This inspection took place on 25 October 2018.

At our last inspection on 25 November 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Lavender Fields - Care Home with Nursing is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The registered manager was registered for two locations both these locations were on the same site. Service users, used both facilities for socialising and activities. Each location had a deputy manager in place.

Lavender fields design enabled good access for wheelchair users. Communal areas included: Lounge, kitchen dinner, study/activity room and a sensory bathroom. All bedrooms were of a good size and decorated to people's taste. All bedrooms had an en-suite facility.

The service was safe. Staff received training about safeguarding and were competent to report any concerns they had. Safe recruitment practices were in place to employ suitable staff. There were enough staff to deliver support at a time people wanted. Care plans contained good risk assessments with appropriate guidance for staff. People were supported to take their medicines safely by competent staff. Staff understood the importance of good infection control.

The service was effective. New staff completed induction and training to meet people’s needs effectively. Staff had access to regular supervision and meetings. The registered manager, deputy manager and staff worked in line with the Mental Capacity Act 2005 (MCA) principles, staff understood the importance of promoting people’s choice. People’s care needs were assessed and supported people’s preferences. Staff supported people with their nutrition and hydration needs. People were encouraged to cook and be involved in their daily support.

The service was caring. Staff knew people well and staff cared for them in a compassionate way. Staff respected people’s privacy and dignity and supported people to maintain relationships. Staff delivered care that was supportive, kind and caring. People were involved in deciding how their care was provided.

The service was responsive. People`s needs were assessed to ensure people received the support they required. Staff used a variety of techniques to communicate and support people’s independence and ensure people had a voice. People were supported to raise concerns and complaints if required. People and relatives where appropriate, confirmed they were involved with care reviews.

The service was well-led. Staff understood their roles and responsibilities. The registered manager was clear about their vision and values for the service and what they wanted to achieve. There were effective systems to monitor the quality of the service, identified issues were actioned. Regular surveys and quality checks were completed to ensure people’s views were sought.

Our previous inspection of Lavender Fields in March 2013, found that certain minimum standards of quality and safety had not been met. People had not always been involved in planning their care or had their privacy respected. People’s needs had not been properly assessed or reviewed and medicines had not been managed effectively. We also found that systems had not been put in place to identify and manage risks. We judged that these had a minor impact on people who used the service at the time.

During our inspection on 20 August 2013, we found that necessary improvements had been made. Records we looked at showed that people had been involved in the planning and delivery of their care.

One person told us, “Care plans are a good idea and I enjoy getting involved.” Another said, “I love living here, it’s great.” We saw that staff delivered appropriate levels of care and treated people with respect and kindness.

The provider had put improved systems in place to ensure that medicines were managed safely and the quality of services provided could be assessed and monitored on a regular basis.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

During our inspection on 22 March 2013 we spoke with three people who used the service and five members of staff. Many of the people who used the service were either out at school or at other activities. We saw that the rooms were personalised to each person.

We found that the service could not evidence how it used people's involvement and views in the delivery of the regulated activity. We also found that people's dignity and privacy was not always respected.

We saw that care was not always assessed to protect people from harm. One person told us they liked living there. When asked if they were happy they said, "Yes."

We found that medication was not managed in a way that minimised risks and was not in accordance with the services policy. We saw that staff were supported and had regular training. This included the opportunity for further development. We saw plans for a 'healthy eating' training month.

We found that the service did not have effective systems in place to monitor the effectiveness of the service provided to people.

The inspection took place on 19 and 25 November 2015 and was unannounced. Lavender Fields provides accommodation with nursing care for up to 10 young adults who live with physical and learning disabilities. At the time of our inspection seven people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the provider worked within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of our inspection we found that nobody who lived at the home had been deprived of their liberty and so DoLS applications and authorities were not required.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their family’s access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.