We carried out this unannounced inspection of The Lawns on 18 October 2016. The last inspection of The Lawns took place on 7 January 2014. The service was meeting the requirements of the regulations at that time. The Lawns provides nursing and residential care for up to 31 people some of whom are living with dementia. Bedrooms were situated on the ground and first floor and there was a stair lift and passenger lift available. The home is situated in the small town of Brixton on a main road on the outskirts of Plymouth and close to public transport networks. At the time of the inspection there were 29 people living at the home.There was 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.
We looked at how medicines were managed and administered. We found people were receiving their medicine as prescribed. However, the first administration round was observed to take most of the morning to complete. This was because some people needed more time and support to take their medicines. The nurse responsible told us “Some days are quicker than others”. The registered manager had made arrangements for pain relief and other essential medicines requiring administration in the morning to be administered at 7am. This meant people were having their medicines when they needed it. Records showed these medicines had been administered at the times prescribed. Regular medicine audits took place to identify they were being administered as prescribed and were safe.
At the time of the inspection work was taking place to repair a boiler which had affected the supply of hot water in parts of the home. Staff were managing to work around this and there was limited disruption. Staff were able to use alternative measures to heat water and the contractor confirmed the repairs would be completed in the next few days.
The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices.
Staff were visible in all areas of the service throughout the day. There were enough staff to spend time with people in addition to providing personal care. People told us “Never have to wait long before someone comes” and “They look after me well.”
Some people had complex needs and were not able to tell us about their experiences, but other’s told us they were very satisfied with the care and support they received living at The Lawns. Relatives told us, “They (people using the service) are being looked after very well” and “They (people using the service) are being amazingly well looked after.”
People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure people’s safety. Care records included details of people’s choices, personal preferences and dislikes.
We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.
Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.
Staff were supported by a system of induction training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training, support and development.
The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.
People were offered a choice of healthy and nutritious meals. Staff made sure people's dietary and fluid intake was sufficient for good nutrition. People had a choice of meals and relatives said they often had snacks and drinks outside of meal times. The cook had information about people’s dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ensure they stayed healthy.
People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Families and staff felt they could raise any concerns or issues they may have with the manager, who they said was approachable. People told us they felt their views and experiences were listened to.
The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits and meetings with all stakeholders of the service. Response from this monitoring showed that there was overall satisfaction with the service.