The Lawns

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 7 quality statements under this key question. We found 2 breaches of regulations.

Audits were not effective at identifying issues with the quality and safety of the care of people or the premises. We were also not assured audits were accurately completed. Systems had not been established to ensure sufficient staff were deployed, to provide suitable staff cover for absence, to ensure risks to people were updated and mitigated and to ensure notifications were made in a timely manner.

Staff found the registered manager and deputy manager to be supportive however found the provider less so. There had been several changes to the registered manager over recent years and staff found this to be unsettling. The current registered manager had given notice and left prior to the publication of this report. Staff expressed concern at the lack of support provided to them when they commenced in their position.

Staff were able to report concerns about the service using an email system and could remain anonymous.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The providers values were, “We are people focused, we are genuine, we have integrity, we will develop, we are a team.”

Overall, comments and feedback from staff did not indicate the provider was working to its own values. They reflected feeling unappreciated and unsupported, they felt relationships in the community the service had developed were being lost and their views as a team were not being heard.

People using the service were not particularly diverse, this reflected the local demographic. The staff team however was diverse and people enjoyed sharing stories about travel and learning more about staff members backgrounds.

At times there had been offensive or discriminatory comments from people however these were dealt with by the registered manager.

The provider had published their values and had policies to ensure no one, whether staff or people felt marginalised. Staff had completed training in the providers values and some policies, however we were not assured the values, or some policies and procedures were embedded into daily practice.

There had been several changes to the manager over recent years, and since Care Dorset Limited took over the service. The registered manager had been in post since October 2023 and was working their notice to leave by October 2024. At the time of preparing this report, they had left the service and there was no registered manager in post.

Staff had struggled with the changes to the management team and with the different approaches by Care Dorset Limited. Six staff members raised concerns that the registered manager was not enabled to manage the service but were ‘micro-managed’ by senior managers. This is concerning as the registered manager is because they are ‘registered’, held accountable for services provided at the Lawns. Not being allowed to make decisions about the service means they are liable for the outcome of other’s decisions.

A staff member said, “Every year we seem to get a new manager. There is something wrong here. There is no consistency. They are micromanaged and the provider treats it as a business and not a care home.”

Staff members were also concerned the registered manager did not receive support and guidance when they commenced in post and had to rely heavily on senior staff at the Lawns for assistance and guidance. They also told us, “[Registered manager] is a good manager. They have tried to turn things around but had no support and yet again is leaving [managers] role. It’s sad they are leaving as they have not been supported at all by [provider].”

Staff also reported they felt the management team could have a more open-door approach and assist with practical care tasks when the team are struggling. Tasks staff believed should be completed by management were delegated taking them away from their own duties. They were also concerned that the whole management team did not attend handovers leaving them unaware of what was happening with people at the service.

Manager meetings were held involving managers from Care Dorset services and the registered manager should have regular supervisions with their line manager, a head of operations. Weekly ‘catch up’ calls were also held between the registered manager and head of operations.

The provider also had specific training courses for managers, there were 5 listed on the training matrix provided by Care Dorset Limited, only 2 of which were completed. Training for managers in safeguarding, MCA and DoLS and Health and Safety had not been completed by any staff at the Lawns.

The registered manager was new to residential care when they commenced in post. They told us their line manager was also new to residential care. This meant there were limited opportunities for the registered manager to develop the skills needed to effectively manage the Lawns.

Relatives were concerned about the management turnover. A relative said, “I do feel, from my time at The Lawns, that they are desperate for some stability. They have had a lot of changes with management etc., and at times you can see the strain this has had on the staff.”

Staff had spoken up to the provider, and to external organisations such as the Care Quality Commission and the local authority safeguarding team. A staff member spoke to us about their experiences reporting concerns internally to senior staff, and how they had then reported the concerns externally when no changes were made.

Staff did not always believe the concerns they raised were acted upon and had preferred to report anonymously.

The provider’s CEO attended a meeting with staff and heard them discuss how difficult the current staffing levels made their job currently and how it had a negative impact on people living at the Lawns. A staff member who attended the meeting said staff were emotional during the meeting, some crying as they made their views known. Following this meeting the staffing levels were further reduced. This gave staff the impression that whoever they spoke with, they would not be heard.

The provider had a ‘speak up’ system where staff could report concerns. They could do this overtly or could report anonymously if they wanted. Emails were sent to a central address where they were reviewed and assigned to a relevant person to investigate. Staff were aware of the speak up systems and knew how to access this.

Staff had been concerned there were no outcomes reported to them when they had used this system however, if reporting anonymously this was not possible. It was also noted that if senior staff reported concerns anonymously, they may then be asked to investigate them. This meant that there was limited objectivity when looking into concerns raised.

The providers policy on speaking up stated it would protect staff if they reported concerns, even when they were unfounded or in error.

Staff told us they did not always feel involved or listened to, “In the last staff meeting I was involved in, run by [manager’s name], it felt as though [they] were not considerate of staffs concerns and didn’t take much interest on how the staff felt overwhelmed and understaffed”, “We not had staff satisfaction survey. Few times I went home wanting to cry. Few people left because of the new provider. I feel sorry for the residents”, and “Staff are feeling overworked, overwhelmed and overstretched.” There had been an overall provider survey, not one specific to the Lawns in 2023 however, it was ineffective in identifying the issues found at this assessment.

