The Lawns Care Home is registered to provide personal care and accommodation to up to 28 people, including older persons and people living with dementia. There were 17 people living at the service at the time of inspection.

At our last inspection we rated the service 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.

People who used the service and their relatives felt they were well supported by staff who ensured their safety on a day to day basis.

Appropriate systems were in place to monitor the risks people may face, in individual care planning and also with regard to the upkeep and maintenance of the building.

Medicines were safely managed by staff who knew people’s medicinal needs well.

There were no concerns regarding the safety of the service when we spoke with external professionals.

People 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 training was appropriate and up to date, with all staff confirming they were well supported in terms of maintaining the skills and knowledge required to fulfil the role.

People and their relatives were complimentary about the food choices on offer and the kitchen staff were passionate about their role. The registered manager agreed more could be done to individualise the choices on offer via the menu.

Staff interacted warmly and patiently with people at all times and demonstrated a good understanding of their needs and individualities. There was clear evidence of strong, friendly bonds formed between staff and people who used the service.

Activities provision was a strength, with a good range of person-centred activities available and good work undertaken by the activities coordinator to network with local community groups to ensure the people could remain a part of that community.

Auditing systems were in place and working well to ensure the registered manager and assistant manager maintained strong oversight of all aspects of the service.

Further information is in the detailed findings below.

The Lawns is a four storey detached property providing accommodation for 28 people who require care and support with their personal and healthcare. There were 15 people living in the service at the time of the inspection.

This inspection took place on 24 and 29 March 2016 and was conducted by one inspector. The inspection was unannounced. This meant the provider and staff did not know we would be visiting the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.'

The service had a registered manager in place. 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 detailed safeguarding and whistleblowing policies in place, which provided information about how to recognise the signs of abuse, and how to respond to any concerns people may have.

People had individual risk assessments in place to keep them safe and to assist staff to support people with their specific health care needs. Environmental health and safety checks had been carried out. There were systems were in place for reporting and recording accident and incidents

Policies and procedures were in place in relation to recruitment. Records within staff files demonstrated proper recruitment checks had been carried out.

Everyone who lived in the service was supported with the management of their medicines. The service had safe systems in place to check that people were managing their medicines.

Staff were given regular training opportunities that linked to the care and support needs of people living in the service. Staff were provided with supervision and appraisal and were well supported in their roles.

The registered manager was aware of his responsibilities relating to the Mental Capacity Act 2005. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’. Application in relation to DoLS had been made for some people.

Staff had an understanding of capacity and consent and had completed training relating to mental capacity and the deprivation of liberty safeguards.

People had access to a range of health professionals when required, including dentists, GPs, community nurses and chiropodists.

Menus were available which provided a choice of meals for each day. People living in the service were well supported with good nutrition.

Care records contained a wealth of information which related to the care and support needs for each person. People were involved in the review of their care plans. Relatives we spoke with were happy with the care and support that was provided. Staff clearly understood the importance of treating people with dignity and respect.

The service had a complaints process in place. People living in the service and their relatives were provided with information to support them to raise any concerns or complaints they may have.

The service had systems in place to check the quality of care people were receiving. A variety of audits were carried out covering areas relating to medicines health and safety, fire and support planning.

We visited the home and gathered evidence to help us answer our five questions:-

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

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

Is the service safe?

Care records contained risk assessments and how these risks should be managed. For example, moving and handling and preventing falls and pressure sores.

Safeguarding procedures were robust and staff had been trained on how to safeguard the people they supported. The manager was aware of incidents that should be reported and who should be contacted. Staff were aware of the procedure to follow if they observed bad practice. They were aware of the different forms of abuse and told us they would not hesitate to report any concerns. Comments included, "If I saw anything was wrong I would be straight in the office to talk about it."

Relatives told us they felt the home was safe and people were well cared for.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

There was a system in place to ensure people's money was safe and any expenditure was appropriately recorded.

The home had policies and procedures in place related to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to help ensure people were appropriately assessed and to make sure that people are cared for in a way that does not inappropriately restrict their freedom. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people would be safeguarded as and when required.

Is the service effective?

People's health and care needs were assessed and care plans were developed with people and their representatives. The care plans provided staff with information about how each person's care needs should be met. Guidelines were in place to inform staff of the actions to be taken in certain situations and these were monitored by the manager.

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met.

The service worked well with other agencies and prompt referrals were made to health care professionals which helped ensure people's health care needs were addressed.

Is the service caring?

We spoke with two people who used the service and their comments included, "I'm well looked after," "The girls are very nice" and "I think it's a nice place to be."

We spoke with three relatives who said they felt the staff were very caring and people were well looked after. Their comments included, "The staff are very pleasant and mum is well cared for," "I have no complaints, it's wonderful. I can stay for lunch and people are taken out in the mini bus" and "I'm happy with the care she receives and she always looks well presented."

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people and were attentive and sensitive to their individual needs.

Is the service responsive?

We saw evidence to show there was a complaints procedure available. Relatives told us they knew how to make a complaint but had never needed to. They said they felt confident that if they did complaint it would be taken seriously and fully investigated.

We saw prompt referrals were made to health care professionals when required and appropriate training was provided for the staff to help meet individual needs.

Monthly meetings were held for the people who lived in the home to discuss day to day issues and ask people their opinions of he service provided.

Is the service well-led?

The provider had systems in place to monitor the quality of the service people received. People were asked their opinion of the service and meetings were held every month to discuss day to day issues in the home, for example, menus and activities.

We saw records to show the manager was responsible for monitoring care records, incidents, petty cash, risk assessments, complaints and health and safety. A senior manager also audited these areas each month to ensure standards were being maintained and any improvements were implemented. The assistant manager was responsible for carrying out a weekly audit of the system for ordering and administering medications.

The staff told us the manager was very approachable if they wished to raise concerns or suggest new ideas. Comments included, "The manager is very good, everything is going well" and "The manager is brilliant and very understanding and supportive." Relatives told us the manager kept them well informed and was always available if they wished to discuss any issues.

There was a complaints procedure in place and a complaints book was maintained in the home.

We spoke with five people and four relatives to find out their opinions of the care and treatment at the service. One person told us, “It’s a nice friendly place to live, I’m very happy here.” A relative told us, “All round, I’m impressed. It’s about the people there, not the staff. He’s stimulated, it’s great. The staff are caring and they spend quality time with him and there's a lovely warm environment there.”

We were unable to speak to all of the people who used the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support was delivered.

Relationships between people and staff were clearly good. Relatives told us and we saw in practice staff treated people with respect and helped them to remain as independent as possible. One person said, “The staff do look after me, but they let me do what I can for myself. They’re there to give me any help that I may need.”

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke to were positive about the care and support people received.

We found that people were provided with a choice of adequate nutrition and hydration.

We saw that there were suitable numbers of skilled, trained and experienced staff.

We concluded that people’s personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

Twenty three people were living at The Lawns Care Home at the time of our visit.

As we walked around the premises, we spoke with many of them although we later spoke with five people in detail. People told us they were happy with the care and support they were receiving at the service.

One person told us, “I like it very much, I couldn’t manage on my own” and another person said, “The staff are very nice, there’s no-one I think, oh! it’s him or her”.