25 June 2018
During a routine inspection
This was the first inspection for the service under the provider United Response, since their registration on 27 June 2017. United Response is a nationwide provider of support for people with learning disabilities. Laura House was previously registered under another provider at the same location.
Laura House is registered to accommodate up to 16 people, in three separate houses and a flat, set within one purpose built building. The service provides accommodation and care to people living with learning disabilities, many of whom also have complex physical disabilities. At the time of our inspection there were 13 people living across the houses within the building.
This inspection took place on 25 June 2018, and was unannounced.
The service has a registered manager. 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.
Laura House had a clearly developed, empowering, person centred and open culture, with a clear set of values, ethos and clear lines of management. Innovative systems were in use and being developed to enable people to have a meaningful say about the service, and the organisational values. The service had links with other local services providing support to people with learning disabilities. People were enabled to have a voice on local and wider national issues affecting people with learning disabilities and their rights were respected.
People living at Laura House had complex needs, including some physical ill health and long term health conditions, communication concerns, complex mobility and positioning needs, difficulties with eating, and significant learning disabilities. However when we spoke with the registered manager and members of staff it was clear the people being supported were not defined by their diagnosis or difficulties they faced. Staff consistently referred to people’s strengths, personalities and achievements, and had a strong positive focus towards helping people maximise opportunities for a full and active life.
People being supported were put first by the organisation. Staff understood people’s needs, and ensured their support plans (referred to at Laura House as working documents) were followed through. Working documents were extensive, including photographs and multi media formats to help staff understand people’s complex communication, positioning or mobility needs.
Plans were just about to start for a full refurbishment and re-design of the building, in line with guidance on good practice, such as “Registering the Right Support”. This would reduce the number of people living at the service, and separate one part of the building to become a completely separate supported living property. The other self-contained houses would reduce to four people in each with en-suite accommodation. This would mean more spacious accommodation for people using complex moving and positioning equipment, as well as a smaller and more homely environment for people to live in.
Regular audits and assessments of the service showed they were performing at a high level and any areas needing attention or improvement were swiftly acted upon. There were regular staff meetings and staff received regular supervision and appraisal to monitor their performance. There were good systems in the home to support staff to develop new skills and make use of their existing ones, and reward outstanding achievement, voted for by people living at the service.
People were protected from the risk of abuse as staff understood the signs of abuse and how to report concerns. Staff had a clear focus on the people they were supporting, their rights and the opportunities to help them reach their potential maximise independence and choices. People were supported to make use of local facilities and services, and have regular involvement with the local community they lived in.
Risks to people were identified and plans were put in place to minimise these risks. For example, where people had health conditions such as epilepsy that could present risks there were clear and well understood protocols in place to guide staff as to actions they needed to take. Systems were in place to ensure any complaints or concerns were responded to and managed, including easy read documentation to support people’s understanding.
People received their medicines safely as prescribed. Medicines were stored safely in each person’s room, and records completed when people received their medicines. Records were kept when medicines were removed from the service when people went out. This meant it was possible to carry out a full audit trail of medicines prescribed to people.
People were supported by sufficient numbers of well trained and supported staff to meet their needs. Staff were very positive about the service and the people they supported. Staff recruitment systems were robust, and helped to ensure that people were not supported by staff who may be unsuitable to work with people.
Staff had a clear understanding of the Mental Capacity Act 2005 and had received training in its implementation. Where people lacked capacity to make an informed decision, staff acted in their best interests, and this was recorded. This had included creative input from relatives and other significant people involved in the person’s care. Applications had been made to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS) where necessary.
The service had a happy, positive and welcoming atmosphere. We saw staff were supportive, compassionate and caring in their relationships with people. People’s communication needs were understood and supported, including people with sensory loss. People were involved in conversations and we saw staff celebrating people’s day to day achievements with them.
Records were well maintained and kept securely. The service had notified the CQC of incidents at the home as required by law.