The Lawns

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We reviewed 7 quality statements in this key question.

People made day-to-day choices such as what to eat, however staff believed there could be more choices available such as cooked breakfasts and more activities. They also expressed concerns the service may become institutionalised as the care became less person-centred.

The provider sought to engage with health and social care professionals, however some improvements were needed for people to fully benefit from these relationships.

Complaints were mostly dealt with according to procedures and people knew who they would speak with if they had a problem.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had positive experiences of making choices about aspects of their care such as what to eat and whether to remain in their rooms or access the communal areas of the service.

Relatives were also happy their family members were able to make choices and had person-centred care however, one was concerned that due to their relative’s memory loss they needed more support at times. For example, they were asked if they wanted to see the hairdresser each week. They forgot each week they had their hair done the previous week and spent more than they could afford on this. The relative queried this with staff and the registered manager said it was the persons choice.

Staff did not feel people always had person-centred care. They told us about people being unable to have cooked breakfasts, a lack of activities and 1-to-1 time with people. They were also concerned about how much time people needed to wait for care or just to be noticed. They were also concerned the service was becoming institutional as a result, as peoples care was fitted into what the service could provide rather than the service accommodating peoples care needs as they wished to have them met.

Care was not always person-centred. We observed people and staff during lunch and saw a person drop their knife. They had just received their meal which was a roast dinner. Staff did not see this happen nor note how they were struggling to manage their meal with just a spoon and fork.

We also saw an agency staff member feed a person who had a care plan stating they needed to be supervised and have their meal cut into small bite sized pieces. Kitchen staff offered them a piece of cake that was not cut into small bite size pieces. Agency staff feeding the person and using the language and sounds they used, as though they were feeding an infant was not person-centred care. Agency staff left person unsupervised during mealtime to answer call bells. We reviewed their care plan which stated they were at risk of choking and needed close supervision during mealtimes.

People and their relatives reported no concerns about access to health and social care professionals bar those discussed about support to attend appointments at community locations.

A person did say they would like to be supported to the beach in good weather. They also believed they would be taken to the shop if they wanted to go however were newly admitted and had yet to ask.

Another person was supported to purchase items from the shop as they were no longer able to access them independently. Staff purchased items on the persons behalf but did not support them to the shop.

Some staff were concerned at a lack of community engagement from the service. People were not supported to access the community as part of the activities programme either in groups or as individuals and the community was not often invited into the service.

A staff member told us, “Staff do try their best to give them the time, but it could be a lot better. They could arrange for more trips out of the home and do more person-centred activities.” A second staff member added, “They have no transport available for any of their homes and therefore this makes supporting people outside the home very difficult!”

We received feedback from 4 health and social care professionals who felt, while people were cared for well, there could be some improvements. One professional told us, “We had a very good working relationship with a previous manager (who left a few years ago). I do not feel that I know the current manager at all other than exchanging a very occasional email. There has been a turnover of management, and this is not always well communicated to the [name] team.” They continued, “They do not always engage with, for example, care home forum meetings or general email requests for information or updates to services provided.” A second professional said, “On the whole there are some management and company issues, and a lack of stimulation. The carers work hard, and I feel the residents are well looked after and have a safe environment.” The management issues they referred to they clarified as being the numerous changes to registered manager over recent years.

Senior staff at the Lawns led when arranging consultations with the Frailty Team and District Nurses (DN’s). Both had ‘lists’ staff could add people to which were used well most of the time, with some inappropriate additions at times. This system ensured most people saw healthcare professionals as needed.

Some improvements were needed to how instructions were followed up from healthcare professionals, 2 told us instructions were not always completed in a timely way.

People were supported to communicate effectively. A person had a communication board enabling them to express their views.

The provider had a suite of information available to ensure it was accessible to the people they supported. People told us they had copies of information such as the complaints procedure. We also saw accessible information on noticeboards around the service. There were also accessible copies of the complaint’s procedures available in communal areas.

The registered manager told us there were options available for people who did not communicate verbally or who could not hear. The told us the following tools were available, “Communication boards, card key rings, communication books, large print books and listening books.”

We were assured that these, coupled with the providers suite of information met the requirements of the Accessible Information Standard.

People’s communication needs were assessed on admission and planned for. These plans were reviewed to ensure changing communication needs were met.

We were assured that the tools available, coupled with the providers suite of information met the requirements of the Accessible Information Standard.

People and their relatives told us they would raise any concerns they had about the Lawns with staff or the management team, and believed these would be dealt with.

A person told us they felt if they had to complain that the management and staff would endeavour to rectify the problem, but they haven’t needed to complain. A relative said, "I know I could complain, and they would do all in their power to help me, but I have not complained."

One relative had no response when they complained about staff taking 20 minutes to open the front door to let them in when they visited. They told us the registered manager had not responded to their concerns. People told us they had access to the complaint’s procedures.

A survey had been issued to stakeholders including people and their relatives in November 2023 however some relatives did not remember this. People and their relatives had an opportunity to feedback anonymously about their service.

We did not receive feedback specifically about this area.

We reviewed recent complaints and there had been clear investigations into all. There were chronologies to show actions taken and all documents were on file and outcomes shown.

There was a lack of involvement with people and relatives when compiling care plans, none of the feedback we received suggested any significant involvement of people or relatives.

People and relatives reported no barriers to care. We were told however, some people had hospital appointments cancelled as they had no relatives to take them. This reflected a barrier to care.

