About the service:

Lawton Rise accommodates 62 people living with dementia across four separate units, each of which have separate adapted facilities. At the time of the inspection 55 people were using the service

People’s experience of using this service:

At the last inspection in December 2017, the service was rated as Requires Improvement overall, with breaches of the regulations in relation to staffing. The provider wrote to us to tell what action they would take to comply with these regulations. At this inspection, we found that the provider had made considerable improvements and there were no longer breaches of the regulations. The home had improved and is now rated as Good.

People's care was not always responsive to their needs. One person did not always receive the support they needed and improvements were needed to support people living with dementia. People had the opportunity to participate in activates they enjoyed. There was a complaints procedure in place.

The care people received was safe. Individual risks were considered. Safeguarding procedures were in place. Medicines were managed in a safe way. There were enough staff available for people. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received an induction and training that helped support people. People received support from health professional when needed. People enjoyed the food and were offered a choice. The environment was adapted to meet people’s needs.

People and relatives were happy with the staff and supported in a kind and caring way. People were offered choices, remained independent and their privacy and dignity was maintained.

There were audits in place which were effective in continually developing the quality of the care that was provided to them. There were systems in place to ensure staff, people and relatives could give feedback on the service.

More information is in the full report.

Rating at last inspection:

Requires Improvement (Last report 13 December 2017). We issued a Warning Notice in relation to Regulation 18 of the Health and Social Care Act (Regulated Activities) regulations 2014.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. However, we had received information of concerns about the service.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This unannounced inspection took place on 13 December 2017. At our previous inspection in March 2015 we found no concerns and rated the service as 'outstanding'. At this inspection we found that the service was not consistently safe, effective, caring, responsive or well led. We found two breaches of the Health and Social Care Regulations (Regulated Activities) Regulations 2014.

Lawton Rise 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.

Lawton Rise accommodates 62 people living with dementia across four separate units, each of which have separate adapted facilities. At the time of the inspection 62 people were using the service.

There was a new manager in post who was in the process of registering with us. 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.

There were insufficient numbers of staff available to meet people's needs and reduce risks of harm and people's medicines were not always managed and administered safely.

Staff did not always follow national guidance in delivering care that met people's needs in an effective way. The provider was not following the principles of the MCA and ensuring that when people lacked the mental capacity to agree to their care they were supported to do so in their best interests.

The building and environment required improvement to meet people's needs in relation to their dementia. We have made a recommendation to offer staff further training in dementia care.

Staff had limited time to spend with people at mealtimes to ensure it was a dignified dining experience and people did not always receive personalise that met their individual needs and preferences due to a lack of available staff and routines.

The provider had a complaints procedure, however some relatives did not feel able to raise their concerns.

People had not always been consulted with about changes to their care routines and some relatives and some staff felt that the manager was not approachable.

People were safeguarded from the risk of abuse and lessons were learned following incidents that had resulted in harm.

Infection control procedures were followed to prevent the spread of infection.

People were supported and encouraged to engage in hobbies and entertainment and offered social stimulation.

People's wishes were gained as to how they wished to be cared for at the end of their life and people and their relatives were involved in their care planning and treated with dignity and respect.

People's right to privacy was upheld and respected.

People's needs were assessed and when their needs changed or they became unwell the appropriate health care support was gained in a timely manner.

People who used the service received a holistic service and were supported by staff who were trained and effective in their roles.

People were supported to eat and drink sufficient amounts to remain healthy.

The provider recognised the needs to improve the quality of care for people and was implementing new systems to bring about the improvements in a timely manner.

Staff worked alongside other agencies to ensure that a holistic approach was taken to people's care.

Audits and analysis of accidents and incidents were effective as lessons were learned and the quality of care was improved when concerns were raised.

We inspected this service on 18 March 2015. This was an unannounced inspection. This was the service’s first inspection under their registration of a new provider.

The service was registered to provide accommodation and nursing care for up to 62 people. People who used the service were living with dementia.

At the time of our inspection 62 people were using the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

There was a very positive atmosphere within the home and people were very much at the heart of the service. People and their relatives were enabled to be involved in the care and staff implemented the service’s core values to ensure people had a meaningful and enjoyable life.

The registered manager and provider regularly assessed and monitored the quality of care to ensure national and local standards were met and maintained. Continual improvements to care provision were made which showed the registered manager and provider were committed to delivering high quality care.

All of the staff received regular training that provided them with the knowledge and skills to meet people’s needs in an effective and individualised manner. Dementia training was also offered to people’s relatives to help them to understand the condition.

People’s health and wellbeing needs were closely monitored and the staff worked very well with other professionals to ensure these needs were met and to prevent hospital admissions. The home had been recognised by a national agency because they had demonstrated they provided high quality and effective end of life care.

A flexible approach to mealtimes was used to ensure people could access suitable amounts of food and drink that met their individual preferences. This helped people to maintain healthy weights.

Staff sought people’s consent before they provided care and support. However, some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Where people had restrictions placed upon them to keep them safe, the staff ensured people’s rights to receive care that met their needs and preferences were protected. Where people were legally restricted to promote their safety, the staff continued to ensure people’s care preferences were respected and met.

The environment was designed to enable people to move freely around the home. There was a parlour room, a pub and outside space that people could freely access. These areas were also used to enable people to participate in social events.

People and their relatives were involved in the assessment and review of their care. Staff supported and encouraged people to access the community and participate in activities that were important to them. Innovative ideas, such as; ‘Magic minutes’ and a ‘wishing well’ were used to ensure people received high quality that was meaningful and personal to them.

Feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

People’s safety risks were identified, managed and reviewed and the staff understood how to keep people safe. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. Systems were in place to protect people from the risks associated from medicines.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. The staff were highly committed and provided people with positive care experiences. They ensured people’s care preferences were met and gave people opportunities to try new experiences.