Archived: Lavenders

We found the following examples of good practice.

People were adhering to current isolation and social distancing guidelines.

We observed staff using personal protective equipment (PPE) appropriately. There were adequate amounts of PPE around the service to ensure it was available when needed.

The deputy manager was working with other local services and agencies in the area regarding infection control and had updated staff practice accordingly.

Cleaning schedules had been increased. Areas including light switches and door handles were cleaned regularly. Regular audits were used to the monitor cleanliness of the service.

The management team provided people and staff information about COVID-19 to ensure they were kept up to date with latest guidance.

People and their relatives spoke positively about Lavenders. They told us it was a friendly and homely place. Comments included, “We are looked after well” and “The carers are very nice people." Another person said, “The care is amazing I couldn’t be looked after better, I’m so much happier here.” People spoke about having developed new friendships with other people since coming to live at Lavenders.

The environment was clean and maintained to a high standard. There was investment in the environment to ensure people had a safe, warm place to live.

People were supported to take their medicines safely. However, we found some improvements were needed to the current system for medicine management. The provider and registered manager acted immediately at inspection to address the shortfalls found and reviewed systems to reduce the likelihood of any similar occurrence. We have made a recommendation about the management of medicines.

Risks people experienced from their environment and because of their own needs were assessed, but the level of detail in some risk guidance was an area for improvement. We have discussed this with the registered manager.

People’s health needs were well managed and good links had been made with health professionals to help support and promote people’s health and wellbeing. People had access to the appropriate equipment they needed for their care and support needs.

People made their own day to day decisions and choices about their care, they were supported to be as independent as they could be, and there were enough suitably trained staff available to support them, when needed. Staff understood people’s likes and preferences and delivered care tailored to meet their needs. Policies and systems in the service supported this practice.

People enjoyed the meals they received. They were consulted about food quality and special diets were catered for. Those at risk of not eating or drinking enough were assessed and monitored and health professionals were contacted where this became a concern.

People were encouraged and supported to maintain the important links with their friends and family who were made welcome when they visited.

People told us that staff were caring and kind, treated them well and respected their privacy and dignity. Staff were observed to have good relationships with people and had time to spend with people during the day.

Staff received appropriate induction, training and supervision to enable them to carry out their role safely. Staff understood how to identify, record and respond to suspicions of abuse and to escalate this appropriately to the provider or external agencies, if needed.

Staff understood the process for reporting incidents and accidents and records showed they took appropriate action to ensure people received appropriate support or treatment and care and risk information was updated. Health and safety checks of the premises and equipment were made to ensure people were safe.

People were consulted about the things they liked to do and how they spent their time. A range of activities was provided to suit different tastes and abilities. Staff understood how to support people with sensory impairments and adjustments were made to ensure activities and information was inclusive for them. There were opportunities for people to go out into the community with staff support.

Several checks and audits were carried out by the registered manager and staff to provide assurance that the quality and safety of the service was being maintained, shortfalls identified were addressed.

The provider and registered manager had a visible presence in the service. People and relatives told us they had no reason to complain, but knew how to do so and felt confident this would be addressed promptly. Staff said they found the registered manager and senior staff approachable and had confidence in their leadership. Staff were given opportunities for feedback at regular staff meetings and handovers.

People and relatives were asked for their views and all feedback was used to make continuous improvements to the service.

Rating at last inspection: Good. Report published 24 March 2017

About the service: Lavenders is a privately-owned care service for up to 53 people over the age of 65, who require accommodation and personal care. The property is a detached older house, to which large extensions have been added. At the time of the inspection 52 people were receiving a service.

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection. The service has remained rated Good overall.

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

Lavenders is a privately owned care home for up to 59 older people who require accommodation and personal care. The property is a detached older house, to which large extensions have been added. The accommodation is divided into wings. These are called Regency, Lavinia and Boswell. At the time of the inspection, the service was providing care to 53 people.

Rating at last inspection

At the last Care Quality Commission (CQC) inspection on 12 April 2016, the service was rated overall Good and Requires Improvement in ‘Effective’ domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 12 April 2016. We found a beach of legal requirements. After the comprehensive inspection, the provider sent us an action plan dated 22 June 2016, telling us what they would do to meet legal requirements in relation to the breaches of Regulation 18 of the Health and Social Care Act Regulated Activities Regulations 2014 Staffing.

We undertook this focused inspection to check and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. We undertook this focused inspection to check that they had followed their submitted action plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lavenders on our website at www.cqc.org.uk.

Why the service is rated Good.

At this inspection, we found that one to one staff supervision had not been consistent. There were gaps in supervisions which showed that staff had not sometimes had supervision for ten months or more. Yearly appraisals were inconsistent. We have made a recommendation about this.

People had access to nutritious food that met their needs. We observed that people had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Care plans evidenced that referrals had been made to the relevant health care professionals as appropriate. People had seen their GP and emergency services when required.

Further information is in the detailed findings below.

Lavenders is a privately owned care home for up to 59 older people who require accommodation and personal care. The property is a detached older house, to which large extensions have been added. The accommodation is divided into wings. These are called Regency, Lavinia and Boswell. At the time of our visit, there were 50 people who lived in the home. People had a variety of complex needs including onset of dementia, physical health needs and mobility difficulties.

There was a registered manager at the 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.

Training records showed that not all staff had completed training in a range of areas that reflected their job role, such as essential training they needed to ensure they understood how to provide effective care, and support for people. There were gaps in the training schedule which showed that not all staff had completed safeguarding, Deprivation of Liberty Safeguards (DOLS), Mental Capacity Act (MCA).

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the home.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to

manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Staff knew each person well and had a good knowledge of the needs of people who lived at the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

People that used the service told us that they were happy with the service provided. They said that the staff are good, and the home is nice and clean. People told us 'I am very well looked after here' and 'The staff are kind and look after us well'.

People were asked for their consent before any care or treatment was given.

Care records showed that the people were supported with their care in a way that was individual and in accordance with their wishes. The care records reflected the health and personal care that people needed, and was appropriately checked and agreed with people or their next of kin.

Medicines were handled appropriately and people who used the service had their medicines given to them in a safe way.

We found that there was a robust recruitment process in place that helped to make sure that only people who were deemed as suitable were employed to care for people that used the service.

We found that people's concerns were listened to, and action was taken to address any issues identified.

We saw that the activities person worked across all units and provided people with a choice of group or individual activities during the day.

All of the people that we talked with spoke very positively about the home. Their comments included phrases such as: 'Caring staff', 'Everyone is friendly' and 'Suits my needs, quite at home here'. Comments received by the home from relatives included 'X's every need is catered for and she is very happy', 'Good ambience, beautiful gardens and views, caring staff, good menu and excellent newsletter' and 'Very good selection of entertainment and things to do'.

We talked with a variety of staff, and observed them caring for people. We saw that they interacted with them in a gentle and caring manner.

We found that people's concerns were listened to, and action was taken to address any issues identified.