Real Life Options - Lawrence House

Lawrence House is a residential care home providing personal care to people with learning and/or physical disabilities. The service can support up to six people but at the time of the inspection, five people were using the service.

The care home accommodates people in one adapted bungalow.

The service has 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The administration and management of medicines required improvement. We found one person had not received their medicines as prescribed on one day and a second person had received out of date medicine. The systems in place to manage risks associated with people's care needs did not always provide staff with information to manage those risks.

The provider’s governance systems to check the quality of the service provided for people were not consistently effective and required improvement.

People using the service at the time of the inspection could not always tell us about their experiences. However, whilst on site, we saw positive interactions between people and staff and people looked comfortable with the way they were being supported. Relatives we spoke with gave us good feedback on the service and the way the staff supported their family members to remain safe.

There were enough suitably recruited staff on duty to meet people’s needs and to keep people safe. The provider worked well with external health and social care professionals and people were supported to access these services when they needed them to ensure their health was maintained. Staff received training which helped them to deliver personalised care. People were supported by kind and caring staff. Staff encouraged people’s independence, protected their privacy and treated them with dignity.

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; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes 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 supported by staff who knew their preferences. Complaints made since the last inspection had been investigated and families knew who to contact if they had any concerns. Relatives and staff were happy with the way the service was being led and there was a clear culture amongst the staff team in providing high quality person-centred care.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 overall good (published 04 March 2017).

Why we inspected

This inspection was planned as part of our inspection programme.

Enforcement

At this inspection we have identified one breache of the Health and Social Care Act 2008 (Regulated Activities 2014) around governance. Full information about CQC's regulatory response is at the end of this report.

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.

We last inspected this service in March 2016. We found that improvements were needed to ensure the service was safe, effective, responsive and well led. The provider was not meeting the regulations regarding consent and good governance. Following our inspection the provider sent us an action plan about what they would do to improve. This inspection in January 2017 found that the issues had been improved and rectified

At the time of this inspection 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.

Staff were responsive to people’s needs and delivered care in line with people’s wishes. People had care plans in place, but some of these were not current. Action to ensure the care plans were updated was in progress. People were supported to engage in activities but further development was needed to promote opportunities for activities in the community. People had access to a complaints system and the registered manager responded appropriately to concerns.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. The staffing arrangements ensured that safe levels of staffing were provided at all times of the day. People received the correct medication at the correct times. All medication was administered by staff who were trained and competent to do so.

People seemed to be calm and relaxed when we visited and indicated they were happy living there. This was confirmed by people’s relatives. We observed caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting.

Staff had received sufficient training and supervision to ensure they had up to date knowledge and skills to provide safe care. People were supported to maintain their health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

There was effective leadership from the registered manager. The provider and registered manager assessed and monitored the quality of care people received.

The service is registered to provide care for up to six people who have a learning disability or autistic spectrum disorder. At the time of our inspection there was not 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.

We found enough staff to cover people's basic needs but there was sometimes not enough suitably competent and experienced staff to accompany people to undertake activities in the local community, and this restricted people’s choices. Some relatives, health care professionals and staff told us of concerns about the staffing arrangements.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. All medication was administered by staff who were trained to do so but some aspects of medicines management needed improvement.

People could not be certain their rights in line with the Mental Capacity Act 2005 would be identified and upheld.

People were supported to maintain good health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

People were at risk of infection as staff knowledge was lacking in some areas of infection control practice.

We saw that attention was needed to the environment. There had been some delays in carrying out repairs to the home but the provider was now taking action to address this.

People told us or indicated by gestures and their body language that they were happy at this home and this was confirmed by people's relatives. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting.

Whilst we received positive feedback from staff about the manager it was evident that they had insufficient time to carry out all of their responsibilities to ensure that people received the support and care they needed. The manager was responsible for the management of four services but the provider had plans to reduce this to two.

It was not evident that arrangements for checking the safety and quality of the service by the registered provider were effective.

We found the provider was in breach of Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We saw that people's needs had been assessed. Care and support was provided according to people's plans. There was detailed guidance for staff to guide them when relating to people whose behaviour had posed challenges to staff at times. We saw staff interacting with people in the ways which were outlined in their behaviour plans.

People were involved in a range of activities in the home and the community. Staff encouraged people to make choices about how they spent their time. Staff told us how they supported people do the things they wanted to do. We saw staff communicating well with people and providing reassurance where needed.

There were good arrangements for the storage, administration and recording of people's medication.

There were enough staff with sufficient skills to meet the needs of the people currently living in the home.

There were good systems for monitoring the performance of the home and for making sure that staff carried out their roles in the right way.

There were good arrangements for making sure that people who lived in, worked in and visited the building were kept as safe as possible.

Evidence of people's choices and decisions relating to social pastimes was noted congruently throughout the home, during observations, on files and from photographs. People who use the service were given appropriate information and support regarding their care or treatment; this was offered in a variety of ways to encompass specific needs.

The home was clean and well maintained which means that people live in a safe and clean environment. They made some of the following comments:

"It's good" one other person was noted to confirm his opinion of the home by putting his thumb up.

Evidence of verbal re-direction was noted to good effect and staff responded appropriately to non verbal communication. During the inspection,staff were heard to be offering choices, and encouragement ensuring person centred care.

You can see our judgements on the front page of this report.