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Inspection carried out on 7 August 2019

During a routine inspection

The Laurels is a residential care home providing personal care to up to six people with mental health needs, acquired brain injury or learning disabilities.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, five people lived at the home and four people received personal care.

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

People told us they felt safe living at The Laurels. However, we found management checks were not consistent to ensure the environment was always safe or clean; shortfalls we found were addressed during our inspection. However, audits and quality assurance processes had not identified or acted on these issues as was their intended purpose.

Medicines were stored and managed safely. There were policies and procedures in place for safe administration of medicines. People received their medicines when they needed them from staff who had been trained and competency checked.

Staff were knowledgeable about the Mental Capacity Act 2005. They knew to seek consent for care and knew the process to help those who lacked capacity to make decisions. People’s needs were met by the adaptation and design of the service.

People were protected from abuse. When potential safeguarding incidents occurred, staff followed correct processes and reporting procedures. Staff had received regular safeguarding training. Managers acted to investigate concerns and informed the Local Authority safeguarding team and the Care Quality Commission as required.

Managers understood and complied with their regulatory responsibilities. Care plans were up to date and contained the level of detail needed. Risks associated with people’s care had been identified and full risk assessments were in place.

People’s care was based on their needs and preferences. People were supported to do things they enjoyed. People were independent and chose how to spend their time. An appropriate complaints system was in place.

People were involved in their assessment to ensure the service could meet their needs. Staff had received the training and support required to enable them to fulfil their roles. 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 told us they were happy living at The Laurels and liked the staff team who supported them. People were supported to express their opinions about their care. People and staff had positive relationships based on mutual trust. Staff understood people’s conditions and needs well and were responsive to these.

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 29 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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 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.

Inspection carried out on 11 October 2016

During a routine inspection

We undertook an announced inspection on 11 October 2016. We gave the provider 24 hours’ notice of our intention to undertake an inspection. This was because the organisation was a small service and we needed to ensure that the people living at the home would be available.

The Laurels is registered to care for up to six people with mental health needs or learning disabilities. At the time of our inspection there were six people living at the service.

There was a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 the staff and management team were caring and always treated them with dignity and respect. They explained how staff supported them to achieve their chosen goals which improved their well-being. Relatives told us they were involved as part of the team to support their family member. All the people we spoke with and the feedback collected by the service said how happy people were to be living at the home.

The management team had a clear ethos that people using the service were at the heart of everything they did. People told us they were important to the staff and the management team. They said they were regularly asked their views about if they were happy with the support they received. People who lived at the home had regular meetings where they could discuss any aspect of their support.

People we spoke with said they had support from regular staff who knew them well. Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns. Staff were knowledgeable about how to manage people’s individual risks, these focussed on supporting people to achieve their goals. People were supported to receive their medicines by staff who were trained and knew about the risks associated with people’s medicines.

Staff had up to date knowledge and training to support people living at the home. Staff always ensured people agreed to the support they received. The management team regularly reviewed how people were supported to make decisions. People were encouraged to make their own choices about the food they ate. They explained that they were supported to make their own decisions and be as independent as they could. People and their relatives told us staff would access health professionals as soon as they were needed.

People and their relatives knew how to raise complaints and the management team had arrangements in place to ensure people were listened to and appropriate action taken. Staff were involved in regular meetings and one to one time with the management team to share their views and concerns about the quality of the service. People and staff said the management team were accessible and supportive to them. The staff team were adaptable to changes in peoples’ needs and knew people well to recognise when additional support was needed.

Staff we spoke with said the leadership from the registered manager was inspirational and motivated them to provide quality care for people living at the home.

The management team monitored the quality of the service in an open way. The registered manager ensured there was a culture of openness and inclusion for people using the service and staff. The management team had systems in place to identify improvements and action them in a timely way. The registered manager and the staff team had been nominated through the providers reward system for awards nationally.

Inspection carried out on 29 January 2014

During a routine inspection

People told us that they were happy living at the service. Their comments included �I like everything�, �The staff are nice� and �They are all nice people�. Relatives we spoke with were positive about the care their relatives received. Comments included �They have done wonders with my [relative]�, their relative has �become far more independent�, the service is �absolutely excellent�, �The staff are helpful� and �The manager is excellent�.

We saw that staff ensured that people�s privacy and dignity was upheld and we heard staff talk with people using respectful language. We saw that people were involved in making decisions about their care.

People received care that met their needs and promoted their rights. Advice and guidance was sought from health and social care professionals to be able to meet people's needs effectively and promote their welfare and safety.

There were systems in place to manage people�s medication effectively and we saw that people who took their medicine without support from staff had been assessed as being safe to do so.

Staff were supported to undertake their roles safely and effectively. They received relevant training, regular supervision and were encouraged to undertake further professional development. Staff told us that �It is a good team� and the manager was approachable.

There was a system in place to manage compliments and complaints and we saw that complaints had been responded to promptly.

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