Archived: Lavender Court

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.

Lavender Court provides adapted accommodation and care for up to seven people with learning disabilities. At the time of our inspection there were seven people using the service, supported in the home by 17 permanent staff. Some of these staff were allocated to the home from another service which was closed for refurbishment. At the time of the inspection there were plans to rota the staff across the two services when it re-opened in the new year.

The property is a large bungalow with seven bedrooms, communal spaces, a rear garden and is close to local amenities. The home was closed between January to July 2018 for a refurbishment project which adapted the premises for people with mobility needs and to provide en-suite facilities.

This inspection took place on the 17, 18 and 22 October 2018. We returned on the 30 October 2018 to provide feedback to the registered manager and operations manager who were both on annual leave during our inspection on the 22 October 2018. The inspection was unannounced on the first day of inspection which means we did not provide the service with warning of our visit. Subsequent days were announced.

The provider is required to have a registered manager as part of their conditions of registration. 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. At the time of our inspection, there was a manager registered with us.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we found breaches of Regulation 12 (Schedule 3), 15 and 18 of the Registration Regulations 2009 and Regulations 9, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service received an overall rating of requires improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) safe, effective, responsive and well led to at least good. At this inspection we found there were repeated breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have satisfactory arrangements to manage individual’s risks and safety. Records were not suitably maintained, accurate and up to date and the governance of the service failed to bring about the improvements required for them to become compliant.

Systems did not always ensure that vulnerable adults were protected from foreseeable risks. People’s risk assessments were completed but were not always clear or accurate and did not contain sufficient information to identify or mitigate risks. The service did not use an effective method to calculate staffing deployment.

The governance of the service was unsatisfactory. A quality assurance tool had recently been developed but was not comprehensive, and not always acted on promptly or sufficiently. Records were not always up to date or appropriately filed. There was not sufficient day-to-day management oversight of the home or enough time allocated to senior staff to achieve delegated management duties.

The service had made improvements to staffing levels which meant people were supported to be safe. The service did not use an effective method to calculate staffing deployment. Staffing was based on people’s funded care, and not their individual needs or dependency. We have made a recommendation about this.

The service did not have a specific safeguarding policy and procedure and we have made a recommendation about this. People were safe from abuse. Staff were able to identify abuse and signs of abuse and understood how to report concerns to management. Medicines were managed and administered safely. Recruitment checks were completed as required.

People’s health and wellbeing needs were met. The service worked closely with clinicians and other professionals and followed advice and treatment plans effectively. Staff understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and the principles of gaining consent or making decisions in peoples’ best interests. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The service provided a friendly atmosphere and staff demonstrated kindness and commitment to people’s welfare. Staff approaches were respectful of privacy and dignity. People’s relatives and relevant others were consulted to make decisions in people’s best interest, where people lacked capacity to consent. Care plans were person-centred and responsive to individual’s current and changing needs. People were supported to follow their interests and work towards their own goals.

You can see what action we told the provider to take at the back of the full version of the report.

The service provides accommodation and residential care for up to eight adults with moderate to severe learning disabilities. Lavender Court is situated in residential area of Slough, Berkshire. The building is a large, detached bungalow on one level. There are eight single bedrooms with a lounge area, a separate dining room, kitchen, office and communal bathrooms. There a large patio and garden at the rear of the premises. Although not registered with us, there is also a separate day services building adjacent to the service, which provides a base for activities such as IT, music, exercise, cooking or arts and crafts. People who lived at Lavender Court attended the day centre at various times from Monday to Friday.

At the time of the inspection, there was no registered 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. Leading up to the inspection, we were required to complete an administrative cancellation of the former registered manager, as they have failed to cancel their own registration. The home manager at the time of our inspection had not applied to add Lavender Court to their existing registration.

Since registration under the Health and Social Care Act 2008 on 20 January 2011, Lavender Court was inspected four times. The most recent inspection was a routine planned visit on 19 December 2013. We inspected five outcomes which were compliant. This inspection is the first visit under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the first rating under the Care Act 2014.

