About the service: Lavender House is a residential care home that was providing personal accommodation for up to 32 older people, including those with dementia related conditions. At the time of inspection 16 people were living at the service.

People’s experience of using this service: There had been significant improvements in the service since the last inspection, however work was still required to improve practice in key areas such as risk management. Systems to check that people were receiving safe and good quality care required further development. The provider had not always notified CQC about important events that happened in the service.

Risks to be people had not been effectively reduced and mitigated.

Improvements had been made to the environment. Decorative work had been carried out, and the environment was more ‘dementia friendly’. Infection control procedures were followed. There was adequate staff to meet people’s needs.

People told us the food was of good quality, however further work was required to enable people to make choices regarding their meals. People told us staff were kind and caring. We observed activities taking place. People were supported to access health care.

People and their relatives were engaged with and included in service delivery. We received positive feedback about the registered manager.

Rating at last inspection: Inadequate. (The last report was published 10 October 2018.) This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: The provider was in continued breach of two regulations at this inspection relating to risk management and governance of the service. You can see the action we have told the provider to take at the end of the full report. A third breach about failing to notify the Care Quality Commission of events in the service is being dealt with separately.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Lavender House 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. The home is registered to provide personal care and accommodation for up to 32 older people, including those with dementia related conditions. It is located in Brough, in East Yorkshire. At the time of our inspection there were 20 people living at the service.

This inspection took place on 31 July 2018 and was unannounced.

At the last inspection in June 2017 we rated this service ‘requires improvement’. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were regulation 15 (premises and equipment) and regulation 17 (good governance). These were continued breaches from a previous inspection in April 2016. During this inspection we have identified continued breaches in regulation 15 and 17 and identified new breaches in regulations 9 (person-centred care), 10 (dignity and respect), 11 (need for consent), 12 (safe care and treatment) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 (notifications) of the Care Quality Commission (Registration) Regulations 2009. This is the third-time breaches of regulation 15 and 17 have been identified and the overall rating of this service is ‘Inadequate’.

The service is required to have a registered manager in post. A registered manager is a person who has registered with 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. At the time of the inspection there was no registered manager in place. We met with a newly appointed acting manager and the registered provider during the inspection.

Maintenance of the building was poor and not completed in a timely manner. A garden area for people to access was unsafe; building materials, rubbish and broken equipment surrounded the service and created a risk to people, staff and visitors to the service. Ceilings were stained and a bathroom had tiles missing on walls. People were left with broken lights, toilets and window chains for weeks before repairs were completed.

Infection control measures continued to be insufficient to prevent the risk of inspections spreading. Bathroom floors were not sealed at the edges to allow adequate cleaning. We found dust and dirt throughout the building. This is the third consecutive time infection control concerns have been raised with the provider during an inspection.

The systems which the provider had in place to assess the experience of people receiving care had not identified the extent of concerns we observed during our inspection. There had been a failure to rectify the failings identified during our last two inspections and this meant people received inadequate care and support in line with our regulations.

Measures required to reduce the risk of harm to people were in place but they were not always completed accurately or were up-to-date. Medicines procedures and systems were in place; however, some improvement was required to ensure medicine practices were safe.

People’s care plan reviews were not always effective at recognising a change in people’s needs. Relatives told us they had not been invited to be part of reviews. As a result, care plans failed to reflect people’s person-centred needs. Daily notes were found to be repetitive and failed to accurately reflect how care was provided in line with the person’s care plan.

Some interaction with people using the service was observed to be 'task' focused. The staff were very busy during the inspection and the newly appointed manager was sti

The inspection took place on 7 June 2017 and was unannounced. When we last inspected on 27 April 2016 we found breaches of legal requirements in Regulation 12, Regulation 15 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The breaches related to the safety of the premises and equipment, the premises not being properly maintained, not having adequate outdoor space that people using the service could safely use and the quality monitoring systems not identifying where improvements were needed. We received an action plan from the provider saying that improvements would be completed by June 2017.

