Laurieston House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People were encouraged and supported to raise safety concerns with the provider. For example, a person told us, “If I’m not happy about something I just tell [registered manager] or the staff and they sort it out for me.”

The registered manager and staff understood the importance of reporting safety concerns and learning lessons when things went wrong.
Systems were in place to support staff to report and record safety concerns and events when they arose. There had been very few incidents or safety concerns, but when they did arise, the registered manager investigated them and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe.
The registered manager occasionally worked care shifts, which helped them ensure any risks associated with the potential development of closed cultures were identified and mitigated.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had an appropriate process for new referrals, obtaining a copy of the person’s initial assessment, and then carrying out their own assessment of need, before deciding whether they would be able to provide support. There was a paper-based care record system in place, which care staff had access to. This helped ensure people’s care was provided in a planned, responsive and organised way.
People were listened to by the provider’s staff when their initial care plans were being created. This helped ensure people were supported to receive continuity of care when they started receiving care from this service.
People were engaged in the process of planning to move between different services. For example, people were supported to decide what community-based activities they wished to take part in when access to traditional ‘day centres’ was reduced by the Local Authority. The registered manager also ensured there was effective communication between the care home and education services in respect of people who accessed those services from the care home.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.
People told us they felt comfortable when staff interacted with them. Staff used respectful language when describing people and their care needs. For example, a person told us, “I like the staff, we have a bit of fun. Just laughter and banter and they don't go over the line.”
The provider had a safeguarding policy and procedure in place. The provider’s safeguarding processes and practices meant people’s human rights were understood and upheld. This helped to protect people from discrimination. Staff received regular safeguarding training.
People also had access to people outside of the service with whom they could raise concerns about their safety if necessary. For example, social workers, community health care professionals, and family members.
Safeguarding incidents had rarely happened at the care home, but the registered manager explained the process they would follow to investigate any incidents which occurred while providing a service to people. They also co-operated with any safeguarding enquiries carried out by the Local Authority. The registered manager’s investigation findings from incidents were used to identify any lessons learned and actions to be taken to ensure people were protected from abuse.
The registered manager had a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and had submitted the relevant DoLS applications to the Local Authority where it had been assessed as being in the best interest of the person.
The care home staff did not use any physical restraint techniques or other restrictive practices. Staff de-escalated potential incidents instead, by using distraction or other gentle techniques to help people who were experiencing acute distress or anxiety occasionally.
The registered manager supported people to understand what their rights meant to them in practice. This included their human rights, rights under the Mental Capacity Act 2005, and their rights under the Equality Act 2010. For example, a person was supported to engage in local community politics and to vote in elections. The registered manager ensured any decisions which had been taken in a person’s best interest were explained to them, so they understood why.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
The provider reviewed any incidents for recurrent trends or triggers. Information was shared with the staff so support arrangements could be changed to reduce recurrences. People were involved in deciding how their individual risks would be managed and mitigated.
People’s individual risks were regularly assessed, and positive risk taking was used as a means of enabling people to maintain as much independence as possible. People were supported and empowered to take reasonable risks to achieve the lifestyle they wanted to live. For example, a person told us, “I decide what I want to do and the staff help me. [Registered manager] helps me a lot.”
People’s care plans detailed how to support them with their care and health needs. Staff knew the people they supported well and were aware of the symptoms and cues which might indicate they were becoming unwell or distressed. Staff told us how they supported and encouraged people, enabling them to make their own decisions, rather than trying to control people.
People’s individual risks were identified and assessed in their care plans. Care plans were amended when people’s needs changed or when they changed how they wanted to receive care from staff.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
At the time of the inspection the provider did not have effective measures in place to manage water safety. There was no water risk assessment in place, so the provider could not demonstrate potential risks from Legionella infection had been assessed by a suitably qualified and competent person. Legionnaires' disease is a lung infection associated with water supply and water outlets. It is uncommon but can be very serious. This was discussed with the registered manager who immediately arranged for a suitable water risk assessment to be carried out.
A few minor environmental issues identified during the inspection site visit were discussed with the registered manager, who took immediate action to rectify them during the days immediately after the site visit. The provider was able to evidence to the inspector that the work had been carried out.
Laurieston House care home is a normal domestic sized property. It provides a homely environment and people clearly felt safe there. The building and garden area met the needs of the people living there at the time of the inspection. People had been consulted about the decoration and furnishings in the care home, and there were adaptations and reasonable adjustments in place to meet their individual needs.
The care home building was generally well maintained and included equipment, such as a stair lift, to meet people’s individual needs.

The registered manager made sure there were enough qualified, skilled and experienced care staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.
The provider had safe recruitment procedures in place to make sure all staff were suitably experienced, competent and able to carry out their role. Some minor gaps were found in the provider’s staff employment records. This was discussed with the registered manager who took immediate action to ensure all the required information was available in each staff member’s employment records.
The registered manager had appropriate staff training in place, and staff told us they received the training they needed to support people safely. The registered manager assessed each new staff member to determine if they had the necessary skills, aptitude, and confidence to support people who have learning disabilities.
Staff received specific training to ensure they could meet the needs of any people living at the care home who had complex care and health needs. This included training related to learning disabilities and autism.
The registered manager encouraged staff to develop their skills and knowledge. A staff member told us, “If required my manager will arrange any training courses I need to support career development. However, this is a small care home, so there are limited opportunities to develop into senior roles. We are a small team.” Another staff member told us, “[Registered manager] always asks me in my supervision meetings if I would like to do this or that extra training for career development, but I’m just happy doing what I’m doing.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. The provider had an infection prevention and control (IPC) policy and procedure in place, which staff had access to.
The provider’s IPC policy and procedures set out the clear roles and responsibilities around infection prevention and control. The provider ensured their staff had access to the necessary personal protective equipment (PPE) to support effective hygiene and infection prevention. A staff member told us, “If we require any additional PPE our manager will arrange this for us.”
Staff were observed using appropriate PPE when preparing food, administering medicines and supporting people with personal care.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were involved in decisions about their medicines, and their medicines were appropriately prescribed, supplied, stored, and administered in line with the relevant legislation.
People’s prescribed medicines were regularly reviewed by external medical professionals as part of their individual health care support.
People had up-to-date information about their medicines available in their care plans and the provider’s medicine records. The provider worked with people to ensure they had the necessary prescribed medicines available to them. People’s behaviours were not inappropriately controlled by medicines.
The provider had appropriate medicines policies and procedures in place which staff could refer to for guidance when needed.