We carried out a review of the data available to us about Lawrence House Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Lawrence House Residential Care Home, you can give feedback on this service.
Lawrence House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care service has not been developed and designed in line with the values that underpin the Registering the Right Support because it is registered for more than six people. However, it does follow best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.
The registered manager is also the registered owner. 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.
People said they felt safe and well cared for. The service remains outstanding in caring because staff were always willing to go the extra mile to ensure people had fulfilling lives. Staff came in on their own time for support to enable people to go out and about. Staff were also extremely skilled at understanding people’s unique ways of communicating. This helped to ensure their well-being was maintained and that they were fully involved in making choices where possible.
There were sufficient staff with the right skills and understanding of people’s needs and wishes. This meant outcomes for people had improved. People said staff were kind and helpful. Our observations showed staff respected people’s dignity and privacy and worked in a way which showed kindness and compassion.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to care and treatment was sought. Staff used the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and understood how these applied to their practice.
Care and support was person centred and well planned. Staff had good training and support to do their job safely and effectively. Activities were tailored to meet individual’s needs. Some people had additional funding to allow one to one staff support for them to access the community.
Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People received their medicines safely and on time most of the time. There was a high number of medicine errors. An action place had been developed to ensure staff had further training and to reduce the number of errors. Accidents and incidents were carefully monitored, analysed and reported upon.
Prior to this inspection we received some information of concern which stated recruitment practices did not include all the necessary checks. During this inspection we found no evidence to support this. There were effective staff recruitment and selection processes in place. People received the right care and support from staff who were well trained and competent.
People enjoyed a wide and varied choice of meals. Mealtimes were relaxed and enjoyable for people.
Quality assurance processes and audits helped to ensure that the quality of care and support as well as the environment was closely monitored. This included seeking the views of people and their relatives.
This unannounced comprehensive inspection took place on 22 and 27 November 2015. Lawrence House is registered to provide care and support for up to 12 people with a learning disability. At the time of the inspection there were 10 people living at the service.
There was a registered manager in post who is also the registered provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
People were positive and enthusiastic about life at Lawrence House and this was evident in our observations throughout the day. People living at the service said they really liked living there. One person said ‘‘I have lived here a very long time. This is my home. I love it here.’’ We observed caring and compassionate support being given at all times. Staff were observant about people’s changing moods and acted quickly to support people when they became distressed or upset about something. Staff had clearly developed close relationships with people and respected and celebrated their diversity. People were offered choices in all aspects of their life. Relatives were very positive about how people were being cared for. Comments included, ‘‘It is absolutely fantastic. All the staff care so much. They really look after (our relative) so well.’’ Another said ‘‘Absolutely wonderful care. I don’t want my relative to go anywhere else. This is their home, staff know them and care so much. The manager is brilliant and has said they will continue to support my relative through palliative care.’’
One healthcare professional said the service was ‘‘Exceptional in their caring approach to people.’’
People had been supported in an exceptional way at the end of their life. Over the last year several people who had lived at this service for a number of years, became ill and needed nursing care. The registered manager and staff continued to support these people even after they moved out of this home. They said ‘‘We wanted to make sure our people had the best possible care and treatment. We did not want them to be afraid and alone in hospital so we made sure one of us was around for their stay and during their final days. One healthcare professional said “ I have found the Lawrence house to be extremely caring and committed to providing a service to past and present residents…..On some occasions this additional support has meant that a person has had a very dignified and more peaceful death than they would have otherwise. I find all the staff know the clients well, are compassionate and well trained so are excellent at informing others taking over the caring role.’’
Staff were experienced and knowledgeable about how to meet people’s individual needs. Care and support was being delivered in an extremely caring and sensitive way. People were being offered choice throughout the day about when they wished to be supported to get up, how they spent their day and what drinks and meals they wished to have. Staff understood people’s different ways of communicating and were proactive in ensuring people were happy, comfortable and enjoying meaningful activities.
People’s health care needs were well met. The service had developed individualised hospital passports for people, for when they needed care and treatment outside of their own environment. One healthcare professional commended the service saying ‘‘Having taken over the care of a patient last night who is one of your residents. I felt compelled to email you to tell you how lovely and how useful her communication passport is. It really helped me give care which was appropriate and tailored to the patient. If only all residents in all homes had something similar. It also suggests that she came from a home with a caring, person focussed ethic....love it!’’
Relatives confirmed they were kept informed about any changes in people’s health or general well-being and enjoyed having regular written updates about what their relative had been doing.
Staff ensured people were eating and drinking sufficient quantities to maintain good health. Staff knew what people’s likes and dislikes were. Staff prepared meals to ensure those who were at risk of choking had the right consistency. They were conscious about ensuring meals looked appetising and people, who were on restrictive diets due to healthcare needs, did not feel they were missing out.
Staff had training, support and supervision to help them understand their role and provide care in a safe way. Staff felt their views were listened to and understood the ethos of the home. This was to provide a safe, homely environment for people to enjoy and to offer people choice in everyday life. Staff said they were valued and encouraged to learn and develop by the registered manager. Staff had access to mentoring and guidance and support from a staff liaison person.
