Archived: Laura House

Updated 17 August 2018

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 was 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.’

This inspection took place on 25 June 2018 and was unannounced. The inspection was carried out by one adult social care inspector and an expert-by-experience. An expert-by-experience is a person who has personal experience of supporting or caring for someone with learning disabilities and complex needs.

People at the service were living with complex needs, and for some people this meant they did not communicate verbally, or had limited verbal skills. For this reason we were not always able to directly speak with everyone about their experiences. We spent time observing relationships and contacts people had. We also spoke with and spent time with people throughout the day and across the individual houses. We used the short observational framework for inspection (SOFI) to help us make judgements about people’s experiences and how well they were being supported. SOFI is a specific way of observing care to help us understand the experiences people had of the care at the service.

Prior to the inspection the provider completed a PIR or provider information return. This form asked the registered provider and registered manager to give some key information about the service, what the service did well and improvements they planned to make. We also looked at other information we held about the service, such as information about specific events they were required to send us.

During the inspection we looked at the support plans for four people living at the service, and sampled others. We spoke with or spent time with eight people living at the service, six members of care support staff, two team leaders, the registered manager, the regional manager and a training manager who was delivering training at the service. We also contacted two people’s relatives by telephone to discuss their support.

Following the inspection we also received additional documentation from the service. We looked at records in relation to the operation of the service, such as risk assessments, care plans (known at the service as working documents), policies and procedures and staffing files, and looked around the building and garden.

Updated 17 August 2018

This was the first inspection for the service under the provider United Response, since their registration on 27 June 2017. United Response is a nationwide provider of support for people with learning disabilities. Laura House was previously registered under another provider at the same location.

Laura House is registered to accommodate up to 16 people, in three separate houses and a flat, set within one purpose built building. The service provides accommodation and care to people living with learning disabilities, many of whom also have complex physical disabilities. At the time of our inspection there were 13 people living across the houses within the building.

This inspection took place on 25 June 2018, and was unannounced.

The service has a registered manager. 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.

Laura House had a clearly developed, empowering, person centred and open culture, with a clear set of values, ethos and clear lines of management. Innovative systems were in use and being developed to enable people to have a meaningful say about the service, and the organisational values. The service had links with other local services providing support to people with learning disabilities. People were enabled to have a voice on local and wider national issues affecting people with learning disabilities and their rights were respected.

People living at Laura House had complex needs, including some physical ill health and long term health conditions, communication concerns, complex mobility and positioning needs, difficulties with eating, and significant learning disabilities. However when we spoke with the registered manager and members of staff it was clear the people being supported were not defined by their diagnosis or difficulties they faced. Staff consistently referred to people’s strengths, personalities and achievements, and had a strong positive focus towards helping people maximise opportunities for a full and active life.

People being supported were put first by the organisation. Staff understood people’s needs, and ensured their support plans (referred to at Laura House as working documents) were followed through. Working documents were extensive, including photographs and multi media formats to help staff understand people’s complex communication, positioning or mobility needs.

Plans were just about to start for a full refurbishment and re-design of the building, in line with guidance on good practice, such as “Registering the Right Support”. This would reduce the number of people living at the service, and separate one part of the building to become a completely separate supported living property. The other self-contained houses would reduce to four people in each with en-suite accommodation. This would mean more spacious accommodation for people using complex moving and positioning equipment, as well as a smaller and more homely environment for people to live in.

Regular audits and assessments of the service showed they were performing at a high level and any areas needing attention or improvement were swiftly acted upon. There were regular staff meetings and staff received regular supervision and appraisal to monitor their performance. There were good systems in the home to support staff to develop new skills and make use of their existing ones, and reward outstanding achievement, voted for by people living at the service.

People were protected from the risk of abuse as staff understood the signs of abuse and how to report concerns. Staff had a clear focus on the people they were supporting, their rights and the opportunities to help them reach their potential maximise independence and choices. People were supported to make use of local facilities and services, and have regular involvement with the local community they lived in.

Risks to people were identified and plans were put in place to minimise these risks. For example, where people had health conditions such as epilepsy that could present risks there were clear and well understood protocols in place to guide staff as to actions they needed to take. Systems were in place to ensure any complaints or concerns were responded to and managed, including easy read documentation to support people’s understanding.

People received their medicines safely as prescribed. Medicines were stored safely in each person’s room, and records completed when people received their medicines. Records were kept when medicines were removed from the service when people went out. This meant it was possible to carry out a full audit trail of medicines prescribed to people.

People were supported by sufficient numbers of well trained and supported staff to meet their needs. Staff were very positive about the service and the people they supported. Staff recruitment systems were robust, and helped to ensure that people were not supported by staff who may be unsuitable to work with people.

Staff had a clear understanding of the Mental Capacity Act 2005 and had received training in its implementation. Where people lacked capacity to make an informed decision, staff acted in their best interests, and this was recorded. This had included creative input from relatives and other significant people involved in the person’s care. Applications had been made to deprive people of their liberty under the Deprivation of Liberty Safeguards (DoLS) where necessary.

The service had a happy, positive and welcoming atmosphere. We saw staff were supportive, compassionate and caring in their relationships with people. People’s communication needs were understood and supported, including people with sensory loss. People were involved in conversations and we saw staff celebrating people’s day to day achievements with them.

Records were well maintained and kept securely. The service had notified the CQC of incidents at the home as required by law.