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Archived: Robert Owen Communities - Laura House Good

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Inspection carried out on 5 and 20 November 2015

During a routine inspection

Robert Owen Communities – Laura House is a care home which provides accommodation and personal care for up to 16 people who may have care needs related to a learning disability or a physical disability. The provider is Robert Owen Communities (ROC), a Devon and Cornwall based organisation that supports people with learning disabilities. The home is located on a residential street and is divided into four areas referred to as three houses and one flat. House one accommodates up to six people, house two accommodates up to five people, house three accommodates up to four people and the flat accommodates one person. People who live at the home receive nursing care from the local community health teams.

The home had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection took place on 5 and 20 November 2015 and our first day was unannounced. At the time of our inspection there were 15 people using the service. People had a range of needs with some people being independent and others requiring more support with their mobility and care needs. Many people who lived in the home had highly complex needs and reduced mobility related to their disabilities. The service was last inspected in November 2014 and was found to be meeting the regulations we inspected.

People’s needs, wishes, preferences and goals were central to the care they received. Staff made sure people were supported in an inclusive and personalised way to lead fulfilling lives. People were cared for in a homely atmosphere by a dedicated and caring staff team. People were treated as individuals and were supported to be involved in their care in a way that enriched their lives.

People living at Laura House required support to take their medicines safely. Staff had undertaken assessments to determine what people could do for themselves in relation to medicines and how they best liked to be supported. Each person’s care plan contained information about the medicines they were taking, what these were for and what the possible side effects were. Records showed that staff did not record the stock of medicines in a way that ensured they could account for all medicines. When we showed this to the registered manager they took immediate action to rectify this.

People told us they felt safe and could talk to staff if they had any concerns. One person said “I feel safe here and my mum thinks I am too”. Where people were unable to communicate using speech staff used photos, pictures and body language to understand people. This enabled people to raise concerns with staff if they wanted. Relatives told us they felt their loved ones were in a safe environment.

People’s needs and abilities had been assessed and risk assessments had been put in place to guide staff on how to protect people.

Staff, people and relatives told us staffing numbers were sometimes low and there was a high turnover of staff at the home. This was an area which was being addressed by the registered manager and all steps were being taken to recruit staff and provide consistent agency coverage in the meantime to ensure people were safe and were cared for by people they knew.

Where accidents and incidents had taken place, the registered manager had reviewed their practice and involved people and healthcare professionals to ensure the risk to people was minimised.

People were cared for by staff who had received training appropriate to their roles and to develop their skills and knowledge. Staff told us their training benefitted the people they care for as they understood their needs and were able to meet those needs.

People were protected by staff who knew how to recognise signs of possible abuse. Staff told us they had received training in how to recognise harm or abuse and knew where to access information if they needed it. Safe recruitment procedures were in place to ensure staff were suitable to work with vulnerable people.

Staff were adequately supervised and appraised to enable them to work to the required standards and to support them in their roles.

Staff had good knowledge of the Mental Capacity Act 2005 (MCA) and sought consent from people before carrying out care. When people lacked capacity to make certain decisions at certain times processes were followed to protect people’s rights. Where people’s liberty was restricted in their best interest or for their safety Deprivation of Liberty Safeguards had been applied for and were awaiting authorisation.

People were supported to eat and drink enough throughout the day and people enjoyed mealtimes as social occasions. People ate at different times depending on their preferences and their daily activities. People had regular access to healthcare professionals such as GPs, physiotherapists, speech and language therapists, neurologists, nutritionists, district nurses, opticians and dentists. Where necessary staff sought specialist advice and knowledge in order to better care for people.

People and their relatives were very positive about staff’s approach and attitude. One person said “They’re nice. I get to do what I want”. Relatives said “The staff are just fantastic”. Staff demonstrated they knew people well. They could tell us about people’s preferences, likes and dislikes and how people communicated. For example, one person was unable to talk and staff could tell us the different physical signs the person used to show they were happy or how they expressed they were uncomfortable.

Staff ensured that people found enjoyment wherever possible. For example, where a person required a haircut, staff organised for the person to travel by train to different hairdressers so they could enjoy the trip there and discover new places. This person’s relative said “They sometimes take her on the train just so she can enjoy the ride and get lunch, they don’t have to do that but they care about her”. People were supported to feel included in events that took place at their home.

People were involved in decisions about how their care was delivered and also who cared for them. This was done by supporting people to be involved in staff recruitment by including them in an interview panel to select new staff.

People’s privacy and dignity were maintained at all times and people’s relatives told us they were encouraged to visit the home at any time day or night and they felt comfortable to do so.

