This inspection was undertaken on 3, 4 and 10 October 2018 and was unannounced which means the provider did not know we were coming. At our last inspection in July 2015 we rated the service as good in each area and Good overall. Following this inspection, we have changed the rating to Requires Improvement.

The Lawns Nursing Home 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.

Since our last inspection the registered provider has extended the home, the new build opened shortly before this inspection. Previously the provider was registered to accommodate up to 40 people. Following a recent extension, the provider is now registered to accommodate up to 57 people. The original part of the building is an adapted building while the new build is purpose built. People are accommodated on the ground and first floor of the building. Care and support is provided to people with a dementia illness as well as nursing and personal care needs. On the day when our inspection commenced there were 29 people living at the home.

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.

There were aspects of the safe management of medicines which needed improvement to ensure people received their medicines as prescribed and in accordance with instructions. Pain relieve patches were not always accounted for and disposed of correctly. Audits carried out had identified areas needing improvement however these were not consistently maintained and some areas were not identified within the provider’s auditing systems.

Records maintained by staff were not always fully completed to evidence the care and support we were assured had taken place. Records within the new build were not always held securely to protect people’s rights to confidentiality.

People were supported to remain as safe as possible and staff were aware of how to protect people from unsafe care. Staff knew what action to take in the event of risks to people’s wellbeing. People, their relatives and staff were confident if concerns were raised plans would be put into place to help them.

The provider was awarded the Gold Standard Frame work for the care provided to enable people at the end of their life to receive the support needed. This included providing care at the home rather than transferring to a hospital setting. People’s needs were considered and people were involved in their needs assessment prior to coming to live at the home so the registered provider could be assured they were able to meet people’s needs.

Staff had received training and were supported so they had the skills and knowledge needed to provide individual care and support to people. People were supported to have the maximum amount of choice and control over their own lives in the least restrictive way possible.

Most people believed sufficient staff to be available to meet people’s needs in a timely way. People liked the staff providing care and felt most were kind and caring and provided dignified care and support. People were supported to choose what they wanted to eat and drink and to received support from healthcare professionals although records did not always show what people support people had received. In the new build people’s personal records were not held securely.

People had fun and interesting things to do throughout the day which involved crafts as well as discussions and other ways of involvement. People believed the service to be well led. Staff were aware of the time spend by the registe

The inspection took place on 1 July 2015 and was unannounced. The Lawns Nursing Home is a care home and the provider is registered to provide personal and nursing care for up to 40 people. At the time of our inspection 32 people lived at the home.

A registered manager was 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.

People and their relatives told us they were happy with the care and support provided by staff. They felt staff understood their needs and they felt safe. Staff knew how to report abuse and unsafe practices. Staff were recruited based upon their suitability to work with people who lived at the home. Staff numbers were assessed and planned for so that people received the right care at the right time to meet their needs and which promoted their safety.

Staff showed a good knowledge of people’s needs and how to meet these. The care and support we saw matched the information in people’s plans and the training staff had received was put into practice. Staff had been supported to assist people in the right way, including people’s end of life care needs. People had been helped to eat and drink enough to stay well. We found that people were provided with a choice of meals. When necessary, people were given extra help to make sure that they had enough to eat and drink. People had access to a range of healthcare professionals when they required specialist help.

Staff knew how to support people when specific decisions needed to be made to meet their needs in their best interests. We saw people were given choices about their care and support. This enabled people to be involved in the decisions about how they would like their care and support delivered.

We saw people were treated with dignity and respect. People told us that staff looked after them well and were kind. Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe care which met people’s individual needs. People were treated with kindness, compassion and respect.

People and their relatives had been consulted about the care they wanted to be provided. Staff knew the people they supported and the choices they made about their care and people were supported to pursue their interests and links with the community were promoted.

There were systems in place for handling and resolving complaints. People and their relatives knew how to raise a concern. The home was run in an open and inclusive way that encouraged staff to speak out if they had any concerns.

The provider’s vision and values were shared with people, visitors and staff so everyone knew what they could expect of the service. The registered manager regularly assessed and monitored the quality of the service provided for people. The provider and registered manager took account of people’s views and suggestions to make sure planned improvements focused on people’s experiences. This assisted in people benefiting from a management team who were continually looking at how they could provide better care for people.

At this inspection we spent time with people who lived at the home to gain their experiences of life in the home. We spoke with three people who lived at the home and three family members. We also spoke with five staff which included the manager and also looked at some records.

All the people that we spoke with were positive about the care and support provided. One person said: “Very good care here.” Another person said: “Can’t fault the care here, they (the staff) will help me when I need it.” One family member said: “it is all good” and: “Staff are really good, helpful and friendly.”

It was clear from what we saw on the day of our inspection that staff knew people’s social and health care needs. This was demonstrated in the individual support people received from staff. What we saw matched the care plans that were personal to each person who lived at the home.

We saw positive interactions between staff and people with lots of chatter and laughter during the day with staff helping people make simple everyday decisions. There were arrangements in place where required to help people with the bigger decisions so that their best interests were upheld.

We saw that the manager had effective systems in place that made sure that there were enough staff. This made sure that people’s needs were effectively met by staff at the right time and in the right way.

The manager had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where necessary.

We saw that the environment was clean and that many of the rooms at the service had recently been refurbished. Several communal rooms had been decorated to a high standard and they appeared warm and relaxing living spaces.

We saw that people's preferences had been considered in the planning and delivery of care. The provider made sure that it invited feedback from people who used the service, relatives and others to identify any potential improvements that could be made.

We spoke with three people who used the service. One person said that they were "So well treated here". Another person told us that they felt that the care they received met their needs. They told us that they didn't have to wait long when they pressed their call bell for assistance. One person said care staff "come without delay" to provide assistance and that care staff take the time to sit with them and talk. One person we spoke with said that they were able to maintain their independence with the support of care staff.

We found that staff were trained to meet the needs of people who used the service and that care staff knew what people's needs were, and how to act to make sure that vulnerable adults were safeguarded.