This inspection took place on 20 June 2017 and was unannounced. At our last inspection in May 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Laurel House is a care home for adults who have a learning disability. The maximum number of people the home can accommodate is five. On the day of the inspection there were five men residing at the home. They all have lived at Laurel House for a number of years and we had met them all at the last inspection.

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.

People told us the staff were kind and they felt safe at the home. Staff understood their responsibilities to keep people safe from potential abuse.

Risks had been recorded in people’s care plans and ways to reduce these risks had been explored with the person and were being followed appropriately.

We saw that people using the service were relaxed with staff and everyone told us they knew each other very well.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately. Relatives told us that the registered manager had worked in collaboration with people’s doctors and psychiatrists to ensure people were not prescribed unnecessary medicines.

Staff were positive about working at the home and told us they appreciated the support and encouragement they received from the registered manager.

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 supported this practice.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People told us they enjoyed the food cooked by staff and that they were offered choices of what they wanted to eat.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

Everyone had an individual plan of care which they had input into and which was reviewed on a regular basis with their involvement.

People using the service and their relatives told us that the management and staff listened to them and acted on their suggestions and wishes.

Both people using the service and their relatives told us they were happy to raise any concerns they had with the registered manager.

People were included in monitoring the quality of the service and we saw that their suggestions for improvements and preferences about how they wanted to live their lives were respected and acted on.

This inspection took place on 5 May 2015 and was unannounced. At our last inspection in October 2013 the service met all the standards we looked at.

Laurel House is a care service that provides accommodation and care to a maximum of five people who have learning disabilities. On the day of the inspection there were five people residing at the home.

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.

People and their relatives told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful. They said they were satisfied with the numbers of staff and that they didn’t have to wait too long for assistance.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff had undertaken the training they needed to support people effectively and the registered manager made sure safe recruitment procedures were being followed.

Staff knew how to care for and support people safely and appropriately and people were involved in planning their care.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service, their relatives and staff were positive about the registered manager and her management of the home. They confirmed that they were asked about the quality of the service and had made comments about this. People felt the registered manager took their views into account in order to improve service delivery.

We found that staff followed people's care plans when providing care and support. Each person had a care plan in place which detailed their needs and what support staff would provide. We also found that risk assessments were in place, which identified risks and the control measures in place to manage these.

One person who used the service told us "staff are nice, they take me out." One person's relative said in respect to the person living at the home " X is happy" and "We have a good relationship with the staff."

We observed that the provider had systems in place for the safe management and storage of medication.

The provider had adequately trained staff so they were able to support people appropriately. We saw copies of the service's rotas and these showed that there were adequate numbers of staff on shift at any one time.

The provider had a complaints policy in place and a pictorial version for people who used the service. Staff we spoke with were able to tell us the complaints procedure and records showed that where a complaint had been made, this had been dealt with appropriately.

We reviewed the service's records including, staff personal files, medication records, people's care plans, risk assessments and office files and the company's policies and procedures.

Where people could express their consent and preferences these were obtained and taken into account when providing care. Relatives and staff were involved in helping people to express their likes and dislikes and to give or refuse their consent to their care or treatment. One person's care plan stated "I can let staff know by saying "no" very clearly when I am not ready to be supported."

We saw that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan and to ensure people’s safety and welfare. A relative said "the support is good, I only have to mention extra help is needed and it is dealt with." Staff and relatives told us that people's behaviour had improved since they had been living at the home. People’s care reflected relevant research and Department of Health guidance.

People who use the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements. Staff told us that de-escalation and breakaway techniques were used and not restraint.

Appropriate checks were undertaken before staff began work and effective recruitment, selection, employment and education processes were in place.

People who use the service and their representatives were asked for their views about their care and treatment by the service and we saw that these were acted on. Records showed that monthly audits had been made by the manager.

We observed staff knocked on people’s bedroom doors and asked to come in before entering. Interactions between members of staff and people using the service were positive and respectful. We saw examples of people’s dignity and privacy being respected on the day of the inspection.

A relative stated that they ‘’were as happy as they could be they had no concerns about the level of care’’.

We asked people if they felt safe living in the care home and comfortable with the other people living in the home including the staff that supported them. A person

replied they were happy. Another person said, ‘’staff are nice’’.

People were satisfied with the service and said they were happy at the home. Comments on feedback forms included “this is an excellent supportive service”.