The inspection took place on 28 September 2018 and was unannounced. At our last inspection on 18 October 2017, the service was found not to be meeting the required standards in the areas we looked at. There were breaches against regulations of the Health and Social Care Act (Regulated Activities) 2014.

The breaches included regulation 9, care and treatment of service users did not always meet their needs or reflect their preferences.

Regulation 11, The provider had not ensured that people’s changing needs were reviewed and updated in their care plans.

Regulation 12, The provider had not ensured the proper and safe management of medicines and had not ensured infection control procedures were managed effectively.

Regulation 17, The provider did not have effective systems to monitor and improve the service. There was a lack of documentation by staff and care records required updating to ensure people's needs were met.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in safe, effective, caring, responsive and well-led to at least good. At this inspection we found that the provider had made the improvements required.

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 time of the inspection there was no registered manager for this location.

Lavender Lodge provides care for up to nine adults with a learning difficulty. At the time of our inspection nine people were living there. Lavender Lodge 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.

The service was safe. There were safe medicine practices in place with regular monitoring to keep people safe. Infection control practices had improved and now met the required standards. Staff received infection control training and checks were in place to ensure best practice. Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Staff had received training in how to safeguard people from harm and knew how to report concerns, both internally and externally. 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.

The service was effective. People were given choice and control over their lives and staff supported them in the least restrictive way possible. Staff received the right training and skills to meet people’s needs effectively. People were supported with a varied and healthy food options, Staff supported people with making healthy choices. People were supported to access health care services. People were involved with the design and decoration of their home environment.

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 and staff promoted their choice.

The service was responsive. People were supported to ha

This unannounced inspection took place on 18 and 23 October 2017. At our last inspection on 3 November 2014, the service was rated as good. At this inspection, we found a number of concerns and the service has been rated as requires improvement. Lavender Lodge is registered to provide accommodation and personal care for up to nine people with a learning disability. At the time of our inspection, nine people were staying at the home.

There was not 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.

There had been an acting manager in place to cover the service. The acting manager spent two days a week at the home. There was also a deputy manager at Lavender Lodge. We also noted the new manager for the service had now completed their induction and since the inspection has taken up the management position at lavender lodge.

The systems in place to manage medicines were not effective, unsafe practices had been identified, but actions had not been taken to address these.

Staff lacked guidance and leadership and robust governance systems were not in place.

Infection control protocols were poor and there were no cleaning schedules in place. Staff had not followed good practice to ensure that required standards of cleanliness and infection control were in place.

People were not supported to keep safe, risk assessments were not reviewed and people’s risks had not been identified. Accidents and incidents were not reviewed or documented to ensure people’s changing needs were identified.

Safe and effective recruitment practices were followed to help ensure that all staff were suitably qualified and experienced. Staff did not receive regular supervisions or meetings to support their needs.

People who lived at Lavender Lodge required reviews to ensure their changing needs were met and to ensure the correct support was in place to maintain their best interests. There was not always enough staff to support people’s needs or preferences.

People who lived at Lavender lodge did not receive regular meetings or one to one time to enable them to be involved with how the home was run and to have a voice to express what is important to them.

People did not receive the support and encouragement to develop their interests and hobbies.

Care plans did not always reflect the person as they had not been reviewed regularly and updated with changes to people’s daily needs.

Staff were caring and kind and knew the people they supported. People felt happy at Lavender Lodge.

People's privacy and dignity were respected and records were kept safe and stored securely.

This inspection took place on 03 November 2014 by an inspector and was unannounced. The service was found to be meeting the required standards at their last inspection on 25 April 2014.

Lavender Lodge is registered to provide accommodation and personal care for up to 9 people who live with learning disabilities and autistic spectrum disorder. At the time of our inspection 9 people lived at the home and a manager was in the process of being registered with the Care Quality Commission (CQC). 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.

People were protected from abuse and felt safe at the home. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s individual care and support needs. Safe and effective recruitment practices were followed and people were involved in the selection of new staff.

There were suitable arrangements for the safe storage, management and disposal of medicines. We found that, where people lacked capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005.

The CQC is required by law to monitor the operation of the MCA 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection no applications had been made to the local authority in relation to people who lived at Lavender Lodge.

People had access to healthcare professionals such as GP’s and mental health specialists when needed. They were given appropriate levels of support to maintain a healthy balanced diet and were looked after by staff who had the skills necessary to provide safe and effective care. People told us they were happy at the home and that staff treated them with kindness, dignity and respect. Relatives were also positive about the care and support provided. We saw that staff knew people well and met their needs in a patient and caring way.

People told us their needs were met and they were supported to take part in a wide range of meaningful activities and development opportunities, both at the home and in the local community. We saw that people who lived at the home and staff had been actively involved in developing all aspects of the service and how the home was run. They were encouraged to have their say about how the quality of services could be improved and were positive about the leadership provided by the manager. We saw that a system of audits, surveys and reviews were also used to good effect in monitoring performance and managing risks.

The manager had introduced a clear vision and set of values based on person centred care, independence and empowerment. These were central to the care provided and were clearly understood and put into practice by staff for the benefit of everyone who lived at the home.

At our last inspection on 09 October 2013, we had found that the service was not meeting the standards we had inspected. The provider had developed an action plan with timescales to ensure that they had taken appropriate steps to meet the standards.

We considered all the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:

This is a summary of what we found:

Is the service safe?

