We undertook this unannounced inspection on 21 September 2017. Lawnfield House is registered to provide personal care and accommodation for a maximum of 41 older people, some of whom may have dementia. The home is purpose built and accommodation is provided on the ground floor, first floor, second floor and third floor of the building. At this inspection there were 41 people living in the home.

At our last comprehensive inspection on 6 November 2015 the service met the regulations we inspected and was rated Good. At this inspection we found the service remained Good.

There were suitable arrangements to protect people from harm and abuse. Care workers were knowledgeable regarding types of abuse and were aware of the procedure to follow when reporting abuse. Risks in relation to treatment and care provided were assessed and risk management plans ensured that identified risks to people were minimised. The service followed safe recruitment practices and sufficient staff were deployed to ensure people’s needs were met. The arrangements for the administration of medicines were satisfactory and medicines administration record charts (MAR) had been properly completed.

The premises were kept clean and tidy. Infection control measures were in place. There was a record of essential maintenance of inspections by specialist contractors. Fire safety arrangements were in place. These included weekly alarm checks, a fire risk assessment, drills and training. Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency.

The service worked with healthcare professionals and ensured that people’s healthcare needs were met. The dietary needs of people had been assessed and arrangements were in place to ensure that people received adequate nutrition. People were satisfied with the meals provided.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had suitable arrangements in place to comply with the Mental Capacity Act 2005 and DoLS.

Care workers worked well as a team and there was effective communication among them. They had received a comprehensive induction and training programme. There were arrangements for support, supervision and appraisals of care workers. There were enough care workers deployed to meet people's needs. Care workers had been carefully recruited and their files contained the required documentation. We noted that the Disclosure and Barring Service (DBS) check of one care worker was over six years old and no updates had been obtained from the DBS. These checks are needed to ensure that care workers are fit to work with vulnerable people.

Care workers prepared appropriate and up to date care plans which involved people and their representatives. The home had a varied activities programme to ensure that people received social and therapeutic stimulation. The service worked at encouraging people to be as independent as possible.

The service listened to people who used the service and responded appropriately. There were opportunities for people to express their views and experiences regarding the care and management of the home. Regular residents’ and relatives' meetings had been held. Complaints made had been carefully recorded and promptly responded to.

Comprehensive checks of the service had been carried out by the registered manager, deputy manager senior staff in areas such as health and safety, catering arrangements and accidents. Audits were carried out three monthly by the area manager and senior managers of the organisation. They included checks on care documentation, medicines, and maintenance of the home.

We undertook this unannounced inspection on 6 November 2015. Lawnfield House is registered to provide personal care and accommodation for a maximum of 41 older people, some of whom may have dementia. The home is a purpose built and accommodation is provided on the ground floor, first floor, second floor and third floor of the building. At this inspection there were 38 people living in the home.

At our last inspection on 28 April 2014 the service met all the regulations we looked at.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

People and their representatives informed us that they were satisfied with the care and services provided. They said that people were treated with respect and they were safe. There was a safeguarding adults policy and suitable arrangements for safeguarding people. People’s care needs and potential risks to them were assessed. Staff prepared appropriate care plans to ensure that that people were safe and well cared for. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

There were arrangements for encouraging people to express their views and experiences regarding the care and management of the home. Consultation meetings had been held for people and their representatives. The home had an activities programme but effort was needed to provide a more varied range of activities so that people could have regular access to adequate and appropriate social and therapeutic stimulation.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensures that an individual being deprived of their liberty is monitored and the reasons why they are being restricted are regularly reviewed to make sure it is still in the person’s best interests. During this inspection we found that the the home had followed appropriate procedures for complying with the Deprivation of Liberty Safeguards (DoLS).

There were suitable arrangements for the provision of food to ensure that people’s dietary needs and cultural preferences were met. People were mostly satisfied with the meals provided. The arrangements for the recording, storage, administration and disposal of medicines were satisfactory.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from their managers. There were enough staff to meet people's needs. Staff worked as a team and communication was good.

The home had comprehensive arrangements for quality assurance. Regular audits and checks had been carried out by managers of the home and the organisation’s service manager.Complaints made had been promptly responded to.

The premises were clean and tidy. Infection control measures were in place. There was a record of essential inspections and maintenance carried out. We however, noted that some areas of the home had an unpleasant odour. Action had already been taken to rectify this problem.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We used a number of different methods to help us understand the experiences of people who used the service, because many of them had complex needs which meant they were not able to tell us their experiences. We spoke with thirteen people and with a visiting family member of one person who used the service. We spent some time observing the interactions between staff and people using the service in the communal areas of the home. We spoke with ten care staff and the acting manager and deputy manager. The Registered Manager had recently left the service but has not yet cancelled her registration.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Risk assessments were carried out for each person and included, for example, pressure sores, nutrition, mobility and the risk of falls. We checked a sample of records to show that the premises were maintained safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff we spoke with varied in their knowledge and understanding of the Deprivation of Liberty Safeguards (DoLS) and said that they had not had specific training.

