This comprehensive inspection was carried out by one inspector and took place on 8 November 2016. The inspection was unannounced. The Lawns provides accommodation with personal care for up to 12 people over the age of 18 who have a diagnosis of a learning disability. People had a range of care needs and some had communication difficulties associated with their learning disability. The home is staffed 24 hours a day. At the time of the inspection, eleven people had lived at the home for a number of years. The home is a large three storey house which also has a separate self-contained two bedroomed flat in an annexe. All bedrooms were for single occupancy, two rooms on the second floor of the main house were en-suite and had a small kitchenette and sitting room. These two rooms as well as the two in the annexe allowed people to live semi-independently. At the time of inspection, 10 people were living in the main house and one person was living in the annexe.
The service was previously inspected in October 2013 when the service was found compliant with all the regulations inspected.
The home was well-run by a registered manager, who had worked in the service since it had started in 1992. They described their passion and commitment to the people at The Lawns Care Home, which was evident throughout the inspection. In October 2016, they had registered with the CQC as the 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 2008 and associated Regulations about how the service is run. The provider also worked at the home most days of the week. People, their families and staff were all very complimentary about the provider, the registered manager and the home. Comments included “fantastic people” and “Both of them are so wonderful.” Staff were also described really positively, for example “always supporting [my relative] to get the most out of life.”
The provider and registered manager had a clear vision for the home and the people who lived there. They described how they, and the staff, were committed to ensuring people were supported to live as independently as possible. The home’s statement of purpose described how the main aim of the service was ‘‘to enable people with learning difficulties to lead a fulfilled life… encouraging and working with the Service User to be fully integrated into the community in which they live and to take part in its activities according to their individual needs, abilities and interests.’ Throughout the inspection we found evidence that these aims were lived up to. Staff followed these principles, treating people with kindness, friendliness and compassion. Staff made sure people had time to decide what they wanted to do both in the home and outside. People were then supported to do their choice of activity.
People were at the heart of the service and were involved in decisions about the home and the support they wanted. Activities were inclusive so everyone was supported to take part. People were happy and excited about what they were doing throughout the inspection. People were encouraged to be part of the local community. For example, people were involved in lots of local celebrations of festivities, including helping to make decorations for a Christmas tree as part of a local church Christmas Tree festival. The home also took an active part in the town’s Goose Fair which was held each year, having a stall to sell produce they had made. People also described how they were involved in drama sessions which led to a production, as well as planning a trip to a pantomime. People chatted to staff about these activities as well as describing other visits and trips they had done. These included holidays and day trips to local attractions. A recent newsletter which was sent to relatives had been partly written by people in the home and described how much they had enjoyed these activities. The home also arranged for entertainers and other visitors, such as Zoo lab to come to the home. People proudly showed us photos of them holding some of the animals that had been brought, including a snake and a very large snail.
People were encouraged to be independent and make decisions wherever possible. One person had been supported to achieve a personal goal of showering independently. Records showed this had been discussed with the person and monitored so that they were now able to do this with minimum staff support. People living in some areas of the home were able to live semi-independently, preparing some meals for themselves and undertaking housework such as cleaning their lounge and kitchen areas. They described how much they enjoyed having their independence whilst recognising the support was there when they needed it.
People were also supported to maintain and increase their independence outside their home. One person worked at a local hotel and some people were also able to go out on their own to the bank and shopping. People attended local clubs to enable them to maintain particular interests and hobbies as well as friendships. Although the atmosphere was lively, staff recognised that some people needed space, peace and a slower pace at times. When this happened, people were encouraged to use quieter areas of the home including the lounge and their bedrooms.
People did activities of their choice and were encouraged to try new things. Staff supported people to achieve their ambitions and potential. People undertook activities on their own and in groups, including work and social activities. These included sports, art, hobbies and social events.
The registered manager was committed to continuous improvement and had looked at ways to improve. This had included introducing a framework to support people with end of life care and bereavement. Staff had been trained to consider how to support people at their end of life with the aim to feel calm, pain-free and safe. The registered manager monitored that the changes had been effective by surveying people, their relatives, visitors and staff. Comments from everyone were very positive about the home and the staff.
People were consulted about how the home was run through regular meetings. Staff had worked with people to make these meetings meaningful and inclusive. Meetings were used to support people to choose the menus for the coming days as well as agree any group activities, for example where to go for holidays. People and staff were also involved when new people were being assessed to live in the home as well as recruitment of new staff. This meant they had the opportunity to choose who lived and worked in the home.
The body language and the conversations of people living at The Lawns showed they were happy and felt well-supported in a safe, comfortable and well-maintained environment. We saw people being treated with respect and dignity, with staff supporting them to have as much independence as possible doing activities they clearly enjoyed. People laughed and joked with staff who responded in a friendly, caring manner whilst maintaining professionalism. One person said “It’s my home”; another person said “I love it here.” Relatives commented that "Staff are amazing."
Relatives were very complimentary about how their family member was supported and cared for. They described the home as “fantastic” and said staff were “always supporting [my relative] to get the most out of life.”
People were encouraged to keep in touch with their family. Staff supported some people to visit their relatives regularly as well as contacting them by phone. Relatives described how they had also been supported by staff in the home and were welcomed as part of the “extended family.” People’s privacy was respected by staff.
Everyone we spoke with praised the home, the manager and staff for supporting people to meet their physical, health, social and domestic needs and aspiration. They described how staff involved them and asked their help and advice when needed. People described how they were involved in care reviews. Records confirmed that people had signed to show care reviews had been discussed with them and that they had agreed the information recorded.
Staff were recruited safely and were provided with a comprehensive induction before they started working with people on their own. Staff were supported, through supervision and appraisal, to reflect on their work with a manager. Staff were trained to deliver care to each person and received regular updates and opportunities to develop their skills further. All the staff were very positive about working at The Lawns and praised the provider and the registered manager.
People’s medicines were stored, administered and recorded safely. Staff had received training to support them in their role, both when they first started working at the home and in order to refresh their knowledge and skills.
Meals were important social occasions which people clearly enjoyed. Meals were prepared using fresh ingredients in a safe clean kitchen. People were supported to have a healthy diet of their choice. Where people prepared some meals for themselves, staff supported people to do this safely.
People had access to health and social care professionals to help them maintain good health. People’s capacity to make decisions about specific aspects of their care, for example their capacity to go out on their own, was assessed. Where they were deemed not to have capacity to make a particular decision the registered manager had recorded this and taken steps to ensure they worked within the Mental Capacity Act 2005. The registered manager confirmed they had discussed Deprivation of Liberty Safeguards (DoLS) authorisations