Laurel Grove

Laurel Grove is a residential care home providing accommodation for persons who require nursing or personal care for to up to 3 people. The service provides support to younger adults with a learning disability or autistic spectrum disorder. At the time of our inspection there were 3 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: There were shortfalls in safely managing people’s medicines; medicine protocols were not in place for the administration of when required medicines. The provider did not always assess risks to ensure people were safe. Staff did not always take action to mitigate any identified risks. Staff were recruited safely and had appropriate training on how to safeguard people using the service.

People’s care plans did not evidence involvement of the person. People’s likes, dislikes and preferences were highlighted in their care plans. This provided guidance for staff to follow to ensure people’s needs and choices were met.

Each person had a communication plan which included information about how people preferred to communicate. Plans contained information in an accessible format.

Right Care: The care people received was person-centred and promoted people's dignity and privacy. People were encouraged to communicate freely and access the community for activities when they wanted to. Staff supported people to maintain important contacts.

People had individual positive behaviour support plans (PBSP) to guide staff when people became distressed or anxious.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service do not support this practice. For example, people's capacity was not always assessed and there was limited evidence of best interest decisions being made.

Right Culture: Staff understood and spoke positively about the importance of person-centred care and helping people to live as independently as they wished.

People were encouraged to share their views of the service.

People were cared for by staff who felt well supported by the managers.

The provider had internal processes in place to drive improvement at the service. A recent internal audit was completed which highlighted key areas for improvement. The registered manager and deputy manager were awaiting the final report.

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 Good, (published 24 October 2018).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

During the inspection we found there was a concern with mental capacity assessments (MCA) so we widened the scope of the inspection to include effective.

Enforcement

We have identified breaches in relation to medicines, MCA and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Laurel Grove on our website at www.cqc.org.uk.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Personal care is provided in one adapted building for up to three adults with learning disabilities. Accommodation is provided over three floors with access to communal kitchen, laundry, dining and lounge facilities, including a quiet lounge and private outdoor space. En-suite and a large adapted bathroom and toilet facilities are also provided, along with dedicated staff facilities. At our inspection, there were three people living at the service who received personal care.

Laurel Grove has a registered manager who supports two small care home locations for the provider. 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. A deputy manager was appointed at this location, to support the registered manager.

People received safe care in a clean, well maintained environment, which they were comfortable and happy with. People and staff were informed and confident to raise any safety concerns relating to people’s care, if they needed to. People felt safe at the service and staff knew how to keep them safe from any risk of harm or abuse.

Staffing measures, emergency contingency planning and related safety procedures, helped to ensure people’s safety at the service.

Risks to people’s safety associated with their health conditions and environment, were assessed before people received care and regularly reviewed in consultation with them. People’s medicines were safely managed.

Any safety or health related incidents were monitored and analysed, to help inform any care improvements needed. Related care or service improvements were shared with staff and monitored to help prevent any re-occurrence.

People received effective care. Staff were trained and informed to provide people’s care. 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 promoted this practice.

People’s needs were assessed before they received care and regularly reviewed. Staff supported people to maintain and improve their health and nutrition in consultation with relevant external health professionals. Staff followed any related instructions for people’s care when required.

Staff consulted with people to optimise their inclusion, understanding and ownership of their agreed care; and to ensure effective information sharing with external care providers when required. People were provided with care and service information in a format they could understand.

People continued to receive individualised care from staff, who were kind, caring and fostered good relationships with them and their families. Staff understood and followed people’s preferred daily living routines and lifestyles. This was done in an individualised way that helped to ensure people’s choice and independence.

Staff knew how to communicate with people in the way they preferred and understood. People were informed to help them understand their rights and what they could expect from their care. Staff supported people to access relevant advocacy, if they needed someone to speak up on their behalf. People and relatives were informed and knew how to make a complaint if they needed to. The provider regularly sought people’s and relatives’ views about the service. Findings from this were used to inform and make any care improvements needed.