Support for staff from managers was inconsistent. Not all

staff understood their roles and responsibilities. Staff told us there was a high turnover of managers which impacted on staff morale, “Staff morale is very low. [Staff] don't feel supported. It used to be a clean, happy place and full of life, the manager knew everything from all angles. Everyone knew what their role was and what was expected of them. Now no one takes ownership of anything. Management are dismissive if approached with the ‘I am busy’ attitude.”

Provider had policies and procedures supporting diversity and inclusion within the service. Equality and diversity were not consistently promoted or effectively evaluated. We were not assured the causes of workforce inequality were always proactively identified or adequately addressed.

Processes to engage with and involve staff were not always effective and proactive, with a focus on hearing the voices of staff with protected equality characteristics and those who are excluded or marginalised, or who may be least heard within their service. Staff did not always feel empowered and confident that their concerns and ideas result in positive change to shape services and create a more equitable and inclusive organisation.

Staff were from diverse backgrounds, and everyone was welcomed into the service. Staff told us they would care for anyone if they needed it, regardless of their background. Staff received training in equality and diversity.

The registered manager told us who was responsible for completing each audit. While the registered manager was responsible for some audits, they told us they had oversight of all audits. Senior staff completed different audits, and the registered manager checked these. There were also audits completed by senior managers which were shared with the registered manager so they could improve on them. The registered manager described finding these difficult to cope with as many of the issues found in such audits, because of the way the service was managed, could not be improved by the registered manager as decisions about them were outside of their remit.

There were a range of audit tools in use, completed by different staff on various aspects of service provision. We were not assured audits were completed accurately. Audits and quality checks to ensure the proper and safe management of medicines were not always effective and had not identified or addressed issues found during this inspection. For the 3 months before our assessment your medicines audit rated the service as outstanding on 2 occasions and good on the other. We found numerous concerns regarding medicines management which would have been present at the time provider’s audits were conducted.

Audits completed in the service were not effective and did not identify issues found during our assessment. Processes to ensure compliance with the requirements of the regulations were ineffective. We found multiple breaches of 6 different regulations during our assessment.

Relatives gave mixed feedback about communication from the service. Some were pleased with the amount of information shared about their family members, some told us they were not informed about them.

A feedback questionnaire was being prepared to issue to people and relatives however the provider had not permitted the registered manager to send one, instead feedback was not being sought until the provider had prepared their own questionnaire.

Relatives told us, “[Staff name] emails things like there is a new hairdresser or about family meetings. I do not feel management keep in touch.” Another said “Everything is well organised. I have never complained. If I did would complain to the manager, they are accessible, have an open door. I am confident they would deal with it. I don’t get information about any changes, no formal updates, or newsletter but getting it would not improve mother’s care.” A fourth relative told us, “They keep me fully informed by email, and if they need chiropody, dentist or optician they deal with it and keep me fully informed. Communication with the home is good, I have nothing negative to say.”

Staff told us they would consult with health and social care professionals as needed. For example, both DN’s and a member of the Frailty Team attended the service regularly. If available, staff would accompany them when attending to people to facilitate effective communication and minimise upset to the person.

Staff were also concerned they were losing some longer standing community partnerships, and not taking advantages of local facilities and forming new ones. A staff member told us, “Community access is poor we have a shop, a post office a college and a junior school very close by, and it’s a missed opportunity we are not involved in the community. Evidence suggests there are great benefits to the mental and emotional health of older people who interact with younger people, and this can be reciprocal.”

Information was shared with partners such as GP a DN services as well as specialists such as SaLT. A professional told us, “One [staff member] in particular often fills my appointment ledger with inappropriate concerns, often with a lack of information to understand the concern. One senior [SCCSO name] stands out as an asset to the care home. They have always managed to demonstrate good knowledge of the residents, if they have not been working, they will always manage to find the answers to my concerns. They will often record observations or weights and communicate with me in a timely manner. They are often dealing with office duties, liaising with external agencies like district nurses and myself, managing medication rounds and leading the other carers. Despite this, they manage to complete all tasks asked of them.”

Senior staff took responsibility for communicating with healthcare professionals. They compiled lists for the Frailty Team, arranged GP appointments and ensured DN calls were arranged. This worked reasonably well however, as previously mentioned, staff had diverse levels of skill when it came to referring and arranging training and guidance for senior staff would be beneficial for them and healthcare professionals.

Staff and leaders reported they did not always have 1-to-1 supervisions as planned or as frequently as they should so did not always receive timely feedback on their performance or have opportunities to contribute suggestions following incidents or to contribute to care plans.

The provider held regular family, staff team and senior meetings during which information was shared. This included learning from incidents and changes to service provision should there be any.

Staff, people and their relatives could raise matters at these meetings, and we saw minutes reflected questions raised were followed up on after the meeting and additional notes added with outcomes.

A daily meeting was held with department leads during which information and updates was shared. This included sharing information about incidents and accidents and any learning which was to be disseminated to staff by team leaders at their earliest opportunity.