This inspection was carried out on 26 and 27 January 2017 and was unannounced.

Lavender House provides accommodation and personal care for up to 20 older people. Some people have dementia related needs. There were 19 people living at the service at the time of the inspection.

A registered manager was 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.

The service was last inspected in October 2015. At our last inspection, we found the provider to be in breach of two regulations. They were not meeting the required standards in relation to staffing and good governance and requirement notices were issued. At this inspection we found that the provider was meeting all the regulations and had made improvements to the areas identified.

People were positive and complimentary about the care provided at the home. The owner of Lavender House is also the registered manager.

We found that the service had made improvements to staffing levels and the way that staffing levels were determined. During the inspection we observed that there were sufficient staff to meet people's needs and provide personalised care. People told us that they felt safe. Staff had an understanding of the safeguarding procedures which should be followed to report any concerns regarding abuse. We saw that where necessary referrals had been appropriately made to the local authority to report safeguarding concerns.

Medicines were managed safely. Staff who administered medicines had completed training and we saw that competency assessments were carried out to ensure staff remained safe to administer medicines. We noted some minor issues regarding the recording for “as required” medicines and the storage on some prescribed creams.

Risk assessments were in place to support people. People were assessed where there were risks to their health and well-being, including nutritional, manual handling, medication and pressure ulcers. Risk assessments identified actions that were put into place to reduce the risks to the person and were reviewed regularly.

We saw that regular fire safety drills had been undertaken and that each person had a personal evacuation plan in place, which showed the support that they would need in the event of a fire. The registered manager told us that following a fire safety inspection in August 2016, the home had been issued with an enforcement notice regarding some areas where remedies were required. We saw that the home had implemented an action plan and the notice had been withdrawn In November 2016.

Staff had an understanding of the principles of the MCA. They told us that people needed to be supported to make decisions about their care and consent was needed. They also told us that there were times when they needed to make decisions for people in their best interests. We noted that training had been undertaken but there remained some gaps in staff knowledge. Improvements had been made since the last inspection with regards to DoLS application being made but we found that some MCA assessments were incorrectly completed. We recommend that the service finds out more about training for registered managers, based on current best practice, in relation to MCA and adjust their practice accordingly.

Staff received training, supervision and appraisal of their work so they had the skills and knowledge to look after people effectively. New staff completed an induction which was based on the Care Certificate. Staff received regular training updates.

People were positive about the food available at Lavender House and we found that people’s nutritional needs were met effectively.

People told us they were treated in a kind and caring manner. We observed that sta

This inspection was unannounced and took place on the 19 October 2015.

Lavender House was previously inspected in June 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Lavender House is an adapted Victorian residence situated on the outskirts of Alsager approximately half a mile from the main shopping area. The service is provided by Lavender House Residential Home Limited and offers accommodation and personal care for up to 20 older people with memory problems associated with dementia. On the day of our inspection the service was providing accommodation to 19 people.

At the time of the inspection there was a registered manager at Lavender House. 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.

The registered manager was present during the day of our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take as the back of the full version of the report.

We found that people were not adequately protected against the risks of unsafe or ineffective care because the registered person was not ensuring at all times, that there were sufficient numbers of staff on duty.

We found that the registered person was not operating effective systems or processes to assess, monitor and improve the quality and safety of the services provided.

Lavender House had a warm atmosphere and people appeared content and relaxed in their home environment at the time of our inspection. People using the service and relatives spoken with were generally complimentary about the care provided.

People’s needs had been assessed and person centred care plans produced to ensure staff understood how to respond to individual needs.

Staff knew how to protect people from abuse and to keep them safe. The registered provider had policies in place to safeguard people from abuse and staff had completed training in this key area.

People had access to a choice of wholesome and nutritious meals and a range of individualised and group activities.

Records showed that people had accessed a range of health care professionals, subject to individual need.

We have recommended that a needs assessment and staff deployment tool be sourced / developed to help demonstrate that the staffing levels are adequate and being kept under review.

We have recommended that a policy on the Mental Capacity Act and Deprivation of Liberty Safeguards is developed to increase understanding of this protective legislation and provide guidance for staff.

We have recommended that a business continuity / emergency plan is developed to ensure an appropriate response in the event of a crisis or untoward incident.

During our unannounced inspection we spoke with the registered manager, members of staff, all of the people using the service, one district nurse, the visiting hairdresser and three relatives.

We observed that the staff were respectful and polite to people living in the home. Also in discussion they demonstrated that they were clear on how to maintain people's dignity and privacy and they gave examples of how they achieved this on a daily basis. One member of staff told us; “It’s their home, it’s important that we respect that.” We saw that staff interacted well with people using the service and were kind and caring in the way that they delivered care to people.

Relatives we spoke with confirmed that they were very happy with the care given and told us; One said “The meals are very nice”, another said “We think that this is a really nice place” and another said “Mum must like it here because when she was in hospital on of the first things she said to us was ‘I want to go back to Lavender House’ ”.

Systems were in place to audit and monitor the quality of care provided to people using the service. This meant that people using the service were protected against unsafe care.

We were not able to ask a number of the people who used the service about their views due to their dementia. We gathered evidence of people’s experiences of the service through observations and by speaking to relatives. Two people who used the service told us that they liked the home.

Our observations indicated that staff were attentive and had a caring attitude towards the people who used the service. When people asked for support they received a good response.

We spoke to the relatives of five people. They described the staff as caring and attentive. They said they were kept informed about their relatives’ well-being and felt the home was a safe place for them to live. Some comments made were:-

“I’m very happy with the home.”

“It’s very homely here. The staff are friendly and caring.”

A tour of the home indicated that the service was clean and well presented.

There had been an improvement to record keeping around care planning. Records showed that people had a care plan in place detailing the support they needed and how staff were to minimise risks to their well-being.

There was a training and supervision programme in place to ensure staff received the support they needed.

A contract monitoring visit had been carried out by Cheshire East Council in July 2012. They made some recommendations for improvements but overall said that Lavender House was a nice place to live with friendly, caring staff.

The people who were able to say told us that they were being treated well by the staff members supporting them. A visiting family member said, “My relative is very well looked after, as are all of the people here; I am always made to feel welcome”. Another person said; “I could not wish my relative to be anywhere else”.

The people using the service who were able to tell us said that they were happy living in the home. One person told us, “The girls [care workers] are good and they look after me well”. A visiting relative told us; “I am more than happy with the care, any problems and they will phone me up”. Another relative said; “The quality of care is very good and they keep us informed”. Other comments from visitors included; “They are very good at keeping us informed”, “The staff are very good with all residents, it isn’t put on”, “The staff get on well with each other”.

We spoke to a visiting district nurse who told us that there was good communication with the home and they kept her and her colleagues informed of any issues that arose. She also said, “They generally do a really good job, care is the priority”.

During a discussion with Cheshire East Council’s contracting team prior to our visit they told us that they did not have any concerns about the home.