Most people lacked capacity, and this had been fully considered in light of the 2014 supreme court ruling, covering mental capacity and the need to consider Deprivation of Liberty Safeguards (DoLS). Applications had been made in respect of people and the service was awaiting assessment and authorisation of the DoLS. Staff understood the importance of giving people choice and worked in innovative ways to ensure people had maximum choices throughout their day.
People were protected by the service having clear recruitment processes, which ensured only staff suitable to work with vulnerable people were employed. Medicines were being well managed which also helped to protect people.
There were a range of audits to ensure the environment was safe, clean and homely. Complaints were responded to in a timely way. Relatives confirmed they had confidence in the registered manager and staff team to be able to respond to their concerns and suggestions. The staff team were proactive in ensuring people’s wishes were considered and actioned.
Care and support had been well planned, with high levels of detail about people's personal, health and emotional needs. Plans had been reviewed to reflect people's changing and complex needs. Staff had received training in working with people with complex needs and demonstrated good understanding of how to work in a person centred way with people. There were enough staff on each shift to meet the needs, and staffing levels were being kept under constant review as people's needs changed.
The environment had been adapted to meet the needs of people who were getting frailer and required more equipment and aids to maintain their mobility and independence.
The provider sought ways of ensuring people could have their say about how the home was being run and be able to raise any concerns about any aspect of their life and be confident they were being listened to.
We carried out a review with an inspection to Lawrence House on 9th May 2012. The purpose of this review was to check compliance in these areas. We looked at key outcomes covering essential standards including consent to care and treatment, care and welfare, safeguarding people from abuse, management of medicines, requirements relating to staff assessing and monitoring the quality of the service and records.
We looked at the records of three people in detail; and where possible we spoke to the individual and or their carer. Some of the people had limited verbal communication and were therefore unable to tell us about their experiences. However, we watched what was going on in the service and how people spent their time, the type of support they got and whether this was a positive experience for them.
People we spoke to said that they 'really like it here, it's the best place'. We saw that people are treated as individuals in a respectful way and made comments about the care workers such as 'They're all very nice, I like all of them'. They are supported to be actively involved in the community where they live and lead busy lives, for example we heard that the majority of people had recently seen a theatre show and enjoyed it. Some people told us that they have jobs at local shops and other people go to clubs like 'Gateway'.
We asked four professionals for feedback and received comments from one. These were very positive and highlighted that people are enabled to plan and spend their lives how they want to. For example, people 'are involved in their review' and their 'needs are well met'.
Since our last inspection significant improvements had been made in the way people's ability to consent to care and treatment was assessed and reviewed. Similarly, care plans and risk assessments had been regularly reviewed and contained greater detailed information on every aspect of each person's health and personal care need. Systems for monitoring medication records had been put in place. Recruitment procedures had been tightened up and were inclusive of the people living in the home. For example, a care worker described the process as being 'the strictest I've ever experienced' and 'we all got interviewed by the residents, which was bit daunting but they asked brilliant questions that challenged us'.
During the visits to the home we spoke to all of the people who live there, and to five in more detail about what they thought of the care and support they receive. Comments included 'yes we are all getting on well here, but I have been waiting to hear about someone else moving in' 'Still very happy here, later I will be going to arts and crafts. I am making a blanket and when I have finished it, it will go to charity. 'Sometimes I get cross and upset but I do like it here.' 'We all get on. I help with doing all the garden and I am growing my own vegetables.'
People told us that they are able to choose how they would like to have their room, what they wear and how they like to spend their days. One person told us they had two part time jobs, one of which they got paid for. Another person told us that they enjoyed going to clubs, arts and crafts group and out for lunch. We saw that people had their own individual style of dress and interests they liked to follow.
People we spoke to said that staff were nice and made sure that they had things to do that they enjoyed. One person told us that they enjoyed helping with household tasks and that they had a rota so that everyone who could helped in some way with everyday tasks around the house.
We observed staff offering help and support in a kind and respectful way. Staff we spoke to on the day of the visit showed a good level of understanding of each persons needs, the way they communicated and what their preferred daily routines were.
We saw that the menu offered people a varied diet and that they had tried to include everyone's favourite meals. The menu was available in the kitchen but it not in a format that everyone would be able to understand. This could be easily addressed with some photos to help people make choices about what food and rink they would like.
We saw that the home was homely, clean and fresh smelling. We saw that individual bedrooms had been personalised and that people were proud of their own personal space. Two people wanted to show us their rooms and belongings.
We saw that staff had equipment available to ensure a clean and safe environment, such as gloves and aprons. Staff we spoke to understood infection control procedures, although they had not seen the new code relating to hygiene.
People we spoke to said that their views were listened to. One person told us that if they had an issue they would talk to the manager, Linda, and they thought it would be sorted straight away. We saw that there were regular meetings with the people who live at Lawrence House, and people were asked their opinion about what food they would like on the menu, what activities and trips they would like. The manager also told us that when potential new staff come for interview, people living at the home were asked for their views about candidates.
We saw that some surveys had been completed in the past by people living at the home, but the manager said that quality assurance was more effective done on a one to one regular basis with individuals, which she said they did, but this was not always well documented.
We saw that care and support was well planned, but that not all records had been well maintained. We also found that for one staff member employed robust recruitment processes were not completed. This could have placed people at risk.