We carried out this inspection on 24 September 2015. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.
Lawreth provides accommodation and personal care for up to two people. Nursing care is not provided. The home is a detached bungalow with three bedrooms, a lounge and kitchen. It is set in its own gardens in a residential area, near to public transport routes and local shops.
The inspection was carried out by an adult social care inspector.
There was a registered manager in place who had been in their present post at the home for over eleven years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 used a number of different methods, for example observing how people were supported to make decisions about their care to help us understand the experiences of people using the service. This was because we were unable to get peoples' direct comments about the care they received. We saw people indicating their choices and wishes to staff who were responding to their decisions and making sure they were empowered to be as independent as possible. Staff treated people with compassion and respect and we saw that they were aware of how to respect people’s privacy and dignity.
Staff engaged people using prompts such as pictures and photographs to help them express their wishes, likes and dislikes and the activities they wanted to do. We found people were engaged in their care and the running of the home. People’s care plans were very person centred and written in a way that described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for service users to understand by using of lots of pictures and symbols.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the registered provider was following legal requirements in relation to DoLS.
Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development
activities to maintain their skills. We also viewed records that showed us there were safe and robust recruitment processes in place.
Throughout the day we saw staff interacting with people in a very caring and professional way. The registered manager and staff that we spoke with showed genuine concern for peoples’ wellbeing and it was evident that all staff knew people at the home very well. This included their personal preferences, likes and dislikes and they had used this knowledge to form very strong therapeutic relationships. We saw all of these details were recorded in people’s care plans. We found that staff worked in a variety of ways, responding to changes in expression or demeanour, to ensure people received care and support that suited their needs.
People were protected from the risk of abuse. The care staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They had undertaken training and were able to describe the different ways that people might experience abuse. Staff were able to describe what actions they would take if they witnessed or suspected abuse was taking place.
We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.
People received a balanced diet. People at the home had specific diets and preferences and staff were very knowledgeable about these. We saw staff offered a selection of preferred meals and people chose what they wanted to eat. There were snacks and drinks available at all times as well as healthy options for people to choose from.
We saw the registered provider had policies and procedures for dealing with medicines and these were followed by staff. Medicines were securely stored and there were checks and safeguards in place to make sure people received the correct treatment.
We found that the registered provider had comprehensive systems in place for monitoring the quality of the service. This included monthly audits of all aspects of the service, such as medication and learning and development for staff, which were used to critically review the home. We also saw the views of the people using the service, their advocates and relatives were regularly sought and used to make changes. The manager produced action plans, which clearly showed when developments were planned or had taken place.
People were supported to take part in activities they were interested in and routines they preferred. Staff were constantly looking for more opportunities for people to try.
People were supported to maintain good health and had access to healthcare professionals and services for treatments where these were needed. People were supported and encouraged to have regular health checks and intensive support from staff had enabled hospital appointments and emergency treatments to take place.