Archived: Dimensions The Laurels 3 Nine Mile Ride

Dimensions - The Laurels is a care home without nursing which is registered to provide a service for up to six people with learning disabilities. Some people have other associated difficulties including, needing support with behaviours which could be distressing and/or harmful. There were four people living in the home on the day of the visit.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The registered person did not always ensure the quality assurance system in place was used effectively to help oversee the service and ensure compliance with the fundamental standards. The registered person did not ensure the management of medicines was always safe. The registered person did not ensure effective recruitment processes were followed so that people were protected from staff being employed who were not suitable. The registered person did not ensure we were informed about events such allegations of abuse in a timely manner.

We have recommended that the registered person ensured they recorded and kept a copy of actions taken as required in the Duty of Candour regulation when a notifiable safety incident occurred.

We have recommended that future ongoing staff training be updated in line with the latest best practice guidelines for social care staff.

Relatives felt they could approach the management and staff with any concerns. However, they felt communication between them and the staff team and what was happening at the service could be improved. The staff members felt staffing levels were adequate most of the time. The manager appreciated staff’s contribution to ensure people received the best care and support. Staff felt the manager was managing the service well, and they were accessible and open with the staff members.

Staff had ongoing support via regular supervision and appraisals. They reportedly felt supported and maintained great team work.

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Relatives felt their family members were kept safe in the service. The manager and staff understood their responsibilities to raise concerns. Risks to people’s personal safety had been assessed and plans were in place to minimise those risks. There were contingency plans in place to respond to emergencies and the premises and equipment were kept clean.

People received effective care and support from staff who knew them well. People enjoyed the food and could choose what they ate and where to eat. People had their healthcare needs identified and were able to access healthcare professionals such as their GP.

The manager was working with the staff team to ensure caring and kind support was consistent. People and their families were involved in the planning of their care. The staff team recognised and responded to changes in risks to people and ensured a timely response and appropriate action was taken. People were encouraged to live a fulfilled life with activities of their choosing and were supported to keep in contact with their families.

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 this service was good (published 13 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dimensions - The Laurels is a residential care home which is registered to provide a service for up to six people with learning disabilities. Some people have other associated difficulties including needing support with behaviours which could be distressing and/or harmful. There were three people living in the home on the day of the visit. The service offered ground and first floor accommodation in six bedrooms. One bedroom was on the first floor and two rooms had fully en-suite facilities.

At the last inspection, on 20 May 2015, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good:

There is a registered manager running 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.

People continued to be kept as safe as possible from abuse and harm by staff who had been trained in safeguarding vulnerable adults and health and safety policies and procedures. The staff team’s knowledge and understanding of how to keep people and themselves safe contributed to ensuring people lived in a safe and secure environment. Staffing ratios ensured people were supported safely and the recruitment procedures were effective in making sure appointees were suitable and safe to work with people. People were given their medicines in safely.

The staff team continued to respond effectively to people's current and changing needs. They ensured their health and well-being needs were met in a timely way. The service worked closely with health and other professionals to ensure they met people’s needs.

People continued to be supported to have maximum choice and control of their lives. Staff offered them care in the least restrictive way possible, the policies and systems in the service supported this practice.

The staff team remained kind, caring and committed and were knowledgeable about people’s needs. People continued to benefit from individualised care planning which ensured staff used a person centred approach. The staff team respected people’s equality and diverse needs.

People received good care from a well led service. The registered manager was experienced and qualified and listened and responded to people, staff and others. The management team were described as approachable and very supportive. The quality of care the service provided was assessed, reviewed, improved and developed as necessary.

People's care plans were person-centred. Information detailed people's physical and emotional care needs. Staff told us communication worked well, and there were robust methods in place to ensure all staff were aware of updates to people's care support. Relatives said staff regularly discussed people's care with them. One relative said 'It's a lovely environment, there's always lots of laughter. Staff are very caring and supportive. They do the best for people, I'm very impressed and pleased with the staff.'

Staff understood the procedure to report safeguarding concerns. The safeguarding policy was available in a suitable format for people who use the service. One person who uses the service told us they felt safe in the home. We spoke with four relatives of people who use the service. They were aware of how to raise concerns, but told us they had no concerns about the care provided for their loved ones.

Relatives we spoke with could not recall completing the provider's annual survey, but told us they felt 'very much' involved in the care of their loved ones as staff spoke with them regularly. We saw the provider conducted quarterly compliance audits of the service to ensure care was provided appropriately. The service addressed any issues identified to ensure people were supported safely and their views were taken into account.

We saw person-centred care plans noting people's preferences and methods of communication. We were told this helped staff to understand and encourage people's decision-making. We saw staff supporting people to make choices.

There were systems in place to get consent from people before providing care. The home was clean and well maintained. Where equipment broke down, it was fixed quickly.

Staff were able to explain the recruitment procedure, and the pre-employment checks they had. We saw evidence the staff recruitment process was followed. We saw training records showed the training staff had taken. However, there were some areas where staff required further training. These included handling difficult or challenging behaviour, and fire evacuation procedures. Complaints were recorded and addressed.