People who used the service were protected from abuse and neglect. Appropriate systems were in place to ensure that any allegations would be reported for assessment and investigation. The service was unable to tell us if any allegations were ever referred to the local authority. There were no records which showed allegations of abuse or neglect.

Some risks for people and the service were assessed, mitigated, documented and reviewed. Risk assessments related to people’s care required better oversight. We found that some risk assessments were missing. For example, one person who had routine falls and others who had epilepsy did not have specific risk assessments to prevent harm. Risks from the building were considered and managed, although records were not kept in an organised format.

We looked at two staff personnel files. The location’s home manager was responsible for ensuring fit and proper person checks were completed and recorded for new staff. We found the service had strong recruitment and selection procedures that ensured suitable, experienced applicants were offered and accepted employment. Personnel files contained all of the necessary information required by the regulations and no documents or checks were missing.

Medicines were safely managed. We examined the handling of people’s medicines during our inspection and found that people were safe from harm. The home manager explained there were no medicines incidents. However, even potential failures in practice that did not result in harm to people required reporting. We advised the provider to seek guidance and support to ensure any medicines incidents were always recorded and reviewed.

The deployment of staff was unsafe and inappropriate. Although organisational restructuring was evident, the safety of people was placed at risk due to inappropriate changes in the staffing levels and roles. People’s dependency levels and satisfactory risk assessment of staff numbers on day shifts were not considered. We observed numerous instances during the inspection where people were at risk because the available staff were busy. The staffing deployment also impacted on people being able to leave the building when they wanted or indicated to.

Staff training, supervision and performance development were lacking. At the inspection we were told that satisfactory records for staff training and supervision were not able to demonstrate appropriate levels of staff support. We wrote to the home manager after the inspection to provide the opportunity for further evidence to be collated.

The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decision making ensured the service complied with the MCA Codes of Practice. People were deprived of their liberty in line with the MCA and associated procedures.

People received nutritious food which they enjoyed. Hydration was offered to people to ensure they did not become dehydrated. Snacks and treats were available if people wanted or chose to have them.

People who used the service were unable to communicate their feelings to us about the care. We found care workers had put in extra effort to ensure that the service was caring. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. Relatives and advocates we spoke with described Lavender Court as caring.

Personalisation of people’s bedrooms was evident. Communal spaces were not personalised or provide a homely feel. The garden and other outdoor spaces were unkempt. People had access to the nearby day centre, but there were limited other opportunities for social stimulation. We saw people’s privacy and dignity was respected at all times.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated as far as possible. Staff knew about the complaints procedure. There were no complaints since our last inspection, however there was also no information available to people and others on how to make complaints.

The workplace culture at Lavender Court required improvement. Despite changes in management of the service, there was a low staff turnover. The service failed to notify us of significant events in line with the regulations. This meant we could not effectively monitor the compliance of the service. A series of audits and checks were not routinely conducted to ensure good governance and quality of care.

We found eight breaches of regulations as a result of this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three care staff who told us that they supported people to be as independent as possible and supported them to work towards and achieve personal goals. We looked at a range of files that demonstrated the personalised approach in place to support the staff's comments. We observed that the manager operated a model of good practice by offering staff regular supervision and access to a framework of training.

We observed staff treating people with respect and were able to see that there was a good relationship between staff and people who use the service. We observed staff assessing people's needs and ensured that care was provided in line with individual care plans. We saw that people were comfortable and that adequate numbers of staff were available to provide the individualised support needed.

Care records provided clear guidance to staff about how to meet people's needs and were personalised to the people they related to. There was evidence that people where possible were involved in their care and able to give consent. Where this was not possible, the appropriate meetings were held with those working on their behalf to ensure their rights were being upheld.

We observed people participating in a cookery activity, laughing and interacting positively with staff.

Staff we spoke with demonstrated a good understanding of people's needs and how they could be met. They also ensured they were kept up to date on any changes to people's needs through handover meetings, staff team meetings and email communications.

The Local Authority ensured that all appropriate recruitment checks were carried out prior to staff starting work. The provider's arrangement for staff induction, training and development provided staff with the knowledge and skills required to meet the needs of people using the service.

Most care records were up to date and reviewed annually; there were some risk assessments that had recently passed their review dates.