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Inspection carried out on 19 January 2018

During a routine inspection

The Lawns is a residential care home without nursing for up to nine people who live with a diagnosis of learning disability and/or autism. Some people living at The Lawns also have physical disabilities. At the time of the inspection there were nine people living at the service, all of whom had lived at the service for a number of years.

At the last inspection in October 2015 the service was rated overall Good. At this inspection we found the service remained Good in all domains.

People, their families, staff as well as health and social care professionals were very positive about the home and the care provided. Comments from people included “I like it here.” “Care worker is nice.” People were relaxed and happy with staff, laughing and chatting with them.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were encouraged to do a range of activities both in the home and in the community. Staff worked with people to support them to choose what they wanted to do and who they wanted to do it with.

Staff knew people well and were kind and compassionate when working with people. Staff were knowledgeable about people’s communication methods. People were treated with dignity and people’s right to privacy was respected by staff. People’s diversity and wishes were understood by staff, including cultural and religious preferences. People were protected from the risks of abuse by staff who understood their responsibilities.

There was a registered manager in post. There was a quality assurance and governance framework which checked that the home was safe and well maintained. There were systems to ensure the home was kept clean and free of infection. There were also quality assurance systems which monitored the care provided to people. Where issues were identified, there were actions to address them. There were policies and procedures in place which ensured the smooth running of the service. The home had a complaints policy and process. People were supported to have an independent advocate where necessary.

There were sufficient staff who had the knowledge, skills and experience to support people with their care. Staff had been recruited safely. Staff were supported to undertake training when they first joined the home and to refresh their knowledge from time to time. Staff were also supported to do nationally recognised qualifications. Staff had regular one to one supervisions with a senior worker which gave them an opportunity to reflect on what was going well, what was not going so well and what support they needed to improve their work.

Care records contained risk assessments and care plans which described people’s personal background, risks, needs and preferences as well as how these should be met. Staff were able to describe how they worked with people to deliver the care in the care records.

People experienced effective care that promoted their health and wellbeing. People were encouraged to eat a healthy diet of their choice. Staff prepared meals to meet people’s special dietary needs. People were offered drinks throughout the day to ensure they remained well hydrated. People’s health needs were monitored and health professionals were involved where necessary. Medicines were stored and administered in a safe way. Staff recorded accurately when medicines were given. Checks were undertaken to monitor the medicine administration.

Further information is in the detailed findings below.

Inspection carried out on 16 and 22 October 2015

During a routine inspection

The inspection took place on 16 and 22 October 2015 and was unannounced. This was the first inspection of the service since the provider changed their legal entity from Voyage Limited to Voyage 1 Limited in June 2014. Voyage 1 Limited is the provider of a number of services throughout the country.

The Lawns provides accommodation with personal care for up to ten people over the age of 18 who have a diagnosis of a learning disability and/or autistic spectrum disorder. The home is a three storey house located in Exmouth, within walking distance of the town and beach. There are bedrooms on all three floors and all bedrooms are en-suite, for single occupancy. The home is staffed 24 hours a day.

At the time of the inspection, eight people had lived at the home for a number of years and one other person was expected to move in during the inspection. People had very complex needs and communication difficulties associated with their learning disability. Because of this, we were only able to have very limited conversations with one person about their experiences. We therefore used our observations of care and our discussions with staff to help inform our judgements.

The home had a manager who had been registered in the role with the Care Quality Commission since 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers and nominated individuals, 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 registered manager had a clear vision for the home and the people who lived there. They described how they and the staff were committed to ensuring people had a happy experience living at the Lawns with as few restrictions as possible.

People’s needs and risks were assessed and care plans were developed to support them to be as independent as possible. Daily notes reflected the care described in the care plan.

The service provided to people living at The Lawns was delivered by a team of staff, who had been trained to support people with learning disabilities and who had in-depth knowledge of people’s needs and aspirations. Staff were supported to undertake training to help them in their role and received regular supervision.

Staff were recruited safely with disclosure barring service (DBS) checks and references taken up before a new member of staff started working at the home. Staff undertook an induction, including training and shadowing experience staff until they were assessed as able and confident enough to work with people on their own.

People were relaxed and happy with staff who were kind. Relatives were very complimentary about the home and the staff who worked there. People were offered a wide choice of activities both in the home and in the community and chose what they wanted to do each day. These activities included swimming, horse riding, trips to places of interest as well as helping staff to prepare meals. Where needed, two staff would support people when they went out on trips. Staff communicated with people using a range of methods including the use of simple sign language and pictures to aid understanding.

Staff were aware of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguard (DoLS) requirements and took them into account when working with people. Applications for DoLS authorisations for each person living at the home had been submitted to the relevant local authority.

Medicines were stored, administered and recorded safely by staff who had received training in medicine administration. Audits of medicines were undertaken internally and also by the dispensing pharmacy who had not found any significant issues.

People were supported to have their health needs met by health and social care professionals including their GP and dentist. People were involved in how the home was run, including what activities were offered and what meals were prepared. People were supported to have a healthy balanced diet.