Loretta House

Loretta House is a residential care home providing personal care and accommodation for up to 10 adults with learning disabilities. Six people were living there at the time of the inspection.

Loretta House is a three-storey detached home. People have their own bedrooms and share two lounges and a large kitchen/dining area. A rear patio leads onto a small garden area. Toilet and shower facilities are shared. All people living at Loretta House require support with personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support for people with learning disabilities although we found the provider was not aware of the publication of these principles. Registering the Right Support ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, or cameras to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

A person whose care needs were not in line with people with learning disabilities had been admitted to Loretta house. This person’s basic needs were met at the time of the inspection although the provider recognised it would be unlikely, they could meet their needs on a long term basis. The provider had not completed an assessment of how this placement would impact on their ability to continue providing a service that was in line with the principles of Registering the Right Support. The policies and systems in the service required improvement to reflect accurately best interests’ meetings to support this practice.

People’s experience of using this service and what we found

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were care for by skilled staff who knew how to keep them safe, protect them from avoidable harm and meet their needs. People had their risks assessed and staff had support and training to manage risks safely. People’s medicines were managed and stored safely. Staff followed infection control and prevention procedures.

People’s needs were assessed and updated on an ongoing basis. Staff we were trained to ensure that they could meet their needs. People were supported to have as much independence as possible and efforts were made to offer support in the least restrictive ways. Policies and systems were in place to support this.

People were supported by staff who were caring and kind in their manner and knew them well. People’s privacy and dignity were respected and maintained.

People’s needs were met, and the service adapted to changes in their needs. Staff were provided with the information and training needed to offer person centred care and had knowledge of people’s health needs.

The quality of the service offered to people was monitored by the management although not always consistently. The management team were approachable and had an open-door policy. People knew and liked the management team. The management team and staff established good linked with relevant professionals and community services.

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

Rating at last inspection

The last rating for this service was good (published 27th July 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make further improvements. Please see the well lead section of this full report.

You can see that action we have asked the provider to take at the end of this full report.

We found no evidence during the inspection that people were at risk of harm from this concern. Please see the ‘well lead’ section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Loretta House on our website at www.cqc.org.uk.

Enforcement

Since the last inspection we recognised that the provider had failed to update the commission of its statement of purpose.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Loretta House is registered to provide residential accommodation and personal care for up to ten adults, who have a learning disability. At the time of our inspection visit there were seven people living there.

There was a 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.

Following our last inspection on 22 and 23 May 2015, we found the provider required improvement when it came to applying restrictions on people in their best interests. At this inspection we found there had been an improvement.

People and their relatives felt the home was a safe environment and staff knew what action to take if they had any concerns about people’s safety. The provider had systems in place to keep people safe from the risk of harm and abuse. Risks to people had been assessed and were appropriately managed and staff had a good understanding of how to reduce the risks to people. People were supported by sufficient numbers of staff, who had been safely recruited. People received their medicines, as prescribed, and there were systems in place to ensure people’s medicines were managed safely.

People were supported by staff that were suitably trained and sought people’s consent before providing support. The provider took action to protect people’s rights and adhered to the legal principles when depriving people of their liberty, in peoples’ best interests, where it was appropriate.

People were able to choose what they ate and drank and were supported by staff to maintain a healthy and nutritious diet. People were supported to access health care professionals to ensure their health care needs were met.

People were supported by staff that was kind, caring and respectful. People were treated with dignity and staff understood people's needs well. People were encouraged to be as independent as possible and were supported to make choices.

People’s health and support needs were assessed and reviewed and their relatives were invited to contribute to the review process. People were encouraged to participate in activities and interests they enjoyed. People knew how to complain, although there had been no complaints made about the service. The provider had internal quality assurance systems to monitor the care and support people received, to ensure it was to a good standard.

On the day of our inspection eight people were living in the home. We spoke with two staff members, the manager and two people about the service. We looked at the care records for five people who lived there and five staff files.

People were asked for their consent before providing care and support. One person said, 'They always ask if it's okay before they give me my medicine or do anything for me.' This meant that people were able to direct the care they received.

Records gave staff enough information to support people with their needs in the way they preferred. People's were supported by range of health professionals who saw them regularly so that their health care needs were monitored and met.

People helped themselves to food and drink during the day. One person said, 'We choose our meals and help to make them.' People's weight was monitored regularly so that action could be taken if people were gaining or losing too much weight.

Systems were in place to ensure that people were safeguarded from harm. Staff had regular training and support to be able to safely care for people in the way that they chose.

The furnishings and presentation of the home provided a homely environment. The home and garden was pleasant and safe.

Robust systems were in place to assess and monitor the quality of the service provided.

We observed how people were cared for to understand their experiences. We saw that attention had been given to their appearance and personal care.

Staff interacted well with people living there. We saw people were treated with dignity and respect.People could choose how they spent their time and what they ate and drank. One person told us 'I go out on the ring and ride to the day centre or shopping. I am busy every day.'

Staff referred people to other professionals and followed their advice to ensure that people's health needs were met. Care plans did not always reflect people's current support needs. This meant that staff did not always have all the information that they needed to support people safely.

Appropriate checks were made before staff started working at the home to ensure that staff were suitable to work with people living there.

Staff showed that they knew how to protect the people living there from being abused to ensure that people were safeguarded from harm.

We saw that staff training was not up to date. Records showed that staff needed additional training to give them the skills and knowledge to know how to meet people's needs and ensure their well being.

Systems to audit the safety and quality of care to ensure that people were safeguarded from harm were in place but not up to date.