Lavender Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Some people shared concerns in relation to staffing levels and at times having to wait for assistance, particularly for personal care if there were not enough staff available there to help them. Our observation and review of the service’s call bell monitoring found that there were not always enough staff on the nursing unit to support people. People felt that permanent staff were aware of their preferences and how to support them with their independence, however they told us agency staff treated everyone in the same way. People were mostly satisfied with the personal care they received although some people thought their individual preferences could be ignored if staff were under pressure People were aware they had care plans in place, however they could not recall these being reviewed with them since they were created. People did not share any concerns in relation to their safety. Staff had a good understanding of people's individual needs and how to keep them safe. The environment of the home was clean and well maintained. Systems were in place for staff to report any safeguarding concerns and they were confident in doing so. People received their medicines in a safe way and as prescribed for them. There had been improvements to some aspects of medicines management since our last inspection, and more improvements were ongoing. Learning was being implemented across the service and shared with staff.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us that they had raised complaints with the manager and were generally happy with the outcome. People’s relatives confirmed that where they raised concerns they were looked into. Comments included, “When I raise something, it gets dealt with” and “We can raise concerns and they are addressed, the staff are helpful and understanding”.

Staff told us how information was shared during daily handover meetings, during staff meetings and supervision meetings.

Learning had been implemented since the last inspection. The registered manager explained to us how learning was identified and shared with the team. For example from section 42 safeguarding enquiries and we saw evidence of this in the team meetings. The service had action plans in place, for example 1 which had been created following learning from safeguarding enquiries.

People had their needs assessed before they moved into the home. This helped to make sure the service was able to meet their needs and expectations.

Staff said new people admitted to the home had an assessment completed by the management team, and information was shared with staff before the person moved to the service. They confirmed they worked with other professionals to help people access healthcare services. For example, tissue viability nurses and speech and language teams (SALT). The provider used an electronic care system. Staff accessed this with protected passwords to ensure people’s information was only accessed by those authorised to do so.

We received positive feedback from 2 professionals working with the service about the responsiveness and transparency of the registered manager.

The staff created hospital passports which described people's health and communication needs. These were in place to ensure if a person needed to be admitted to hospital other healthcare professionals could provide personalised care.

People and their relatives did not share any concerns in relation to safety at the home. People’s relatives told us that their loved ones were safe living at the home.

The deputy manager told us staff were confident in reporting and recognizing safeguarding concerns and know who to go to. They told us they had a good relationship with the local authority safeguarding team. Staff were aware of how to report safeguarding concerns and were confident in reporting, some having had experience of doing this already.

We observed no concerns in relation to people’s safeguarding during our site visit.

The service had a system of oversight in place of all safeguarding investigations. Safeguarding concerns were reported to the local authority safeguarding team and the CQC as legally required. Learning was drawn from safeguarding investigations and incorporated in the service’s action plan. Systems of oversight were also in place in relation to all Depravation of liberty safeguards (DOLS) applications. The registered manager was following up applications which were still due to be authorised. Where people had conditions on their DOLS authorisations, the registered manager told us how these were being met by the service. Through their own quality monitoring systems the registered manager and provider identified shortfalls in relation to mental capacity assessments and best interest decisions as well as staff knowledge related to this area. We saw actions had been identified in relation to these concerns and the registered manager provided assurances that all people who are under a DOLS had the relevant mental capacity assessments and best interest decisions in place and explained the progress made in relation to staff knowledge.

