About the service The Lawns Care Home is a residential care home providing accommodation and personal care to up to 62 people. The service provides support to older people and people living with a dementia, in one adapted building across two floors. At the time of our inspection there were 45 people using the service.
People’s experience of using this service and what we found
People’s medicines were not managed safely, and people did not receive their medicines as prescribed. Risks to people were not always appropriately assessed, monitored and managed. People’s nutrition and hydration needs were not adequately recorded or known by staff. No action was taken if people at risk did not have enough to drink. Staff were not always deployed throughout the service appropriately, and staff consistently told us there were not enough care workers. Pre-employment recruitment checks for agency staff were not always fully in place. The service was not clean. Lessons were not always learnt when things went wrong.
Leadership, governance and culture within the service did not ensure high quality care was delivered. Care records were not always person-centred and up to date. We received mixed feedback about the atmosphere within the home. Quality assurance was ineffective, and the service had deteriorated since our previous inspection. The provider did not have appropriate or effective oversight of the service. People were not always referred to healthcare professionals in a timely manner.
People told us they felt safe and they liked the staff. Immediately after our inspection the provider implemented an action plan to address the concerns identified around medicines, the environment, risk assessments and people’s nutrition and hydration needs. Visitors to the service were appropriately screened for COVID-19 and visiting arrangements were in line with government guidance. The service had enough PPE and staff took part in a regular COVID-19 testing programme.
Following our feedback, the provider ensured that appropriate support was provided to the service. The provider understood their regulatory requirements and their duty to be open and honest when things go wrong. Relatives generally told us they were kept up to date. The provider and acting manager were receptive and responsive to feedback and worked with CQC to implement action plans to resolve the issues identified.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 26 February 2020).
A targeted inspection took place in November 2020 (published 25 November 2020). The service was inspected but not rated and therefore this did not change the last rating for the service.
At our last comprehensive inspection, we recommended that the provider consider current guidance on medicines management and take action to update their practice. At this inspection we found the provider had not acted upon this recommendation and had not made the necessary improvements.
Why we inspected
The inspection was prompted in part due to concerns received about management of medicines, cleanliness of the service, and safeguarding concerns. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
The overall rating for the service has changed from good to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
During the inspection we fed back our concerns to the provider. We also liaised with the local authority and relevant stakeholders.
The provider and the acting manager were very responsive to our feedback. The provider immediately prepared and implemented a robust action plan. The provider and the acting manager prioritised the concerns which posed the highest level of risk to people. Steps were taken to address our concerns, minimise risk, and ensure the safety of people using the service. The provider arranged for the acting manager to have ongoing support from the senior management team, who visited the service regularly to support with improving the quality of the service. We have had positive feedback from professionals following the implementation of the provider’s action plan.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lawns Care Home on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, nutrition and hydration, staffing and good governance at this inspection.
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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.