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The Laurels Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 February 2019

Dolphin Homes, the provider, delivers care and support for adults with learning difficulties, behaviour which challenges others, physical disabilities and complex health needs, autism and Asperger's syndrome. The Laurels provides care and support for up to seven people with complex health needs and a learning disability and / or a physical disability.

People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. This inspection took place on 7 and 9 January 2019 when there were seven people using the service.

The service had a registered manager. 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 Laurels had been developed and designed in line with the values that underpin

Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service lived as ordinary a life as any citizen. People were given choices and their independence and participation within the local community was being encouraged and enabled.

At our last inspection we rated the service as overall good. At this inspection, we found some areas where improvements were needed and one breach of the fundamental standards. We have now rated the service as requires improvement.

The provider’s governance and quality assurance systems were not being fully effective at monitoring the quality and safety of the service. We found a number of areas where records relating to people’s care, and to the management of the service, were not complete, accurate and up to date.

Where people were unable to make more complex decisions about their care and support, staff had not always demonstrated how they were acting in accordance with the MCA 2005.

Whilst staff knew how to support people in a way that minimised identified risks, records relating to this were not always accurate. Similar concerns were found in relation to medicines records. We were concerned this could impact on people’s safety.

Overall, the design and layout of the premises met people’s needs, but further action was needed to ensure that all aspects of the premises were well maintained and in a good state of repair.

There were sufficient numbers of staff to meet people’s needs.

Staff followed infection control guidance and the home was visibly clean.

Incidents and accidents were investigated and remedial actions taken in response.

Health and safety checks were carried out to ensure the safety of the building and equipment within it, but we have made a recommendation about window restrictors.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

Staff understood their responsibility to raise concerns and report on incidents and accidents.

Staff received the training and support they required to meet people's individual needs. Staff worked well with external health care professionals and people were supported to access health services when required.

People were treated with dignity and respect and staff were kind and caring in their interactions with people. People received care that was centred on them as an individual.

People were supported to follow their interests and take part in social activities both within the home and within the community.

Relatives were confident they could raise concerns or complaints and these would be dealt with.

We have made a recommendation about developing end of life support planning for people using the service.

Relati

Inspection areas

Safe

Requires improvement

Updated 8 February 2019

The service continued to be rated as requires improvement.

Whilst staff knew how to support people in a way that minimised identified risks, records relating to this were not always accurate. Similar concerns were found in relation to medicines records. We were concerned this could impact on people�s safety.

There were sufficient numbers of staff to meet people�s needs.

Staff followed infection control guidance and the home was visibly clean.

Incidents and accidents were investigated and remedial actions taken in response.

Health and safety checks were carried out to ensure the safety of the building and equipment within it.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

Staff understood their responsibility to raise concerns and report on incidents and accidents.

Effective

Requires improvement

Updated 8 February 2019

The service had deteriorated to requires improvement.

Where people were unable to make more complex decisions about their care and support, staff had not always followed relevant guidance in the MCA 2005.

Overall, the design and layout of the premises met people�s needs, but further action was needed to ensure that all aspects of the premises were well maintained and in a good state of repair.

Staff were all aware of people's dietary needs and preferences and people appeared to enjoy the food provided.

Staff received the training and support they required to meet people's individual needs. Staff worked well with external health care professionals and people were supported to access health services when required.

Caring

Good

Updated 8 February 2019

The service remained good.

Responsive

Good

Updated 8 February 2019

The service remained good.

Well-led

Requires improvement

Updated 8 February 2019

The service had deteriorated to requires improvement.

The governance and quality assurance systems were not being fully effective at monitoring the quality and safety of the service. We found a number of areas where records relating to people�s care, and to the management of the service, were not complete, accurate and up to date.

Relatives and staff expressed confidence in the registered manager and their ability to manage the home well. Everyone continued to speak positively about the friendly and homely culture within the home.