Lavender House is a care home that provides care and support for up to 18 people living with past and present mental health needs. The service did not cater for people with high physical dependency but did support people with some additional health needs including diabetes and physical disabilities including sight loss.

At the last inspection, the service was rated Good. At this unannounced inspection we found the service remained Good. This inspection took place on 30 October 2017 and 17 people were living in the service.

The service had 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.

Systems for effective management had not been fully established in all areas. Management systems that included quality monitoring did not always ensure safe and best practice was established and followed. For example, the care documentation did not reflect the care and support required in all areas. Audits were not established to identify risks in all areas for example, to respond and minimise the risks associated with infection control. The service’s policies and procedures were not all comprehensive, up to date or embedded into practice to support best practice. For example, recruitment practice did not follow a robust and effective procedure. These areas were identified as requiring improvement.

People were looked after by staff who were genuinely empathetic and understood people’s individual needs well. Staff had a very caring and professional approach and supported people to maintain their independence and psychological welfare. People’s dignity was protected and staff were respectful. All feedback received from people and visiting professionals was very positive about the care, the atmosphere in the service, and the approach of the staff. Visiting professionals held the registered manager and staff in high regard, praising their commitment to supporting people in a facilitating way.

People’s medicines were stored, administered and disposed of safely by staff that were suitably trained. People were protected from the risk of abuse because staff knew how to recognise and report any safeguarding concern. Staff were trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and knew the correct procedures to follow in order to protect people’s rights.

Staff were provided with a training programme which supported them to meet people’s needs. Staff felt well supported able to talk to any of the management team including the provider. On call arrangements ensured suitable management cover. Staff were motivated and worked well together and were able to undertake professional development as they wished. Staff were listened to and valued with their views taken into account when planning care and developing the service.

People were supported to be involved in a variety of activities this included one to one time with staff, shopping and socialising. Staff recognised the importance of family and friends and worked hard to re-establish and maintain important contacts with these. People had enough to eat and drink and their nutritional needs were well assessed and monitored when needed. People enjoyed a range of nutritious food and drink throughout the day and were able to help themselves to drinks and snacks.

Staff related to people as individuals and took an interest in what was important to them. They took time to establish effective communication with people. In this way they ensured they worked with people to maintain and improve their health and to promote their independence. People’s choices and

We inspected Lavender House on the 7 September 2015. Lavender House is a residential care home that provides care and support for up to 18 people living with past and present mental health needs. On the day of the inspection, 18 people were living at the home. The age range of people living at the home varied between 40 – 70 years old. Predominately people required support with their mental health, support was also needed in relation to diabetes, sight impairment and physical healthcare needs.

Accommodation was provided over three floors. A lift was in place, but was decommissioned and not used by anyone living at the home. Everyone living at the home could safely use the stairs. Located in Hove, the home provides access to the city centre and seafront. There is good access to public transport which was regularly used by people living at Lavender House. During the course of the inspection, people were seen coming and going independently, going out with staff and spending time in the home’s garden. People spoke highly about living at the home. One person told us, “We all get along like one big happy family.”

There was 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.

At the last inspection in August 2014, we asked the provider to take action to make improvements in the management of medicines and the quality assurance systems of the home. This was because the stock levels of medicines were not consistently checked and prescription medicines were not always administered in the presence of two care staff. The provider had also not identified essential training that staff required to provide effective mental health care. The provider was in breach of Regulations 10 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 now Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. An action plan had been submitted by the provider detailing how they would be meeting the legal requirements by 27 February 2015. At this inspection, we found improvements had been made and the provider was no longer in breach of the Regulations.

People and staff felt the home was sufficiently staffed. One person told us, “There is always staff around.” One staff member told us, “There is definitely enough staff.” The provider was in the process of implementing measures to demonstrate that one member of staff at night to 18 people was safe and the home could safely be evacuated in the event of a fire at night.

There was strong leadership at Lavender House. The registered manager communicated a strong ethos focusing on person centred care and ensuring a good quality of life for the people. Staff told us they felt valued and appreciated for the work they did by the management team. The home promoted a culture whereby people were recognised for their individuality and a calm and relaxing environment was maintained.

Staff received training to help them undertake their role and were supported through regular supervisions and appraisal. Staff had training in working with the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff had a strong understanding of what good mental health care consisted of. One staff member told us, “It’s about empathy and knowing the person.”

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept records that were accurate. People were also supported to self-administer their medicines independently.

A collaborative approach to managing risk was fostered with staff, the provider and registered manager working in partnership with people to manage behaviours that challenge. Staff recognised the importance of promoting people to take positive risks and the provider adopted an overall positive approach to risk taking whereby staff enabled people to live independent lives with minimal restrictions.

A person centred approach to safeguarding was adopted. Staff worked in partnership with people to ensure peopled lived free from harm and abuse. The registered manager encouraged a firm focus on prevention with specific risk assessments in place identifying any possible safeguarding concerns. When safeguarding concerns were raised, staff worked in an anti-oppressive manner (manner which acknowledges oppression), gaining the views of people and ascertaining what outcome they wished to achieve from the safeguarding. All possible associated risks were explored and mitigated.

People’s equality and diversity was respected and upheld. Staff called people by their preferred name and people were encouraged to treat the home as their own. People were seen opening the front door to visitors and spending time how they wished. Staff understood the importance of respecting people’s dignity. Staff knocked on people’s bedroom doors and recognised that it was their private space. The provider recognised the importance of animals and how animals can bring companionship to people. One person had their cat with them which provided them with comfort and reassurance.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

People were supported to make sure they had enough to eat and drink and their nutritional needs were met to ensure they stayed healthy. They told us they enjoyed the food prepared at the home and had a choice about what they ate.