One relative was unable to attend family meetings. These were arranged during the day when they were working. They were not happy with the level of communication about their family member and meetings always being during the day did not help this situation. They told us, “They have family meetings when I am working so cannot go.” Arranging meetings during the evenings, weekends and during the day in turn would enable more relatives, particularly those who work, to attend.

Staff and leaders shared mixed feedback about equity at the Lawns. A staff member was positive and told us, “I do feel like the people we support at the Lawns have a good life due to all of the support we give them and how hard all of us work to give them a good life.” However, another staff member described how it was difficult to support everyone to ensure they all had their needs met. They said, “I believe personally we need more staff to be meeting our residents’ needs in a timely manner. I often see the lounge left unattended with people who are at high risk of falls being in the unattended rooms, this is due to the staff answering call bells or on 'doubles'.” They went on to say the high number of people who needed support from 2 staff, meant other people received less staff support.

A visiting health and social care professional thought people at the Lawns had a good life but that it could be better. They said,

“Reviews allow individuals to have time and a voice, some with support from families or advocates. The residents of The Lawns need to have more of a voice and for some to feel that they can have one, they need to be asked questions like: are you happy? Is there anything that can be done to improve your life? Are there any changes you feel need to be made? Is there anything you’d like to do? Too often care homes have a daily routine in which the residents engage with, seemingly content, however, I do feel residents at The Lawns need more options to have a voice. Monthly questionnaires? Monthly meetings? Asking individuals and their families how things can improve?

as can have a significant impact on the health and wellbeing of the individuals. They also described how their support had enabled a person and their relative to look into possible community activities. This was because they asked the person what they wanted and investigated ways of making it happen. Without staff taking time to enable people to communicate effectively, they would be unlikely to access what they want.

Access to a member of the local frailty team was available to people as they held a weekly surgery at the service. District nurses attended as needed to support people living with diabetes or who had pressure wounds.

People were also able to access advocates as needed and social care professionals visited the service regularly.

We identified an inequality to access to care and mentioned it earlier in this report. People were not always supported to attend appointments as planned if they had no relatives to support them due to a lack of staff availability.

We received mixed feedback from people and their relatives about equity in experiences and outcomes. People and relatives were not actively encouraged and enabled to feedback about care in ways that work for them. People and relatives did not feel in control of planning their care and support and to regularly review their experiences and outcomes. Comments included, “They moved [my loved one] downstairs as concerned [they] could fall and forget where [their] room was. They adjusted care, now [they] have a walking aid and sometimes uses a chair. There has been no risk assessment. They never reviewed the care plan”, “[My loved one’s] care needs assessment was after [they] were admitted. Hospital had said [they] were not incontinent, care home thought [they] were – not sure. I never had a discussion about [my loved one’s] care needs. I go into the office to ask if [they] need anything or more money, not held a meeting. I am working with the social worker to get [my loved one] moved”

And “[My loved one] is supported to maintain their human rights Staff make sure [they] have a choice.”

Staff believed they no longer had time to involve people in planning their care and support, “The allocated paper days were to discuss with residents their care, build our relationships with families and talk to carers in more depth about the care and support they are given and analyse day to day personal care etc; this was literally gone over night.”

Staff told us care and support was well managed, “I thought [seniors’ names] all had amazingly in-depth knowledge about every single resident there and truly cared about their wellbeing and happiness” and “When people are new to the home, they are often not used to people being around them when they are attending to their personal care needs, and it is important that staff remember this and respect it. Involving the resident in their care is of paramount importance.”

People's care plans were detailed; however, they were not always personalised and up to date. People and their relatives were not always involved in care planning and reviews. Systems to receive people, staff and professional feedback were not effective. People and relatives knew how to complain and were confident any issues raised would be addressed and resolved. The provider complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes.

We received feedback from some people and their relatives telling us they had not discussed or seen care plans for the future. They were positive about staff members however telling us they were understanding and empathetic so they were confident their family members future care would be delivered well. Another relative told us, “We have talked about end-of-life care with the GP and hospital, have a DNR and agreed would not want them to go to hospital.”

Two different staff members raised concerns there had not been enough staff to sit with a person at the end of their life. One told us, “What has been a very upsetting experience is when we have people approaching the end of life and no one [staff] can sit with them to offer them the reassurance they deserve.” This was something staff members were passionate about, wanting to ensure people had a good death.

Staff had discussed future plans with people and had been kind and careful to find appropriate times to do so. For example, when a person had been unwell, they did not discuss end of life care as this would have alarmed them, instead they waited until the person recovered to meet with them and their family.

Another person understood their lifestyle caused significant risks to their health, they had been told to cease drinking alcohol and smoking. However, they understood the risks associated with these behaviours and chose to continue to enjoy their life, albeit shortened, rather than cease what gave them pleasure. Staff ensured the person understood the risks and supported them with engaging in their chosen activities.

Care records held some advanced care plans for people called ‘Thinking ahead’. Some people and their relatives had discussed what was important to them and whether they understood they may need a hospital admission in future. One person responded the most important things were her family and friends and they would like to remain at the Lawns as it was their home. Additional information in these plans could be added such as which funeral directors and any advanced funeral plans.

The provider had been accredited by an end-of-life pathway in the past; however they are not currently accredited. The registered manager told us they would apply again in future. They continued to use the principles of the pathway however we saw these were not used consistently.