We saw that some of the improvements had been made but found continuing breaches of Regulation 15 and Regulation 17 of the Health and Social Care Act 2008(Regulated Activities) 2014. This was because the environment was not properly maintained and had no secure outdoor space for people. This was important as the service was positioned close to a busy main road and some people were living with dementia. In addition record keeping was not consistent and areas for improvement had not been identified which meant that the service was not learning from past issues and making improvements. We have asked the provider to send us a risk assessment of the environment and an action plan to show us how they are going to address these matters using our powers under section 64 of the Health and Social Care Act 2008.

Lavender House is a care home in the centre of Brough which provides accommodation for up to 32 older people, some of whom are living with dementia. At the front of the house there is a grassed area and car parking. An extension to the service is in progress.

There was a registered manager employed at this service. 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. Throughout this report we will refer to the registered manager as ‘the manager’.

There were safeguarding policies and procedures in place which staff were aware of. Staff had received training to support those procedures.

Risks to people's safety had not always been identified. There were areas such as the outside of the building that were not safe. Accidents and incidents had been recorded in detail and analysed with trends identified.

Staffing levels were sufficient to meet people's needs. Recruitment procedures were robust. Staff had the skills and knowledge to meet people's needs. They were supported through one to one supervisions.

Medicines were managed safely.

The staff worked within the principles of the Mental Capacity Act and requested that deprivation of liberty safeguards be put in place where appropriate.

People's nutritional and hydration needs were met.

People were familiar with the building but it was not adapted for those people living with dementia. This would have more of an impact for new people to the service.

We observed many positive interactions between staff and people who used the service. People told us that staff treated them with respect.

Care plans were focused on the person but were not always fully updated following reviews.

Activities took place at the service but there were few meaningful activities for people living with dementia.

There had been no complaints about this service since the last inspection. There was a poster displayed telling people how to complain if they wished to do so.

The home was friendly and close knit. Staff were happy working at the service. There was clear evidence of partnership working particularly with healthcare professionals.

Lavender House is situated in the centre of Brough and provides accommodation and personal care for up to 32 older people, including people who may be living with dementia. There were two lounges, one with dining space, and four bathroom facilities, although only one bathroom was in use on the day of this inspection. A passenger lift provided access to the upper floor. At the front of the house there were unsecured gardens and car parking was available.

This inspection was carried out on 27 April 2016 and was unannounced. One Adult Social Care (ASC) inspector carried out the inspection. The service was last inspected in December 2013 and the service was found to be compliant in all of the standards apart from requirements relating to infection control. This was followed up in March 2014 and the service was found to be compliant.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager 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 2008 and associated Regulations about how the service is run.

We found that the services premises and equipment were not always safely maintained. A bath chair was found to be in an unsafe condition and annual maintenance checks had not been completed for the fire alarm, emergency lighting and the bath chair. This was a breach of Regulation 12. You can see what action we told the provider to take at the back of the full version of the report.

We found that the premises were not properly maintained and did not have an adequate outdoor space that people using the service could safely use. This was a breach of a Regulation 15. You can see what action we told the provider to take at the back of the full version of the report

We found the registered provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support. However, we found it had failed to detect that several maintenance certificates had expired, that equipment was broken and that parts of the premises were not adequately maintained. This was a breach of a Regulation 17. You can see what action we told the provider to take at the back of the full version of the report

We found that staff had a good knowledge of how to keep people safe from harm and there were enough staff to meet people's assessed needs. Staff had been employed following appropriate recruitment and selection processes and we found that the recording and administration of medicines was being managed appropriately at the service.

We found assessments of risk had been completed for each person and plans had been put in place to minimise risk. Apart from the services only bathroom, other areas were clean, tidy and free from odour and cleaning schedules were in place.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the home deemed essential, such as, safeguarding, moving and handling and infection control and also service specific training such oral care, person centred care and end of life care.

The registered manager understood the Deprivation of Liberty Safeguards (DoLS) and we found that the Mental Capacity Act 2005 (MCA) guidelines had been followed. The home did not use restraint, and this was confirmed during conversations with staff.