People’s care and care documents were highly personalised. People had been supported to be as independent as possible and lead a fulfilling life. People took part in a variety of activities based on their preferences. For example one person had access to technology which enabled them to participate in computer games using eye movements. This had enhanced their enjoyment and their development through interactive and sensory games. People’s rooms reflected their likes and preferences and people had been consulted in the decoration of the lounges and dining rooms of the different houses. Multimedia, including computers, music systems and DVDs, was being used to entertain people, to assist with their care and to gain their feedback. Video footage of people was being used to train staff in how best to care for them and to gain people’s physical reactions to different activities when they could not verbalise their feedback. People and their relatives had been consulted prior to this taking place.

People and their relatives were confident if they made a complaint this would be dealt with. One relative said “Laura House have always dealt with things. I feel comfortable going to the manager”.

ROC had clear vision and values for the service and this was reflected in staff practice. Relatives said the service’s ethos was always demonstrated by staff practices. One relative said “The ethos of it is very person centred and caring and respectful”. There was an open culture in the service. The registered manager told us they sought people’s views and continually sought to improve the service. People and their relatives confirmed they were able to speak with staff and management about anything and at any time. Staff were encouraged to challenge and question practice and were supported to share their ideas to improve people’s quality of life.

ROC continually strived to deliver outstanding care by recognising where improvements could be made in consultation with people and then taking action to make these improvements. The service undertook a number of self-assessment evaluations and sought outside views. Where concerns had been identified action was taken to respond to this. As part of their quality assessment, ROC organised for external volunteers to conduct unannounced audits. One of these inspections had taken place between our first and second inspection visits. The registered manager and senior carers regularly monitored staff skills, performance and knowledge.

Inspection carried out on 29 November 2013

During a routine inspection

We visited Laura House as part of our scheduled inspection plan. Prior to our visit we had received information that people had been left on their own in a swimming pool. However, we were told by staff at Laura House that their investigations had concluded that the people who were left unattended in the pool did not live at Laura House.

Laura House had also been subject to a safeguarding investigation in relation to the care of an individual. This had resulted in a new communication strategy being put in place to minimise the risk of reoccurrence.

We saw evidence that people had been involved in completing their care plans (referred to as working policies by the home). For example, the documents included comments and preferences expressed by the individual. We saw that information about people's care needs was contained within a number of files.

We saw that people�s working policies included information on day-to-day support needs, a person centred plan, a healthcare file, a daily diary and for some people additional files regarding the management of epilepsy.

Care workers were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring. This included contacting people outside of the Robert Owen Communities (ROC).

One told us they felt �really well supported� by the manager and ROC. We found that people�s personal records were accurate and fit for purpose. We saw that care workers received relevant training.

Inspection carried out on 14 May 2013

During a routine inspection

We visited Laura House to carry out a routine inspection and to follow up on our last inspection from January 2013. We saw that people receiving care were asked about their wishes and for their consent before care was delivered. Staff were skilled at interpreting communication from people who were not able to do so verbally. We saw people followed an active daily programme of their choice, and were treated with respect.

We saw that care to meet people's needs was well planned and delivered safely. People we met were not able to tell us about how they spent their time, but we saw people working with staff to achieve their goals and develop new skills and experiences. Some people had complex physical needs as well as learning disabilities and we saw that the external medical and community support people needed was accessed. We found the provider had completed their action plan from the inspection of January 2013 with regard to the management of medication and that they were compliant with safe practice.

We saw the home had clear systems for the recruitment and support of staff. We found that people living at the home were supported to have a say in the running of the home and there were systems for quality assurance and for ensuring people's voices were heard. However systems for the recording of incidents were not robust enough to ensure people were protected.

Inspection carried out on 11 January 2013

During a routine inspection

We visited Laura House for a scheduled inspection. We also wanted to follow up on some concerns about the way one person was supported and about medication administration. The service had previously investigated these concerns themselves and sent us a report on what they had found. We did not find these concerns in place when we visited. However, we did identify some other concerns about medication management.

We found people were being supported well. People were being involved in making decisions around their care and how they spent their time. We spoke with one person about this. They told us they had not wanted to have a working policy/care plan at first but now they had one and were happy with it. They told us they liked their routines written out for them so that they understood what was going to happen next. They told us they kept their own plan in their wardrobe and that the staff updated with them.

We saw people treated with respect, and care was delivered in private. We spoke with the relatives of one person living at the home. They told us that they were happy with the support given at Laura house and that they had full confidence in the staff to manage their relative�s complex care needs. People living there told us they were happy.

We were also told about people living at the home competing in national wheelchair dancing competitions. A group called �ROC on wheels� had been formed to do this, and we saw photographs of their recent successes.

Reports under our old system of regulation (including those from before CQC was created)