Is the service effective?

The service was effective. Sufficient staff were on duty at all times to meet the needs of the people who used the service. One person told us that staff were available when they needed them. They said, “It’s nice to know you can always ask for help and there is someone there.”

People attended hospital appointments and received advice and support from healthcare and social care professionals.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. The communal rooms and bedrooms were furnished with comfortable furniture and provided a sociable and domestic environment. People we spoke with told us that they were happy with their rooms.

Is the service caring?

The service was caring. The care and support plans contained detailed information about each person’s specific needs for staff to follow.

We observed that staff interacted with people in a respectful and sensitive manner. We spoke with a relative of one person who used the service. They said, “It’s just fantastic, the whole place is fabulous. The level of care is very good, and most staff have good understanding of my relative’s needs for dementia care.”

Is the service responsive?

The service was responsive. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. There were regular meetings for both people who used the service and for their family members.

We saw that monthly reviews of people’s needs were carried out and that changes were recorded and appropriate action taken in response to those changes.

Is the service well-led?

The service was well-led. The management team supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided. Staff we spoke with said that managers provided them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They carried out a quarterly assessment of compliance with their corporate standards and an annual satisfaction survey. These were both followed with action plans to address any concerns.

People told us they received the care they needed and wanted and spoke positively about the staff that supported them. We saw staff supported people in a friendly, sensitive and professional manner. Staff knew about their roles and responsibilities in meeting the varied and complex needs of people.

People had been involved in assessment of their needs and had a recorded plan of care and support which they kept in their bedrooms. We saw care provided to people had been carefully monitored and the healthcare needs of people who use the service had been met. We saw from records and from speaking to people that people attended health appointments and had been visited by a significant number of health and social care professionals.

People told us they made decisions about their lives. We saw people make a number of choices and these decisions were respected by staff. People spoke about the activities they participated in and enjoyed. We saw people take part in a number of leisure pursuits.

People told us they felt safe and knew who to talk to if they had any worries or concerns. Arrangements were in place to ensure that people who use the service were protected from abuse.

There were systems in place to monitor and to make improvements to the service provided to people.

As part of this review, we spent time talking to all the people using the service to gain their views about living in Lawnfield House. A significant number of people had some difficulties in conversing with us due to their individual communication needs. Those people that couldn’t answer our questions in detail answered ‘yes’ and ‘no’ to our questions, other people signed, nodded or shook their head in response to our questions. Throughout our visit we looked for signs of people’s ‘well being’ (happiness, comfort, welfare, safety and health).

People told us; they liked living in the home, they chose their meals, the food was good, they had their health needs met, and staff listened to them. They also told us they had the opportunity to participate in a range of activities.

People were positive about the care and support they received at the home. People spoke of the staff being ‘kind’, ‘friendly’,’ nice’, and approachable. They told us they felt safe living in Lawnfield House. People knew who to talk to if they had any worries or concerns, and told us they felt that staff would respond to these in an appropriate manner.

People spoke about being able to make choices about their lives.

People confirmed that they attended healthcare appointments and saw a doctor when they needed to, and had contact with a variety of other health care and social care professionals.

People were positive about the environment of the home and were happy with their bedrooms. Some people told us they had personalised their rooms. A person spoke of having brought some items of furniture with her when she moved into the home.

Comments from people included; ”I choose what to do”, “I like my room”, the staff “are nice”, “helpful” and “kind”, staff “ask me want I want”, “I like the food”, breakfast was “good”, and “I chose this meal”, “I have seen a doctor” and I am “very happy with the home”.

Comments from staff included “I like it here”, “I like the residents and have got to know them very well” and Lawnfield House is “a nice place to work”.

We used a number of different methods to help us understand the experiences of people who use the service, because many of them had complex needs which meant they were not able to tell us their experiences. We spent some time observing the interactions between staff and people using the service in the communal areas of the home. The people we observed were alert and showed interest in their surroundings and other people. We did not observe anyone who showed signs that they were withdrawn and not aware of what was happening around them.

The care files contained records of the involvement and advice of other health professionals. Appropriate referrals were made when needed, for example for assessments by a dietician or speech and language therapist.

The home was clean in all the areas that we visited. Staff we spoke with told us about the procedures that they followed to reduce the risk and spread of infection, including the use of gloves and aprons and the importance of hand washing.

The staff who we spoke with told us that they received support and training that supported them to meet the needs of the people in the home. However they told us that there were times when there were not enough staff available to meet people’s needs, and we found evidence to support their view.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.