Staff had a good understanding of people's individual needs and how to keep them safe. There was a system in place which involved people in a monthly review of their care plans and risk assessments through the 'resident of the day’ process. People we spoke with knew they had care plans in place when they came to live at the service, however most could not recall anyone talking to them specifically about their care needs subsequently. Generally, people felt that permanent staff were aware of their preferences and how to support them with their independence, however they told us agency staff treated everyone in the same way. Feedback from people’s relatives in relation to being involved in care plan reviews was mixed, however they confirmed they were kept informed about their loved ones’ care. One relative told us, “I was involved with the care plan. I’m not sure that it has been reviewed. I have regular conversations with the senior staff. I was asked consent for her to have the flu jab. The relationship between the manager, senior personnel and myself is sufficiently open and ongoing.” Another relative commented, “I was involved with his care plan. They ring me if he is not well or has had to see the G.P.” People’s relatives spoke highly of the care the service provided. Comments included; “They have looked after Mum as well as could be expected” and “I appreciate the level of care that they give them”. Most people appeared to like living in the home and overall they were happy with the care that they were receiving. One person told us; “This is my home, I’m happy here. I wouldn’t be happy anywhere else, everything that needs to be done is done”. Other comments included; “I think it’s lovely, the staff try their best, I think it’s ideal” and “It’s lovely, a wonderful place to stay, the carers know exactly what they’re doing”.

Staff knew how to use manual handling equipment and how to support people to move in a safe way. Some people were at risk of choking or needed specialist diets including texture modified food and drinks. Kitchen staff told us they were informed of people’s dietary needs; this included being informed about new people moving into the service and when people’s needs changed.

Staff kept people safe by regularly reviewing and updating people's risk assessments and care plans as their needs changed. Care plans guided staff practice, to ensure people’s needs and preferences were understood and met. We saw staff knew people’s individual needs, routines and preferences well and cared for people in a safe way. We observed people being supported by staff in a person-centred way. They were supported by staff who were patient and promoted people’s independence.

Risks to people were not all being safely managed. We found a cupboard containing potentially dangerous cleaning products had not been locked and some cleaning products stored in cupboards which were not lockable. The registered manager took action immediately to address this. The provider used a ‘resident of the day’ process to regularly review people’s care needs and risk assessments. Staff had completed these and they accurately reflected people’s needs. We shared people’s feedback in relation to their involvement in reviewing their care plan with the registered manager and provider. The registered manager and provider had identified? that further improvements were needed to this process and had a plan in place to action this, which included ensuring all residents and/or their families were involved in the process.

People's rooms where they chose were personalised and had their names on their doors. People felt they lived in a safe environment. People gave examples of rules and regulations being followed in the home such as fire alarm practice and moving and handling.

The registered manager told us about the improvements to the environment they had made and which areas had been refurbished and decorated, in particular the ground floor unit which supported people living with dementia. They told us they had plans for further decorations and improvements.

The environment was suitable to meet the needs of the people who lived there. Accommodation was over 3 floors, which could be accessed by a passenger lift and all rooms were wheelchair accessible and had ensuite facilities. The home was very clean, tidy, well-lit and free from clutter. Housekeeping staff were knowledgeable about their work and knew people living at the service well. The signage in the home was poor which meant people and visitors may not be able to orientate themselves around the building. We discussed this with the registered manager, and they confirmed they were aware of this and would be addressing the signage at the home.

The provider ensured equipment was well maintained and regularly serviced. The staff carried out regular checks on the environment including fire safety and legionella disease. Risks related to the environment were being managed, however we found that the actions from the legionella risk assessment were not clearly evidenced. The provider told us they will be looking into this at an organisational level to ensure effective recording of evidence. The staff had developed personal evacuation plans to describe the support people needed in the event of an emergency evacuation.

Most people felt that staff were caring, friendly and polite. They were confident staff would respond as quickly as possible when help was needed. Some people raised concerns that on occasions, they had to wait for assistance if there were not enough staff available there to help them. This appeared to be a particular problem in relation to toileting especially at night. People were mostly satisfied with the personal care they received although some thought their individual preferences could be ignored if staff were under pressure. Some people felt there was not always enough staff especially at the weekends and during the night. Generally, they preferred permanent staff to agency staff as they felt the permanent staff knew their care needs much better. We received some mixed feedback from relatives relating to staffing. Whilst most relatives thought that there were enough staff on duty. Some relatives told us that there were less at weekends and evenings. Relatives told us that they heard call bells, but thought that they were answered quite quickly, however their relatives reported to them that they had to wait when they rang the call bells. Comments were made in relation to the use of agency staff. One comment was made in relation to agency staff needing more training on how to us a stand aid. This was fed back to the registered manager.

