This inspection was unannounced and took place on the 8 and 12 November 2018.

Lawton Manor Care Home is a ‘care home’ operated by the Four Season Group. 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 care home provides accommodation, personal and nursing care for up to 63 older people in one adapted building. Most of the rooms have en-suite facilities. Communal bathing and toilet facilities are also located throughout the care home. At the time of our inspection, the care home was accommodating 54 people.

At the last inspection in May 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of the inspection 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.

The registered manager was present during the two days of our inspection and was supported by their regional manager and deputy manager. The management team were helpful and transparent throughout the inspection process and demonstrated a commitment to the ongoing development of the service.

Lawton Manor Care Home presented as a warm and comfortable environment in which to live. We observed that management and staff communicated and engaged with people in a caring and supportive manner and that people were encouraged to follow their preferred routines and lifestyle.

People’s needs had been assessed and care plans had been produced to help staff understand people’s needs and their support requirements. Risk assessments and other supporting documentation was also available for reference. Since our last inspection, an extensive review of care plan records had been undertaken to drive continuous improvement. Ongoing work was in progress to archive and update records at the time of our inspection.

Overall, people spoken with during the inspection told us that they were cared for appropriately by staff and confirmed they were treated with dignity and respect. We observed positive interactions between staff and people living in the care home and noted that staff were attentive and responsive to people’s needs.

People were supported to attend healthcare appointments and staffed worked in partnership with GPs and other healthcare professionals as necessary to maintain people’s health or support them at the end of life. People were also protected against the risk associated with unsafe medicines management.

A programme of individual and group activities was in place which included both on and off-site activities. People were seen to participate in a range of activities during the inspection and records of participation were maintained.

Staff had access to induction, mandatory and service specific training to help them understand their roles and responsibilities. Systems were in place to monitor the completion of training and to address the outstanding learning needs of staff.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were sufficient numbers of staff in post to meet the needs of people using the service. The registered provider had a staffing tool in place

This inspection was unannounced and took place on the 17 May 2016.

The service was previously inspected in January 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Lawton Manor is a care home with nursing for up to 63 older people with nursing, residential and respite needs, and also offers dementia, convalescence and palliative care.

Lawton Manor Care Home is a two storey Georgian detached house, which has been converted and extended into a 63-bedded care home. There are two passenger lifts and staircases. Wheelchair access is good within the building and grounds.

The home has a number of communal spaces, including two dining spaces, lounges, a conservatory, library, cinema room, and games room and a landscaped garden, tiered fountain, and large patio area outside for residents to relax and socialise in.

Sixty people were being accommodated at the time of the inspection.

At the time of the inspection there was a registered manager at Lawton Manor Care Home. 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 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 the inspection we found Lawton Manor Care Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service spoken with was generally complimentary about the standard of care provided. People living at Lawton Manor Care Home told us the registered manager was approachable and supportive.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people using the service. However, we noted the job application form did not allow room for the applicant to provide a full employment history.

We noted that a system had been developed by the provider to review the dependency of people using the service and to calculate staffing hours deployed. Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff told us they were well supported in their roles and responsibilities.

Corporate policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). We found staff were aware of the people using the service who were subject to a DoLS.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

There was a quality monitoring system in place which involved seeking feedback from stakeholders and people who used the service and their relatives about the service provided periodically. This consisted of surveys and a range of audits that were undertaken throughout the year.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

We observed the lunchtime meals and saw staff supported people appropriately and in an unhurried way.

Staff were very attentive, friendly and quick to respond whenever a person need

We considered all the evidence we had gathered under the outcomes 'care and welfare of people who use services' and 'staffing'. This helped us to answer one of the five questions we always ask:

• Is the service responsive?

We found that the service did not have appropriate systems in place to assess the dependency needs of people using the service and for the effective deployment of staff. We found evidence that some people using the service were waiting for staff for prolonged periods of time when they had activated their call bells.

We have issued a compliance action to the provider to ensure appropriate action is taken to address this matter. This will ensure people using the service receive appropriate support in a timely manner and help to safeguard their health and welfare.

When we carried out our inspection we spoke to five people living at Lawton Manor and one relative about their experience on the home. We asked one person if they were looked after and they said “they do”. They said “we can go on travels”, referring to trips out in the home’s own minibus and that the home was “like a little hotel”. A relative of another person agreed saying “what a good description”. Asked if they had any concerns they told us they sometimes needed to “wait a while” for someone to come when they rang the call bell.

A second person told us that they had “no strong feelings” about the home but that they enjoyed activities such as the newspaper reviews and “going out from time to time”.

A relative told us they were assured that their spouse “gets their breakfast properly” and that their spouse was “kept clean” and “kept comfortable”.

Asked about the food one person said that the food was “very good really, can’t find much to worry about”. Another said the food suited them and there were “usually one or two things on offer” that they liked. A third person said the food was “acceptable” and that it compared favourably to hospital food.

Several people mentioned that they felt that responses to call bells were not always quick enough.

We found that the building was properly maintained and that staff were recruited properly with the proper checks having been carried out.

One resident told us of how the chef recently went out during the day to get a pudding for a resident who requested it and they said this was typical of the way people were treated in the home.

A relative of a person living in the home told us that their relative had difficulty and lack of enthusiasm for eating. We were told that to encourage them the catering staff had been prepared to “do anything for him” when it came to the preparation of meals. They said staff were “very gentle” and were enthusiastic about the support provided by the home.

Another relative told us that the staff were “very open about talking to you” when finding out about what you wanted.

We spoke to a person who was in receipt of nursing care and their spouse who approached us as they wished to let us know about the care received. Their experience was very positive and the care provided had resulted in a much better outcome than expected for the person.

Another relative told us that the care that their spouse had received was “Excellent”.