People were encouraged by staff to be independent, and maintain hobbies and interests that were important to them. People were supported and encouraged to access their communities. One person told us, “I went out to a dance last Friday with the manager.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Lavender House is a mental health care home for up to 18 people. It provides care and support to people who have experienced long term mental health needs. At the time of our inspection there were 18 people living at the home. People spoke highly of Lavender House and everyone we spoke with had positive comments. One person told us, "I don't want to leave." Another person told us, "Staff are amazing, and they look after me well."

Accommodation was provided over three floors. The ground floor comprised the lounge, kitchen, conservatory, clinical room and people’s bedrooms. The second and third floor consisted of people’s bedrooms. We spent time observing staff interactions with people on the ground floor.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Staff had not received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had very little understanding of legal requirements under MCA and DoLS. When discussing what may constitute a deprivation of liberty, staff confirmed they required further training. We have asked the provider to make improvements in this area.

People’s medicines were stored safely and in line with legal regulations. However, staff were not completing stock checks of controlled drugs. Classified medicines were not being administered in the presence of two care staff. Therefore, good practice guidelines as set out by the National Institute for Health and Care Excellence were not being followed. We have asked the provider to make improvements in this area.

Staff felt supported by management and the provider. However, we found that following any incidents of verbal abuse or physical harm at work, staff were not offered the opportunity of counselling. We brought this to the attention of the registered manager who acknowledged our comments and agreed that outside counselling could be obtained.

Each person had a care plan that outlined their needs and the support required to meet those needs. Care plans included information on the person’s communication skills, money management, family connections and hobbies and interests.

People were actively involved in their care. At each care review, a short term goal would be set. This included the action the person would take to meet the goal, and the action taken by staff to help the person achieve their goal. People commented they were aware of their care plans and felt involved in decisions about their care and treatment,

Risk assessments were developed and reviewed on a regular basis. Assessment of risk included risk of violence, suicide and self-neglect. The provider had explored possible triggers and the behaviour of the person. Guidance was available to staff on how to manage behaviour that could be challenging in nature.

Staff treated people with dignity, kindness and compassion. Observations of care clearly found staff had spent time with people and gained an understanding of their personal history, background and a built rapports with them. People were happy on the day of the inspection, we saw them approach staff freely and there was friendly chatter and joking between the people and staff. People spent time on their own or with staff as they chose. Throughout the day, people presented as comfortable and content in the company of care staff.

People were encouraged to take day to day risks and live autonomous and independent lives. People were seen freely coming and going from Lavender House. One person told us they were off shopping. Another person was supported to go into town with a member of staff.

People were encouraged to bring furniture and items of importance. With pride, people showed us their bedrooms. One person told us, “I’ve got my cat here with me which I love.” Lavender House encouraged people to see it as their own home. People could lock their own room and have their own privacy. Access to the internet was available and staff supported people with online shopping. People commented they could cook their own meals if they so wished and enjoyed spending time in the garden and conversatory.

Staff received regular supervision to discuss any concerns or make suggestions. People were provided with the opportunity to express their opinions about Lavender House. This information was used to improve the running and quality of the service provided.

The registered manager and provider met on a weekly basis to discuss the running of Lavender House. Every three months, they would complete a management review which considered all aspects of Lavender House and any changes that were required to be made. The provider interacted with people during their weekly visits. During the inspection, we observed the provider had clearly built rapports with people and provided support when necessary. Discussions with the registered manager and the provider demonstrated they clearly understand the strengths and weaknesses of Lavender House and had a clear vision of what they wished to improve.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spent a day at Lavender House. We spoke at length with four people who lived in the home. We spoke with an experienced support worker, a recently appointed support worker, the manager and deputy manager. We looked at care plans and records for the people we spoke with.

People were involved in the planning of their care and support. One person told us “what I’ve got here is what I’ve agreed to; they check with us they’re doing what we want.” People agreed short-term plans so at any time the support they received was focussed on goals they wanted to achieve, such as going out more or increasing independence in different ways.

There was evidence of close working relationships between the home and community mental health and primary care services.

All people we spoke with said they felt safe living in the home. One said “Yes, that’s why I like it. It’s a calm place, you live your own life but get all the help you need.”

Medicines were administered only by staff who had been trained in safe handling of medicines. People told us they received medicines reliably on time, and in private. They had a good understanding of what their medicines were for. There were no individual protocols to demonstrate safe decision making about the use of ‘as required’ medicines and there was no formal system for periodic checking of staff competency in handling medicines.

The provider visited the home every week. People living in the home and staff appreciated this and told us they found the provider very supportive. We saw the management found out about people’s views of the home by regular surveys, meetings and through everyday communication. They showed they were responsive to what people told them.

There were 17 people who used the service at the time of our inspection. We used a number of different methods to help us understand their views and experiences. We talked to four people who used the service. We observed the care provided and looked at supporting documentation. We spoke with one member of care staff, the manager and the provider.

We saw that people had been involved in making decisions about their care and treatment. Records showed that people’s care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. People told us they were happy living at the home. They told us they could be independent and that staff respected their choices. They told us that they were free to live the life that they chose. We found that people had a greater opportunity to exercise choices than at our last inspection.

People who use the service were protected from the risk of abuse and told us that they felt safe at the home. Improvements to the home had been ongoing. One person commented, “I have a lovely room it is cleaned and polished once a week. The place has been refurbished and is very smart. I have a new carpet in my room".

The staff were well trained and demonstrated a good knowledge of people's needs. People who used the service said that staff provided them with all the support and assistance that they needed and wanted.

There were systems in place to identify, assess and manage risks to people who used the service.

People told us that they were happy living at the home. They said that they could be independent and that staff respected their choices. They told us that they were free to live the life that they chose.

People considered that their support needs were met. They were satisfied with the staff and the care and support that they provided.