Lavender House

Lavender House is a residential care home providing personal care and support to up to 18 people. The service provides support to people with mental health care needs. At the time of our inspection there were 18 people using the service who were all accommodated in 1 adapted building.

People’s experience of using this service and what we found

At our last inspection we found the provider had not always operated their quality monitoring systems effectively, which we discussed with the provider at that time. At this inspection we found the provider had taken enough appropriate action to improve how their governance systems were managed.

People living in the care home and various community mental health, medical and social care professionals we contacted all spoke positively about Lavender House. A person told us, “I am very happy living here. The managers and staff are all lovely and really do know how to take care me, especially when I'm feeling emotionally unwell.” A community health care professional added, “Lavender House is a very good service and people living there receive good care and support. They [staff] work very well with them and are always calm, caring, and competent.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service was adequately staffed by people whose suitability and fitness to work at the care home had been thoroughly assessed. People were kept safe and were confident any concerns they raised would be listened to. Staff understood how to safeguard people. People were cared for and supported by staff who knew how to manage risks they might face. The premises was kept clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. Medicines systems were well-organised, and people received their prescribed medicines as and when they should.

People living in the care home, community mental health and social care professionals, and staff working there were all complimentary about the way the service was managed, and how approachable the managers were. The provider promoted an open and inclusive culture which sought the views of people living at the care home, their relatives, community care professionals and staff. The provider worked in close partnership with various community mental health and social care professionals and agencies to plan and deliver people's packages of care and support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good overall (published 23 December 2017), but the key question well-led was rated requires improvement. This was because at our last inspection we found the provider did not always operate their established quality monitoring systems effectively, which we discussed with them at the time.

At this inspection we found the provider had taken the appropriate action they said they would at their last inspection and had significantly improved how they operated their governance systems.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We also looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lavender House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information, we may inspect sooner.

At the last inspection, the service was rated Good. At this unannounced inspection we found the service remained Good. This inspection took place on 30 October 2017 and 17 people were living in the service.

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.

Systems for effective management had not been fully established in all areas. Management systems that included quality monitoring did not always ensure safe and best practice was established and followed. For example, the care documentation did not reflect the care and support required in all areas. Audits were not established to identify risks in all areas for example, to respond and minimise the risks associated with infection control. The service’s policies and procedures were not all comprehensive, up to date or embedded into practice to support best practice. For example, recruitment practice did not follow a robust and effective procedure. These areas were identified as requiring improvement.

People were looked after by staff who were genuinely empathetic and understood people’s individual needs well. Staff had a very caring and professional approach and supported people to maintain their independence and psychological welfare. People’s dignity was protected and staff were respectful. All feedback received from people and visiting professionals was very positive about the care, the atmosphere in the service, and the approach of the staff. Visiting professionals held the registered manager and staff in high regard, praising their commitment to supporting people in a facilitating way.

People’s medicines were stored, administered and disposed of safely by staff that were suitably trained. People were protected from the risk of abuse because staff knew how to recognise and report any safeguarding concern. Staff were trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and knew the correct procedures to follow in order to protect people’s rights.

Staff were provided with a training programme which supported them to meet people’s needs. Staff felt well supported able to talk to any of the management team including the provider. On call arrangements ensured suitable management cover. Staff were motivated and worked well together and were able to undertake professional development as they wished. Staff were listened to and valued with their views taken into account when planning care and developing the service.

People were supported to be involved in a variety of activities this included one to one time with staff, shopping and socialising. Staff recognised the importance of family and friends and worked hard to re-establish and maintain important contacts with these. People had enough to eat and drink and their nutritional needs were well assessed and monitored when needed. People enjoyed a range of nutritious food and drink throughout the day and were able to help themselves to drinks and snacks.

Staff related to people as individuals and took an interest in what was important to them. They took time to establish effective communication with people. In this way they ensured they worked with people to maintain and improve their health and to promote their independence. People’s choices and preferences were explored and integral to the care and support provided.

There was an open culture in the service the registered manager listened to the views of people and staff. Both the registered and manager and provider were visible and approachable taking time to talk and respond to people’s and staff feedback. Staff enjoyed working at the home and felt very supported. Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback.

People were involved in the planning of their care and support. One person told us 'what I've got here is what I've agreed to; they check with us they're doing what we want.' People agreed short-term plans so at any time the support they received was focussed on goals they wanted to achieve, such as going out more or increasing independence in different ways.

There was evidence of close working relationships between the home and community mental health and primary care services.

All people we spoke with said they felt safe living in the home. One said 'Yes, that's why I like it. It's a calm place, you live your own life but get all the help you need.'

Medicines were administered only by staff who had been trained in safe handling of medicines. People told us they received medicines reliably on time, and in private. They had a good understanding of what their medicines were for. There were no individual protocols to demonstrate safe decision making about the use of 'as required' medicines and there was no formal system for periodic checking of staff competency in handling medicines.

The provider visited the home every week. People living in the home and staff appreciated this and told us they found the provider very supportive. We saw the management found out about people's views of the home by regular surveys, meetings and through everyday communication. They showed they were responsive to what people told them.

We saw that people had been involved in making decisions about their care and treatment. Records showed that people's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. People told us they were happy living at the home. They told us they could be independent and that staff respected their choices. They told us that they were free to live the life that they chose. We found that people had a greater opportunity to exercise choices than at our last inspection.

People who use the service were protected from the risk of abuse and told us that they felt safe at the home. Improvements to the home had been ongoing. One person commented, 'I have a lovely room it is cleaned and polished once a week. The place has been refurbished and is very smart. I have a new carpet in my room".

The staff were well trained and demonstrated a good knowledge of people's needs. People who used the service said that staff provided them with all the support and assistance that they needed and wanted.

There were systems in place to identify, assess and manage risks to people who used the service.