People's nutritional needs were met. People told us they enjoyed the food and that they had enough to eat and drink. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day.

People told us they were well cared for and we saw people were supported to maintain good health and had access to services from he

When we inspected the service in December 2013 we found there were inadequate systems in place with regard to infection control to ensure the safety of people that used the service. When we inspected the service in March 2014 we found that some changes and improvements had taken place.

We saw that there had been improvements in the cleanliness of the general environment and in the care practices of the staff. This meant people had experienced improvements in reducing the risks of infection from cross contamination or poor hygiene practices.

People were satisfied with the standards of cleanliness and the service of care they received.

We found that people were satisfied with the service of care they received and so we assessed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. They said, "I am fine", "I'm happy here, the girls are lovely", "Oh yes I am quite satisfied with everything" and "I am very satisfied".

We found that peoples' health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in cooperation with others and shared information in the form of specific documentation.

We found that people were not properly protected against the risk of infection from poor hygiene and cleanliness within the service because the provider had not ensured good infection control practices were carried out. We had some concerns about cleanliness of the premises and staffing resources to enable good infection control practices to be followed.

We found that although there was sufficient care staff to meet peoples' needs there was poor deployment of care staff so that staff worked excessive hours. There was insufficient cleaning staff to ensure the service was tidy, organised, clean and meeting infection control standards.

We found from viewing documentation and speaking to people that used the service that the provider had an effective system to regularly assess and monitor the quality of service that people received.

We had made a compliance action in relation to regulation 13 'management of medicines' at our inspection on 22 January 2013. The provider had supplied an acceptable action plan and we visited the service today to assess compliance with the regulation.

We did not speak with people that used the service about receiving their medication and we were unable to observe medication being administered. However, we looked at medication storage, systems for administering, disposing of and recording of medication and we assessed the secure handling of controlled drugs. We found systems to be very well managed and recorded.

We found that staff had received updated training in medication handling and there had been a major re-organisation of the medication room. This resulted in people having their medication reviewed by their GP, all medication being stored in locked facilities, all excessive medication stocks being returned to the pharmacist and a complete clearance of unnecessary items from the medication room. Staff told us they had found the management of medication much easier and more organised since the clearance of the medication room and the reviewing of peoples' medication needs.

We spoke with six people that used the service, as well as the manager and a district nurse to obtain views about the care provided in the home. We also observed people being supported and cared for by using a 'short observational framework for inspection' (SOFI) and we looked at documents and records. We saw the lunch time meal being served, we carried out an audit of the medication systems in use and we observed a staff member administering medication to people.

We found that people were satisfied with the support and care they received, enjoyed the meal provision, interacted well with each other and staff and were treated with respect. People said, "The staff are lovely, they always help us when we need it and they do work so hard" and "I have lived here for quite a while now and I like it very much, I have some friends and the staff are very helpful." They said, "We are well looked after" and "I am given as much help as I need." A district nurse told us that the service took their advice and cared well for people.

We found, through use of the SOFI, that staff were caring and considerate. We found that there were some concerns regarding the handling and storage of medication, and we concluded that medication was not being administered safely and records did not account for when they had been administered or refused.

We found that staff had been safely recruited and that there was an appropriate system in place to address and resolve complaints.

We asked people if they made their own choices about daily living and they told us they did whenever possible. One person told us they needed assistance to get up in the morning and that staff had not been to help them early enough that day.

We did not discuss any of the outcomes directly with people, but we passed the time of day with them as we looked round the home. They were generally cheerful.

We spoke with two people about living in the home and they told us they felt they had been included in compiling their care plan and were asked each day about the support they required.

They told us they thought their privacy and dignity was respected.

People told us that their permission was obtained to be assisted with daily care and that the staff delivered care and support the way they preferred and wanted it. They told us the staff were very nice and helpful.

People told us they enjoyed the food and that the cook knew their likes.

They said they had good relationships with the staff and were quite happy at Lavender House.

We spoke with people about feeling safe in the home and they said the staff were very kind. They told us they had no concerns about the way they were treated and that they had not seen anyone else treated other than well.