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Inspection carried out on 12 July 2017

During a routine inspection

The Laurels is a specialist rehabilitation service. It provides care and support for up to 12 people who have an acquired brain injury and complex neurological conditions. The service supports people to access a range of rehabilitation programmes. These are designed individually with the aim to support people to return to life in the community. There were 12 people living at the service time of this inspection.

The service can also provide care for people in their own homes in the city of Lincoln and its surrounding villages. At the time of our inspection there were no people receiving care in this way. However, the registered persons had ensured systems were in place so that this type of service could be provided if needed at any time.

The service was run by a company that is the registered provider. There was a registered manager in post. 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. In this report when we speak about both the company and the registered manager we sometimes refer to them as being, ‘The registered persons’.

At the last inspection we carried out on 23 June 2015 the service was rated ‘Good.’

This inspection was carried out on 12 July 2017 and was announced. During this inspection we found the service was ‘Outstanding.’

There was a registered manager in place who ran the service. 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. In this report when we speak about both the company and the registered manager we sometimes refer to them as being, ‘The registered persons’.

The registered manager was known personally to everyone at the service and people were kept at the heart of the services provided. People were actively involved in the preparation and on-going review of their personal care plan. Staff understood what was important to each person and worked closely with each other and external health and social care professionals to promote people’s well-being.

The creative and individualised approach to support displayed by the registered manager and staff provided clear therapeutic benefits for people. People received individualised support which was responsive to their diverse and changing needs and preferences.

The registered persons provided staff with strong, values-led leadership. Staff worked together well and were proud to work for the service. They felt listened to and well supported through supervision and training to work effectively.

The registered persons had assessed potential risks to people. When any accidents or incidents had occurred they had put preventive measures in place to reduce the risk of them occurring again. Staff knew how to recognise and report any concerns they had for people’s safety in order to ensure people were kept safe from harm.

Staff were recruited using safe systems to do this and there were enough staff in place to provide the care each person needed and in the way they had chosen to receive it.

People were involved in making decisions about their care and how they wanted to be supported. The registered manager had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons

Inspection carried out on 23 June 2015

During a routine inspection

The Laurels provides care for up to 12 people who have an acquired brain injury and complex neurological conditions. The service supports people to access a range of rehabilitation programmes. These are designed individually with the aim to support people to return to life in the community. There were 6 people living in the service at the time of the inspection.

The service had an established registered manager in post at the time of our inspection. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection two people who used the service had their freedom restricted in order to keep them safe and the provider had acted in accordance with the Mental Capacity Act, 2005 and DoLS.

People were cared for safely and they were treated with dignity and respect. They were able to access appropriate healthcare services and nutritional planning took account of their needs and preferences. Their medicines were managed safely.

People were involved in planning the care and support they received and staff listened to, and respected their views about the way they wanted their care delivered. They were also supported to enjoy a range of activities and interests of their choice.

People could voice their views and opinions to the registered manager and staff and were able to raise concerns or complaints if they needed to. The registered provider, the registered manager and staff listened to what people had to say and took action to resolve any issues as soon as they were raised with them.

Staff were appropriately recruited to ensure they were suitable to work with vulnerable people. They received training and support to deliver a good quality of care for people. They understood how to identify report and manage any concerns related to people’s safety and welfare.

Staff delivered the care that was planned to meet people’s needs and took account of their choices, decisions and preferences. Staff cared for people in a sensitive, warm and friendly manner.

The registered provider maintained systems to regularly assess, monitor and improve the quality of the services provided for people.