The Laurels

The Laurels provides care and accommodation for up to 6 people who have learning disabilities and/or autistic people. At the time of the inspection 6 people were living at the service. The service was based in a large, semi-detached building set within its own gardens in a village location.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: The service operates a model of Care and setting that maximises people’s choice, control, and independence.

People told us they 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. One person told us, “We do things for ourselves, the staff help if we need it.” People were fully involved in the running of the service on a day-to-day basis and participated in household tasks, people had their own jobs around the house which they valued.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. Staff supported people to play an active role in maintaining their own health and wellbeing.

Staff, people and their relatives cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Care: Care is person-centred and promotes people’s dignity, privacy, and human rights.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood and responded to people’s individual needs. People told us they liked the staff and we observed both staff and people spoke to and about each other with genuine regard.

People's care, and support plans reflected their range of needs and promoted their individuality, wellbeing, and enjoyment of life. People could take part in activities of their choosing in the wider community and pursue their own interests. Some people had employment and voluntary work. Staff received training and support to provide care effectively.

Staff worked in partnership with healthcare professionals to maintain people’s health and wellbeing.

People told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive, and empowered lives.

Staff placed people's wishes, needs and rights at the heart of everything they did. The stable management and staff team supported people to receive consistent care from staff who knew them well. We observed people receiving compassionate and empowering care which was tailored to their needs throughout the inspection.

Staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate. All the relatives we had contact with were complimentary and positive about the service and the care and support their loved ones received. One relative said, “They are really happy, I couldn’t ask for more.”

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 27 January 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service and the age of the rating. We undertook a focused inspection to review the key questions of safe, responsive, and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Laurels on our website at www.cqc.org.uk.

At the last inspection in July 2015 the service was rated Good overall. However it was Requires Improvement in Safe. This was because people had not been assessed regarding the safe management of their medicines when they handled and administered their own medicines. Risk assessments were not always carried out and recorded in sufficient detail when people went out in the community with staff.

At this inspection we found the service Good in all areas.

Why the service is rated good:

Suitable risk assessments for people who self-medicate were now in place. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to enable people to retain as much independence as possible.

People were supported to maintain good health through regular access to external health and social care professionals, such as the local GP surgery for health check-ups. This helped to ensure people’s health and wellbeing was monitored.

The service did not have a manager who is registered with the Care Quality Commission. However a new manager had been employed. 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 current manager is currently in the process of registering.

We met and spoke to all six people during our visit. People when asked if they felt safe said they did. One said; “Yes I feel safe because staff are here with me.” A relative said; “Yes definitely safe there.” Another said; “We have no concerns over […] being safe and well cared for here.” One staff member said; “We are proud that we put people first here.”

Staff had completed safeguarding training and all had a good knowledge of what constituted abuse and how to report any concerns they had. Staff understood what action needed to be taken to protect people against harm and were confident any incidents or allegations would be fully investigated.

People had sufficient staff available to meet their needs. Staff had completed the company’s mandatory training and had the right skills and knowledge to meet people’s needs. New staff completed an Induction programme when they started work and staff competency was assessed. Staff also completed the Care Certificate (A nationally recognised training course for staff new to care) if they did not have any formal care qualifications. Staff confirmed that as part of their training they discussed the Equality and Diversity policy of the company. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people.

All significant events and incidences were documented and analysed. Evaluations of any incidents were used to help make improvements and help keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from relatives, professionals and staff.

People lived in a service which had been designed and adapted to meet their needs. People lived in an environment that was mostly clean and hygienic. However a hall carpet was in a poor state of repair. The environment had been assessed to ensure it was safe and meet people’s needs. The service was monitored by the manager and provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

People lived full and active lives and were supported to access a wide range of activities that reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had full input and were able to assist in preparing meals and drinks.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought.

People’s care records were detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were involved with their support plans as much as they were able to be. People had family members or advocates to assist and support staff to complete and review people’s support plans. People’s preferences were sought and respected.

People’s emotional and behavioural needs were recognised and met. People were treated with kindness and compassion by the staff who valued them. People were engaged in different activities during our visit and enjoyed the company of the staff. People were busy and there was a friendly happy atmosphere within the service.

People’s relatives told us they were always made to feel welcome and some people visited their family members. There were plans in place for most people to stay with family over the Christmas period. One family member spoke very highly of the staff supporting their relatives.

People’s equality and diversity was respected and people were supported in the way they wanted to be. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. Information held included peoples previous history, any cultural, religious and spiritual needs.

Each person’s communication needs were individually assessed and met. Staff informed us how they supported people to help ensure each person received individualised personal support.

People’s end of life wishes were documented to help ensure staff understood people and families wishes if required.

People lived in a service where the company’s values and vision were embedded into the service, staff and culture. People, relatives and staff members spoke very positively about the newly appointed manager, senior support worker and the company. The manager was committed and passionate about the service, including the people and staff, and the company they worked for. Staff also spoke passionately about the people they cared for and the respect they held for people.

People benefited from a manager who worked with external agencies, and the manager said they worked with professionals in an open and transparent way. This helped to ensure there were positive relationships fostered. The manager kept their ongoing practice and learning up to date to help develop the team and drive improvement.