Lavender Villa

Lavender Villa provides nursing and personal care for up to 40 people who require functional mental health care. At the time of our inspection there were 35 people using the service.

Lavender villa is a purpose build single story building set within the Grosvenor Villas complex of care services. People have their own bedrooms and can access a variety of communal areas including living, dining and outside areas and adapted bathrooms.

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

Systems for checking the safety of care were not always robust and did not identify some of the shortfalls we found at this inspection. The management and staff team were keen to drive improvement within the home and people spoke positively about how they were supported to achieve good outcomes. The service was in the process of restructuring the management team and some recruitment in this area was ongoing.

People were happy with how they were supported with their medicines. However, records did not always contain enough detail about how staff should support people who required their medicines to be given covertly or had medicines prescribed that they needed occasionally. We made a recommendation that the provider review best practice guidance to ensure people are safely supported to take their medicines. Staff were safely recruited and generally there were enough staff to meet people’s needs. The service completed relevant risk assessments and staff knew how to reduce these risks as much as possible and relevant records were in place.

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.

Care plans were in place, although the quality of records varied. People spoke positively about how they were supported, and staff had received a variety of relevant training and spoke positively about the induction process. People were supported to access health care services as needed. People enjoyed their meals and could choose what they wanted to eat.

Staff were kind and caring and knew people well. People’s privacy and dignity was respected. People were encouraged to remain independent where possible and supported to make decisions for themselves.

People and relatives were involved in developing care plans. People were supported to access a range of activities both within the service and in the community. People felt able to raise concerns, and where complaints had been made these were investigated. People’s end of life care needs were considered and staff were able to complete training in this area.

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

Rating at last inspection

The last rating for this service was requires improvement (published 30 April 2020) and there were a number of breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made but the provider was still in breach of one regulation.

Why we inspected

This was a planned inspection based on the previous rating.

We 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.

Enforcement

We have identified a continued breach in relation to the robustness of the systems of checks and audits at this inspection. We found no evidence during this inspection that people had come to harm from this concern and the provider took quick action to address any shortfalls we identified. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lavender Villa provides nursing and personal care to up to 40 adults whose primary needs are associated with their mental health. At the time of our inspection, there were 36 people using the service. Some people using the service were also living with dementia.

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

A lack of robust governance and daily management oversight had resulted in issues relating to the quality and safety of the care people received. Governance systems in place had failed to identify the concerns we found and whilst regular checks and audits were in place, they were not effective at driving improvement. Although the registered manager and management team were keen to promote a person-centred, inclusive and empowering culture, the current processes in place did not allow staff the opportunity to implement this within their daily role.

People's safety was not always managed effectively. Some staff had not received specific training to manage people's assessed risks such as those related to food and drink intake. We observed some staff performing manual handling procedures incorrectly, potentially placing people at risk of avoidable harm. The service had failed to take robust action following previous safeguarding incidents to prevent re-occurrence and keep people safe from harm. Some records relating to people's assessed risks were not legible making it difficult to determine whether information was accurate.

Safe recruitment processes were not always followed. Whilst checks on applicant's safety and fitness had been carried out, some references had not been followed up and verified. Appropriate assessments had not been completed where information regarding applicants' previous history had been disclosed. The service did not always deploy enough staff with the knowledge and experience required. Some staff working on both days of inspection were newly recruited which meant only a small number of experienced staff were deployed.

Whilst people's needs had been assessed in line with guidance, some information recorded was inconsistent and not easy to read. We found no evidence that people were not receiving effective care, however records maintained were not always up-to-date.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Although relevant polices were in place the systems in the home had not ensured that people's pre-made decisions were being met in their best interests. Staff did, however, provide people with choice and control over day-to-day decisions about their care.

People did not always receive care that was person-centred and based on individual needs and preferences. Where some people had specific conditions associated with their DoLS authorisation, these were not always being met. Care plans lacked detailed information regarding people's life histories and end-of-life care wishes and preferences.

People spoke positively about the caring nature of staff and observations showed positive interactions when providing support. However, care and support was often task-led with a lack of quality time spent with people. People's equality characteristics were not always fully protected and staff did not always use dignified language when referring to people's distressed behaviours.

People were supported to maintain a balanced diet and care plans clearly documented people's individual dietary requirements. Staff provided people with support they needed at mealtimes. People received support to access healthcare professionals and services.

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

Rating at last inspection

This was the first inspection since the provider re-registered the service in April 2019. The rating from the last inspection at the previous address was rated requires improvement (report published 29 December 2018). We used this rating to inform our inspection planning.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding people from the risk of abuse. A decision was made for us to inspect and examine those risks.

We have identified breaches in relation to keeping people safe, recruitment, person-centred care and the leadership and oversight of the service at this inspection.

Prompt action was taken by the registered provider after the inspection to mitigate risk and improve the quality of care in response to the concerns we found during our inspection.

Please see the action we have told the provider to take so far at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.