The Lawrence

We found the following examples of good practice.

There were measures in place to prevent any visitors from spreading infection at the entrance and on entering the premises. These included well stocked supplies of PPE and hand sanitisers.

Staff supported people to understand the current restrictions through easy read documents, videos and discussions. Arrangements were in place to enable people to go out and access their local community and return safely.

People living at The Lawrence and staff were tested regularly in line with government guidance. People were supported to self-isolate as appropriate. The registered manager kept track of staff test results to ensure they returned to work only when they were able to do so.

The registered manager was working on the advice from the local authority IPC team to improve the cleanliness of the premises and further reduce the risk of the spread of infections.

People’s experience of using this service:

¿ People were safe at The Lawrence. Systems associated with recruitment, risk assessment, medicines and safeguarding protected people from abuse and harm, and the building was clean.

¿ Choice was offered and respected, and people received the right support to enable them to make decisions. Staff had the training and support to provide effective care, and other health professionals were involved as needed.

¿ People lived in a caring environment, and were able to maintain friendships and their independence. There was consultation with people about their care, although we found some improvements could be made in documentation to ensure it was accessible and always responsive to their needs. People had access to meaningful activities in the home and in the community.

¿ There was good leadership in the home, and regular checks were made on the quality of care and support being provided, although there were some occasions when more discretion was needed when discussing care. People and staff were supported to express their opinions about the service.

¿ We have made recommendations about checking staff confidence in making safeguarding referrals and improvements to the format some of documentation.

Rating at last inspection: Our last inspection report was published in October 2016, and the service was rated ‘Good’. At this inspection the overall rating has remained ‘Good’, although one key question is now rated ‘Requires Improvement.’

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we are scheduled to return. We inspect according to a schedule based on the current rating, however may inspect sooner if we receive information of concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Lawrence provides accommodation and personal care for up to 14 people who have a learning disability. There is a small garden area to the front and parking to the rear of the home. It is on a main bus route and close to the M1/M62 link roads. Situated in Wrenthorpe it is only a few minutes journey from the centre of Wakefield and all amenities.

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.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and act to report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

Risks to people arising from their health and support needs or the premises were assessed, and plans were in place to minimise them. Risk assessments were regularly reviewed to ensure they met people’s current needs. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

We saw safety checks and certificates completed within the last twelve months for items that had been serviced and checked such as fire equipment and electrical safety. The service had a programme of redecoration and repair of the premises in place.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection there had only been six accidents and incidents, however the deputy manager had found a trend to show why one person would have an accident or incident. The deputy manager had reviewed staff rotas to deal with this trend.

There was sufficient staff to provide the support needed and staff knew people’s needs well. At the time of inspection 91 hours were funded to provide a 'one to one' service.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers and obtaining a Disclosure and Barring Service (DBS) check before they started work in the home. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruitment decisions and also to minimise the risk of unsuitable people working with children and vulnerable adults.

People were safely supported to access their medicines. Accurate records were kept of administration, and medicines were securely and safely stored in each person’s room.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life.

Staff received support through regular supervisions and appraisals. Staff felt confident to raise any issues or support needs during supervision and found these meetings useful.

Staff understood and applied the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards to ensure that people’s rights were protected. Care plans contained evidence of mental capacity assessments and best interest decisions.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People had nutrition plans in place.

The service worked with external professionals to support and maintain people’s health. Care plans contained evidence of the involvement of GPs, district nurses and other professionals.

Staff treated people with dignity, respect and kindness. Staff knew people well and had a good rapport with people. Staff understood each person’s preferences and adhered to these. People and their relatives spoke highly of the care they received.

Procedures were in place to support people to access advocacy services should the need arise. One person using the service was working with an advocate at the time of our inspection.

End of life care plans were in place and provided detail of people’s preferences and wishes.

People’s care records were person centred. Person centred planning (PCP) provides a way of helping a person plan all aspects of their life and support, focusing on what is important to the person. The care plans contained a life history about the person. People who used the service and staff had a one page profile. A one page profile captures all the important information about a person on a single sheet. Where staff’s one page profile showed they had hobbies or interests that matched a person who used the service they were then matched as a key worker for that person.

People had access to a wide range of activities. People decided what they wanted to do each day and staff accompanied them to go shopping, to the seaside or for a pub lunch.

The service had a clear complaints policy that was applied when issues arose. People and their relatives knew how to raise any issues they had. At the time of inspection no one had raised a complaint.

Staff were able to describe the culture and values of the service stating nothing was hidden, and that they felt supported by the registered manager and deputy manager in delivering them.

The registered provider had developed a quality assurance system and gathered information about the quality of their service from a variety of sources.

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people in the communal areas of the home. We found that care and support was offered appropriately to people.

We spoke with one relative and they told us that their family member was treated respectfully and that they were happy with the quality of support their family member received.

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. People who used the service that we spoke with told us that they felt they were in a safe place.

We found that the service had enough qualified, skilled and experienced staff to meet people's needs.

We saw that the service had provided people with information about how to complain. People who we spoke with told us that they regularly attended the resident's meeting where they could raise any concerns they may have.

We found that people's needs were assessed and care was planned and delivered in line with their individual care plan. We saw that staff had a positive attitude towards the people who used the service and we observed throughout the visit that staff took time to answer questions and engage with people.

People who used the service had regular monthly meetings with their key worker and this was documented in their care records. This enabled the staff time to get to know people's likes, dislikes and discuss any issues or concerns.

During this inspection we saw that improvements had been made to the kitchen and laundry room. Also redecoration had taken place of the staircase, bedrooms and corridors.

We reviewed two staff files and saw evidence of bi-monthly supervision and annual appraisals. We looked at training records and saw that staff had completed their mandatory training including safeguarding.

We saw that there were good systems in place to assess and check that appropriate and safe care was being delivered. We saw a commitment to the continual improvement of the service.