Archived: Lavender Court

Updated 11 September 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was undertaken by two inspectors. One inspector visited the service and another

inspector made phone calls to relatives of people living at Lavender Court and staff members. The

inspection activity was over four days, including two days of on-site visits and remote meetings with the registered manager.

Service and service type

Lavender Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We announced the inspection at very short notice; this was to have some preliminary discussion around the use of Personal Protection Equipment (PPE) and maintaining social distancing on inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection. We considered the information received from the provider in response to our Emergency Support Framework (ESF) call on 24 June 2020.

During the inspection

People’s needs and communication difficulties meant we were not able to seek direct feedback from people. Opportunities to observe staff supporting people were limited due to covid-19 risks. To gain a balanced view we attempted to make contact with all relatives and professionals who were involved with the service. We spoke with four relatives about their experience of the care provided. We spoke with seven members of staff including the registered manager, senior care worker, care workers and an agency member of staff. We received written feedback from three professionals from the community learning disability team.

We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, such as health and safety compliance certificates and checks, incident reports and infection control protocols were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, quality assurance records and policies and procedures. We received feedback from two professionals who had been involved with the service after our inspection.

Updated 11 September 2020

About the service

Lavender Court is a residential care home providing personal care to seven people with a learning disability in one adapted building. At the time of our inspection seven people were supported.

Not all aspects of the service have been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use

the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control,

choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service is registered to support up to seven people. This is larger than current best practice guidance. However, the size of the service was mitigated by the building design and a refurbishment of the premises in 2019, which reduced the number from eight to seven. There was no signage to indicate it was a care home and staff did not wear uniform that suggested they were care staff when coming and going with people.

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

People did not consistently receive safe care and support. The registered manager had not routinely ensured they were up to date with national guidance and did not always keep accurate records in relation to risk management. Staff did not always mitigate potential risks to people.

Incidents were not always escalated appropriately by the registered manager or reported to the safeguarding authority. The service did not always operate systems effectively to ensure suitable staff were recruited or make sure staff had the right training to support people safely. Systems were not always in place to ensure the effective management of medicines which meant people were at risk of not receiving their medicines as prescribed.

Systems were either not established or operated effectively to monitor and assess the safety of the service or standards of care. Several key policies and procedures were not in place to provide staff with clear processes to maintain good standards of care. Audits completed by staff to check the quality of the service did not always identify or address areas to drive improvement. Records in relation to people's information and the management of the service were not always accessible, complete or up-to-date.

Relatives were positive about the standards of care provided however, communication from the provider and registered manager was inconsistent. For example, relatives received formal correspondence about a significant event but did not receive written guidance about the management of covid-19 or visiting agreements.

Processes to manage the risk of covid-19 were established and implemented by staff to reduce the risk of infection. Relatives told us they felt their family members received safe care and had no concerns about staff practice. Staff were positive about team collaboration to meet people’s needs and generally felt supported.

The service didn’t always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons. Care provision was not always designed to meet people’s personalised needs. Staff did not receive specific training for managing people’s behaviours that challenge. There were no systems in place to monitor whether positive behaviour support plans were implemented effectively or continued to meet people’s individual needs.

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 Requires Improvement (published 15 January 2019) with two breaches of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17, 18, 22 and 30 October 2018. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We identified concerns in relation the governance and risk management of the service during our contact with the service following our emergency support framework engagement call. We undertook this focused inspection to check these areas of concern, to make sure they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains Requires Improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment, fit and proper persons employed, duty of candour, failure to notify CQC of certain events, and good governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 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.