against the risk of abuse.

We found that appropriate staffing was in place to deliver people’s care.

We found that systems were in place to deal with comments and complaints.

We inspected Lavender Court on 2 and 21 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Lavender Court is a modern purpose built single storey facility. The home provides care and accommodation for up to 18 older people. The home supports people who may be living with a dementia or experience memory loss. It has car parking to the front and enclosed gardens to the rear. It is close to the local facilities and bus routes.

The home had a registered manager in place and they have been in post for over five years. 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 had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training but were unclear about the requirements of the Act. We found that there was no information to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finances. No records were in place to show that staff completed capacity assessments where appropriate and made ‘best interest’ decisions. We found that some people had difficulty making decisions; were under constant supervision; and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, which are needed if people lack capacity to make decisions and these types of restrictions are made.

We found that the registered manager was being guided by the supervisory body and was waiting DoLS authorisations to be approved. The registered manager felt the guidance from the supervisory body instructed them to complete DoLS applications for all of the people who used the service, irrespective of whether the person lacked the capacity to make a decision. This was an incorrect interpretation of the MCA and DoLS authorisations can only be made for people who have a mental disorder, which has led to them being unable to make decisions about the care and treatment they receive. The registered manager recognised that further action was needed to ensure the staff understood how to apply the requirements of the MCA.

People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People told us that the staff worked with them and supported them to continue to lead fulfilling lifestyles. We saw where people were living with dementia, staff matched their behaviour to people’s lived histories (the time of the person’s life they best recall) and this enabled individuals to retain skills and work to their full potential.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. Four care staff were on duty during the day and two staff were on duty overnight. We found information about people’s needs had been used to determine how many staff were needed to support them.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained comprehensive and detailed information about how each person should be supported. We found that risk assessments were very detailed. They contained person specific actions to reduce or prevent the highlighted risk.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia and Parkinson’s disease. We found that the registered manager not only ensured staff received refresher training on all training on an annual basis but routinely checked that staff understood how to put this training into practice. Each month the manager questioned staff about different aspects of the courses and when staff struggled to find the correct answer they ensured staff received additional training.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. A designated infection control champion was in post and we found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. The registered manager had ensured people were supported to access independent advocates when needed. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

Regular surveys, resident and relative meetings were held and the registered manager also conducted a weekly surgery so people could drop in and speak with them. We found that the analysis of the surveys showed the majority of people believed the home delivered an outstanding service and this view was echoed in our discussions with people during the visit.

The provider had developed a range of systems to monitor and improve the quality of the service provided. We saw that the registered manager had implemented these and used them to critically review the service. This had led to the systems being extremely effective and the service being well-led.

We found the provider was breaching one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to adhering to the requirements of the MCA. You can see what action we took at the back of the full version of this report.