The Laurels

The Laurels is a specialist rehabilitation service. It provides care and support for up to 12 people who have an acquired brain injury and complex neurological conditions. The service supports people to access a range of rehabilitation programs. These are designed individually with the aim to support people to return to life in the community. There were 11 people living at the service at the time of this inspection.

The Laurels is split over 2 floors with ensuite bedrooms and a variety of shared spaces such as a training kitchen, laundry, areas for exercise and therapy, a lounge, a dining area and garden.

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

People told us they felt safe and were supported by a staff team who understood how to recognise abuse and were confident to report concerns. The registered manager ensured the relevant authorities were notified of all reportable events.

People had their needs fully assessed and risks to their health and well-being assessed and staff understood how to meet their needs.

People were supported to receive their medicines safely and medicines were regularly reviewed. Staff received training on safe administration of medicines and had their knowledge and practice assessed.

People were supported to access food and drink that met their needs and preferences. Health professionals monitored the needs and support of anyone who had difficulty eating or drinking.

People who required adaptations to their environment or to access specific equipment to support their mobility and improve their level of independence were supported to access or adapt what they needed.

People and those important to them were supported to be involved in reviews of their care and had regular opportunities to speak up. People told us they were happy to approach the registered manager if they had concerns or wanted to change their care and support. People felt listened to.

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 registered manager and senior staff team conducted regular audits of the service and used this information to drive improvement.

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 the service under the previous provider was outstanding (31 August 2017)

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe, effective, caring and well-led only. For the key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We did not find any concerns at The Laurels but the overall rating for the service has changed from outstanding to good based on the findings of this inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Laurels on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service can also provide care for people in their own homes in the city of Lincoln and its surrounding villages. At the time of our inspection there were no people receiving care in this way. However, the registered persons had ensured systems were in place so that this type of service could be provided if needed at any time.

The service was run by a company that is the registered provider. 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. In this report when we speak about both the company and the registered manager we sometimes refer to them as being, ‘The registered persons’.

At the last inspection we carried out on 23 June 2015 the service was rated ‘Good.’

This inspection was carried out on 12 July 2017 and was announced. During this inspection we found the service was ‘Outstanding.’

There was a registered manager in place who ran the service. 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. In this report when we speak about both the company and the registered manager we sometimes refer to them as being, ‘The registered persons’.

The registered manager was known personally to everyone at the service and people were kept at the heart of the services provided. People were actively involved in the preparation and on-going review of their personal care plan. Staff understood what was important to each person and worked closely with each other and external health and social care professionals to promote people’s well-being.

The creative and individualised approach to support displayed by the registered manager and staff provided clear therapeutic benefits for people. People received individualised support which was responsive to their diverse and changing needs and preferences.

The registered persons provided staff with strong, values-led leadership. Staff worked together well and were proud to work for the service. They felt listened to and well supported through supervision and training to work effectively.

The registered persons had assessed potential risks to people. When any accidents or incidents had occurred they had put preventive measures in place to reduce the risk of them occurring again. Staff knew how to recognise and report any concerns they had for people’s safety in order to ensure people were kept safe from harm.

Staff were recruited using safe systems to do this and there were enough staff in place to provide the care each person needed and in the way they had chosen to receive it.

People were involved in making decisions about their care and how they wanted to be supported. The registered manager had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken the necessary steps needed to ensure that people’s rights were protected. At the time of this inspection four people had their freedom restricted and the registered persons had acted in accordance with the Mental Capacity Act 2005 (MCA).

People had access to a varied diet and were supported to eat and drink enough to promote their health and well-being. People who needed staff assistance to take their medicines were supported safely to do this.

People and their relatives were encouraged to voice their views and opinions about the service provided. People knew how to raise concerns or complaints and were very confident that the provider would respond promptly and effectively if they raised any concerns with the registered persons.

A range of effective auditing and monitoring systems were in place which were used by the registered persons to ensure the approaches to care and the delivery of it reflected people’s preferences and needs.