We found that people's needs had been assessed when they first moved to the home and that the identified needs had been met appropriately. One person said "I like it here. Staff look after us and I have my friends here.” Another person said “It is a nice home. It is clean and comfortable. We feel safe and we help each other." Staff had received training in safeguarding people from abuse and were aware of their responsibilities to inform the manager or the relevant authorities if they felt that someone was at risk of abuse. People received their medicines regularly and on time. There were sufficient numbers of staff on duty to support people in meeting their needs. People's confidential records had been kept safely and securely.

Is the service effective?

We spoke with five people who lived at the care home. They all said that that they were happy with the care and support they received. One person said "The staff are very caring and supportive. We go out on our own to the shops and the town centre." Another person said “I go to work and I look after myself. The food is good and I have no concerns. We are well looked after." Each person had a daily activity plan which they were aware of and participated in. People had their own keys to the home and their own bedrooms.

People had a risk assessment carried out and the staff were aware of the management plan to ensure that the risk had been managed appropriately. People had been involved in the decision about their care and support. We saw evidence that people who used the service had a capacity assessment, which held details on people’s ability to make decisions. The manager said that a Deprivation of Liberty Safeguards (DoLS) had not been applied for any person as they were able to make decisions for themselves and were able to leave the premises on their own.

Is the service caring?

People told us that there needs had been met and that the staff were supportive and helpful. We observed that there was a good interaction between staff and people. One person said "The staff discuss my care plan with me and I make the decisions about my care and support." Another person said “This is our home and we share the house work”. The staff had received the relevant training and were experienced and skilled in meeting the needs of people.

Is the service responsive?

The care plans we reviewed demonstrated that people's need had been assessed when they first moved to the care home. People had been involved in the decisions about their care and any changes in their care needs, had been discussed with them and their relatives. People accessed amenities and facilities in the local community. One person said “We all have our own keys and we go out and come back anytime we want except for if we are late we let the staff know”. Another person said “I walk a long distance to visit my parents because I enjoy walking. We have families and friends and they do come to visit us as well.”

Is the service well-led?

The home carried out an annual questionnaire survey for people using the service. The feedback from the surveys had been positive. People said that they had regular house meetings and discussed issues relating to the day to day running of the home and that they felt that their views were listened to and acted on. Regular audits had been carried out to ensure that people’s needs were met and that they lived in a safe and comfortable environment.

During the inspection we followed up concerns identified as part of a previous inspection in May 2013. We did not talk to people who used the service as part of this inspection because the concerns previously identified related to documentary evidence.

We had previously identified concerns around the management of medication, staff training, quality monitoring and record keeping. As part of the recent inspection we found that some improvement had been made but more was needed. We also identified some new concerns around how the finances of people who used the service were controlled and managed. Statutory notifications had not always been made to the Care Quality Commission in accordance with the regulations, when reportable incidents had occurred.

We have asked the manager to provide us with regular updates on how some of these concerns are being managed.

We talked to people who used the service and staff about their experiences as well as making observations during our inspection.

People told us they were happy living at the service, and that a lot of improvements had been made since our previous visit.

Previously people had told us that they were not able to go out very much and that not all members of staff interacted well with them.

People told us that this had changed significantly since our previous inspection and that this was now a nice place to live. One person said, “It is much nicer here now, its more relaxed and we do a lot more activities. Staff interact with us more and there is no tension like before” and that “you can sit and chat with staff, you can tell them if you’re upset and they will help you”. Another person told us, “The home is improving; there are all new staff and its much better, this month we’re going to Southend, the cinema and the zoo. They ask us what we’d like to do”.

Although we found that improvements had been made and the people who used the service were much happier, we found some problems with record keeping,quality assurance and management of medicines. We also found that whilst staffing arrangements had improved, because there were a lot of new staff, the majority of staff had not yet attended relevant training, although we were informed a date had been agreed for all staff to attend the required mandatory training.

People told they were happy living at the home , although they told us that they thought that most of the staff were lovely but there were some staff who did not always interact well with them. People also told us that they did not get to go out as often as they would like because there were not enough staff on duty to take them out. People told us that they were prompted to take care of themselves and their rooms but that some staff were better at doing this than others. One person told us, “There are not enough staff, if there were more staff we could do more activities. At the moment one or two people go out whilst others stay at home. Sometimes I feel left out because there are not enough staff to chat to”. Management advised us that staffing levels were being looked in to.

Another person told us, “Sometimes staff can be a bit lazy and go on their phones a lot”. We were told that some staff were very friendly and very good. We found that the systems in place for managing controlled drugs did not meet best practice guidance.

We saw evidence that people were listened to if they made a complaint and that regular meetings were held so that the people who lived at Lavender Lodge could express their views. We found that other aspects of quality monitoring arrangements needed improvement.

We also identified some other concerns which were reported to management as well as the Local Authority.

We met five of the nine people who live at Villosa 2 when we visited the service on 27 October 2011.

The people we met were positive about their involvement in planning how they spent their time and it was evident from the conversations we had that individuals were being encouraged to develop new skills and try out new things.

We met six of the nine people who live at Villosa 1 when we visited the service on 27 October 2011.

We asked a group of people what it was like to live here. People said it was ‘cool’ and ‘wicked’. They said it was an ‘excellent’ home that was ‘full of love’. People said they had the ‘best’ staff’ who were ‘helpful’ and ‘listened to you’. People said that they felt safe living here.

People told us about the activities they take part in at home and in the community. This includes going to college and volunteer jobs in St Albans town centre.

People told us they had enjoyed a recent Halloween party in St Albans and were making plans for one of their own.

We had conversations about a recent holiday which people said they had enjoyed.

People told us they are involved in how their home is run and the jobs they enjoy doing. One person takes responsibility for looking after the plants and another person looks after the lawn.

People told us that they usually get on well with the other people who live in the house but problems get sorted out if they occur.