Lorenzo Drive

Updated 26 April 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was undertaken by an adult social care inspector over two days.

Service and service type:

Lorenzo Drive is a ‘care home’; people in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

In addition, there are eight additional places for tenants to be supported in supported living accommodation. In ‘supported living’ settings, people are tenants and can live in their own home and be supported to be as independent as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission [CQC] does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.’

Notice of inspection:

This was an announced inspection which took place over two days on 25 and 26 March 2019. We announced the visit by giving 48 hours’ notice as we needed to ensure the registered manager was present and we also needed to establish consent to visit people living in supported living.

What we did:

Our planning considered information the provider sent us since they had been registered. We also considered information about incidents the provider must notify us about, such as abuse or other concerns. We obtained information from the local authority commissioners and safeguarding team and other professionals who work with the service.

We assessed the Provider Information Return [PIR] which is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection, we spoke with three people using the service to ask about their experience of care. We also spoke with the registered manager, two senior managers for the provider and five members of the support staff. We received feedback from five professionals who work with people at Lorenzo Drive.

We looked at five people’s care records and a selection of other records including quality monitoring records, training records, staff records and records of checks carried out on the premises and equipment.

Updated 26 April 2019

About the service:

Lorenzo Drive is a purpose-built rehabilitation service for people with brain injury. There is a 12-bedded unit providing accommodation and personal care. In addition, there are eight additional places for tenants to be supported in supported living accommodation. In ‘supported living’ settings, people are tenants and can live in their own home and be supported to be as independent as possible. At the time of our inspection there were 12 people being supported in the care home setting and six people in supported living.

People’s experience of using this service:

There were systems in place to monitor medication so that people received their medicines safely. However, some of the medication records did not meet the providers own standards and increased potential risk; this was addressed during the inspection. We were also concerned about the safe management of ‘thickening’ agents used to thicken people’s drinks if they had swallowing difficulties. The registered manager advised us the policy and staff awareness for this would be reviewed. Storage for some medicines needed to be reviewed.

What was particularly noticeable about Lorenzo Drive was an atmosphere of positive regard for the people being supported mixed with focused and individual programmes of support based on people’s involvement and input.

There was strong shared culture based on people receiving support in one rehabilitation setting with a settled staff and therapy team; this gave people a confidence to build relationships and develop ongoing achievable goals.

Care planning supported people’s diversity and human rights. We found support for people who needed to promote their identity in terms of gender recognition. We spoke with professionals who told us the support provided was good and had contributed to people being able to develop their identity as individuals.

People’s individual communication needs were addressed and supported. Technology and a flexible approach by staff was used to fully support people to communicate their care needs, preferences and choices.

We were given positive feedback from the people we spoke with who were living at Lorenzo Drive. They told us they enjoyed living at the service and their quality of life was enhanced by the staff support, sense of community involvement and how they were included in all aspects of their care and running of the service.

People said they were well supported. People were listened to. People had the support they needed to express their needs and wishes. People could make decisions and choices. We found examples where people had improved their quality of life since they had been living at Lorenzo Drive and had been able to access the local community and develop new skills where as previously they had lacked confidence and had been anxious.

The assessment and planning of people’s care was individualised. We found care records that supported people were always completed and reviewed with the person’s input and included a high level of detail regarding peoples wishes and choices, aims and objectives. Support plans were tailored very much to people’s ability and need to live a ‘normal’ a life as possible, including family life.

There was a range of specialist therapeutic support for people as needed such as physiotherapy and psychological therapy as well as therapy such as music and drama which helped to increase peoples identify and wellbeing. One person told us, “I’ve come a long way since I’ve been here; I can live a life now.”

The service was staffed appropriately and consistently. We found staff communicated and supported people with dignity and respect. Staff could explain each person’s care needs and how they communicated these needs. People told us that staff had the skills and approach needed to ensure people were receiving the right care.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was ongoing. All the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed where obvious hazards were identified. We found the environment safe and well maintained.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We saw people’s dietary needs were managed with reference to individual needs and choice. People had individual dietary needs and planning was made accordingly.

The manager could evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. These were generally effective in managing the service and were based on getting feedback from the people living there as well as the various stakeholders involved with the service. The quality assurance processes were being developed to ensure the service was monitored safely and could continue to learn and develop. The medication audit was discussed and needed to be further improved to ensure improved monitoring.

Rating at last inspection:

Lorenzo Drive is a new service which was registered in August 2018 and this was the first inspection by CQC.

Why we inspected:

This was a planned comprehensive inspection.