Lawrence Mews

Lawrence Mews is a residential care home which can provide personal care for up to five people. The service specialises in supporting people who have a learning disability, are on the autistic spectrum, or have mental health support needs.

The care home comprises of two adjacent buildings with separate facilities. One building accommodates two people and the other building accommodates three people. The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People were not always protected from the risk of potential health infections, and there were lapses in good food hygiene practices by staff. Some parts of the care home could not be effectively cleaned because of deteriorated paintwork and surface damage. Maintenance issues were not always well managed. However, staff understood how to protect people from potential abuse and people’s prescribed medicines were well managed.

The provider’s quality monitoring and governance processes were not always effective. The impact of this was seen in the way some maintenance and environmental safety issues had not been identified by the provider until we inspected. The registered manager supported people to achieve good care outcomes and understood their responsibility to notify relevant authorities when incidents occurred. The service had a positive relationship with specialist health care agencies who were involved in supporting people at the care home.

Although people lived in a care home that needed internal redecoration in some areas, they liked where they lived and had personalised their bedrooms. Staff understood and met people’s care needs; and received the necessary training to work effectively. Staff felt well supported by the registered manager and provider. People enjoyed the food provided and were supported to manage their diet. Staff worked in partnership with other agencies to meet people’s needs and ensured people’s rights and choices were respected.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure 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.

People were supported by staff who were kind and compassionate. People were involved in deciding how their care was provided; and staff supported people, who were nonverbal, to express their views by observing their body language. People’s privacy and dignity was respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s care plans were comprehensive and guided staff on how to support them. People’s communication needs were understood. People were supported to establish, and maintain, relationships with family and friends. When concerns were received, the registered manager responded positively and acted to resolve issues.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 Outstanding (published 2 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the assessment and prevention of the potential spread of health infections, and the cleanliness of some parts of the care home, at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

On the day of our inspection there was a registered manager in place. 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.

The risk to people’s safety was reduced because staff understood the procedure for reporting concerns, had attended safeguarding adults training and could identify the different types of abuse. Risk assessments had been completed in areas where people’s safety could be at risk, including the environment and risks to their day to day health. Accidents and incidents were investigated. People had the freedom to live their lives as they wanted to. Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe. People’s medicines were managed safely.

People were supported by staff who felt well trained and supported by the registered manager to carry out their role effectively. People and their relatives felt staff understood how to support them effectively.

The registered manager ensured the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. The registered manager was aware of the requirements to apply for and implement Deprivation of Liberty Safeguards.

People were encouraged to lead a healthy and balanced lifestyle and support was in place for new people to the home to help determine their food likes and dislikes. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

People had excellent, meaningful relationships with the staff. People were treated with respect and dignity and staff were very kind and caring towards them. Staff understood the importance of providing dignified care and support and did so to a high standard. People were encouraged to lead independent lives and care and support was tailored to enable people to do so. Innovative methods were used to communicate with people and there were individualised processes in place to help people understand and contribute to, decisions about the care. All people were treated equally with staff having an excellent awareness of how to respect people’s rights. People were provided with the information they needed if they wished to speak with an independent advocate, to support them with decisions about their care. People’s friends and relatives were able to visit whenever they wanted to and people were supported to develop and maintain relationships with family and friends.

People received excellent person centred support focused on what mattered most to them. Clear processes were in place to ensure that people had a smooth transition when moving into the home. People’s care and support needs were frequently discussed with them and progress on achieving their goals was regularly reviewed. People were encouraged to take part in activities that were important to them and staff provided as much or as little support as people wanted. People were provided with the information they needed, in a format they could understand, if they wished to make a complaint.

People, relatives, staff and health and social care professionals spoke highly of the registered manager; they found her to be dedicated, approachable and supportive. The provider, via their Head of Care demands excellence and registered managers were provided with the resources needed to aim high and to achieve the best possible results for all. The registered manager understood their responsibilities and ensured people, relatives and staff felt able to contribute to the development of the service. People were supported to be valued members of their local community. The continued development of the skills and performance of the staff was integral to the success of the home. People who used the service were invited to attend staff meetings and forums with the aim of improving staff performance. Quality assurance processes were in place which were based upon the vision of improving the lives of all people living at the home.

We were supported by a staff member to speak with one person using the service. We also observed staff interacting with people. We spoke with two relatives, three members of staff and the manager. We also looked at care records and other information.

A member of staff facilitated us talking with a person using the service. When we asked the person using the service if they liked the home and if they were happy living there, they said, 'Yes.'

Both relatives told us they were really happy with the service on offer and the staff were nice and pleasant. They told us they felt involved in their relative's care and they were always kept informed. One relative said, 'The manager tells the truth and I am glad of that, I am very happy with everything.' The other relative said, '[My relative] is getting what they need, I am really pleased, I think [they] are safe and are being looked after.'

We found that the people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found staff supported people using the service to have a nutritious intake. People were also supported to be involved in food planning, shopping and preparation.

We found there had been improvements made to the building and the home was well maintained. Both relatives told us they were happy with the environment and they felt it was well maintained. One relative said, 'They replace furniture when it is damaged.' The other relative said, 'It's a lovely place, [my relative] has lovely home.'

There were sufficient staff available to support people and we saw that staff were attentive to people's needs.

We saw there had been an improvement in regards to record keeping and records were stored in a confidential manner.