Staff mostly told us they felt supported. They told us the service was well led and they had the information they needed. We received some mixed feedback from staff relating to staffing levels. One staff member said the staff daily allocation did not consider staff fatigue. Another staff member told us that shifts can be busy at times and on other days the workload can be fine. They did not share concerns about being able to meet people’s needs. Another staff member told us that the nursing unit was busier. Staff were positive about the induction they had when they first started and about the training they were receiving.

On the first floor which supported people with a nursing need, staff were very busy and going from one task to another. We discussed this with the registered manager and area manager. They told us they had recognised with the clinical manager that the dependency of the nursing floor was high, and agreed to increase the staffing levels the next day. Through our own assessment of the service’s call bell response times, we identified long response time for call bells predominantly located on the nursing unit. During the site visit we observed the support people were receiving on the nursing unit was not provided in a timely manner as on other units and was more routine orientated.

The area manager told us about a project called the ‘Genie project’ the provider was undertaking looking at staff levels across all their units. This included looking at the completion of the provider dependency tool to ascertain if it was being consistently completed. The provider and registered manager had identified the need to increase staffing levels on the nursing unit, however at the time of our site visit this had not been implemented. The folllwing day staffing numbers had been increased and feedback had been positive. Systems were in place to monitor staff training. The registered manager and provider had identified training needs and were planning the delivery of this. While most staff told us they felt supported, records showed gaps in staff induction, supervision and appraisals. This had also been identified as an area of improvement during a recent local authority visit report. The registered manager told us that this had also been identified by them as an area of improvement, they were aware of the gaps and had planned the actions to take in relation to this. We found that information related to pre-employment checks was missing from staff’s recruitment folders. There were gaps in people's employment history which had not been explored, interview notes were missing as well as health questionnaires. Not all reference were available in line with the providers recruitment policy. The registered manager took action during the assessment to review their recruitment processes. They also provided assurances that all staff recruitment files had been reviewed.

People spoke highly of the housekeeping team. Comments from people in relation to the cleanliness of the home included, “There’s daily cleaning, everywhere is spotless” and “Marvellous cleaning, spotless bathroom”. Feedback from relatives in relation to the cleanliness of the home was also positive. One relative told us; “The cleaning department is brilliant, there is no smell, they are excellent, I can’t complement them enough”. No concerns were shared by people in relation to the use of personal protective equipment (PPE) and people’s relatives confirmed staff were wearing PPE.

Staff told us they received training in infection prevention and control.

On the day of the site visit we observed the home was very clean and we saw regular cleaning staff completing tasks throughout the home. The home appeared hygienic and we did not observe any concerns in relation to infection prevention and control. We saw there were adequate supplies of personal protective equipment, such as disposable gloves and aprons, and staff wore them appropriately.

The service had systems in place to ensure infection prevention and control (IPC) measures were in place and followed by staff. For example, the management team carried out a monthly environmental walk around. In addition, a daily manager walk around was being carried out which looked at IPC. The head housekeeper carried out various audits relating to the cleanliness of the home.

People received their medicines safely as prescribed for them.

Staff told us that they felt well supported with medicines, and they knew how to report any issues. They had training and competency checks to make sure they gave medicines safely. They were knowledgeable about people and their medicines. Staff administering medicines wore red tabards to advise staff not to disturb them. Staff were observed taking time supporting people with their medicines, in a kind and calm way.

Records showed that people received their medicines safely as prescribed. There were suitable arrangements for the storage, administration and disposal of medicines. There had been some issues with stock supplies leading to some missed doses. However improvements had been made to the ordering and checking in processes, and there was increased oversight by managers. This appeared to be improving, and we were told it would be carefully monitored going forwards. When medicines were prescribed to be taken ‘when required’ there were detailed and person-centred protocols in place to guide staff when these might be needed. Risk assessments were not in place for all high-risk medicines such as some blood thinning medication and flammable external preparations. We were told this had been addressed during the assessment.