Laverstoke Gardens is a residential care home for a maximum of seven people with a learning disability. At the time of the inspection there were six people using the service.

This inspection was unannounced and carried out on 25 October 2017.

At the last inspection the service was rated Good, at this inspection we found the service remained Good.

The service had 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.

Adult safeguarding procedures were in place and followed by staff to support people from potential harm and abuse. Staff supported people to manage the risks around their daily living which ensured they were safe to take part in activities of their choice. Fire safety instructions and equipment were available for staff to use in the event of fire. Staffing levels were based on people’s care needs and changed if people required additional support. People received their medicines in line with good practice.

The service ensured that people consented to their care and treatment. Staff knew their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s nutritional needs were assessed and they had support to meet their dietary needs and requirements. People were supported to access health care professionals who ensured their wellbeing was monitored and maintained. Staff regularly attended training courses to ensure they carried out their roles and responsibilities in line with the services policies and procedures. However, staff were not trained to support people with mental health needs. After discussing this with the registered manager, the mental health training course was booked for staff the next day.

The atmosphere within the service was welcoming and relaxed. People’s views were listened to and support provided was respectful towards the people’s care needs. People were treated with dignity and kindness and staff encouraged people’s privacy. People made choices about the activities and social gatherings they wanted to take part in.

Care plans were in both written and pictorial format which helped people to understand their contents better and get involved in making decisions about their care. Care records were detailed and guided staff in meeting people’s care needs. People and their relatives were supported to raise concerns and complaints. Feedback surveys were sent regularly which ensured that people’s views about the service were collected.

The registered manager provided good leadership at the service and was approachable and responsive to people’s and staff’s needs. Systems were in place to support staff with their responsibilities and the concerns raised were acted on to ensure good care for people. Regular audits were undertaken and looked at all aspects of the service. Where issues were identified, action was taken to make improvements.

We conducted an inspection of Laverstoke Gardens on 9 February 2016. The inspection was unannounced.

At our last inspection on 23 December 2014 we identified some concerns around risk assessments not being updated and care plans not being fully completed. We also identified some concerns around quality monitoring as lessons were not always learned from incidents that occurred. As part of this inspection we checked that improvements had been made.

Laverstoke Gardens provides care and accommodation for up to seven women with learning disabilities. It is located in the Roehampton area. At the time of our inspection there were six women using the service.

There was a registered manager at 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.

Staff followed safe practises for administering and storing medicines. Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and care plans contained clear information for staff. Separate action plans were in place to monitor people’s progress against their goals and these were evaluated every month with the person’s key worker.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. People’s rights were protected and their liberty was only deprived in accordance with legal requirements and for their own safety.

Most staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People who used the service and their relatives gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs and were supported to access a range of healthcare professionals. Some people had complex needs and staff demonstrated a clear understanding of this.

People using the service, their relatives and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

People were encouraged to participate in activities they enjoyed. People had a separate activities schedule which was discussed with people.

The organisation had adequate systems in place to monitor the quality of the service. Feedback was obtained from people through residents meetings and annual questionnaires and the results of these were positive. There was evidence of auditing in many areas of care provided and action plans were in place to secure improvement.

During our visit we spoke with the interim manager. The aim of the visit was to check that staff had received regular supervision sessions and that the complaints book was accessible.

We saw that staff had attended supervision sessions with the interim manager in November and December 2013. The interim manager confirmed that they were in the process of planning staff supervision sessions for 2014. We saw that the notes of the supervision sessions included information on what was discussed and any actions. The records were signed and dated by the member of staff and the interim manager.

The interim manager explained that they had introduced a method for staff to alert them if a person wished to make a complaint. They explained that the complaints book was kept securely to maintain confidentiality. During the visit the interim manager located standard forms for recording complaints, investigations and outcomes which were part of the complaints policy and procedure. They confirmed that they would start to use these forms to improve the information recorded about a complaint and any actions taken.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. A new manager had been recruited and was awaiting their Disclosure and Barring Service (DBS) check before starting as the manager and registering with the CQC.

During our visit we spoke to four people using the service. They told us "I’ve been here for years and enjoy living here", "I’m working at the Kairos Centre where I prepare food and tables", "I went shopping yesterday" and "I have a keyworker".

People told us and we saw that staff treated them with dignity and respect.

They were given information and were able to visit if they wanted to before they moved in.

They were supported and encouraged to make their own decisions and choices in a risk assessed environment, including activities they wanted to do and those that helped improve their life skills if they wished.

Their care plans were up to date.

People felt safe and protected by caring, competent and professional staff.

The house where they lived was fit for purpose, clean, well decorated and maintained.

The staff were friendly, supportive and there were enough of them to meet people’s needs.

People enjoyed the way staff spoke and interacted with them and everyone spent a lot of time laughing, joking and smiling.

We saw and staff told us they had not received minuted one to one supervision since June 2013.

The complaints book could not be located during our visit although staff and some people we spoke to said they had no current complaints.

People said they enjoyed living at Laverstoke Gardens and were encouraged to live independently. One person said they, “really enjoyed the food and especially the lasagne” and another said they enjoyed the opportunities they had outside of the home such as attending college and working locally. People felt staff were respectful, supportive and there was a warm and enjoyable atmosphere in the home.

Staff conveyed a good understanding of peoples’ individual needs and of their preferences in relation to the support they require. We observed the staff interacting respectfully with the people who use the service and supporting them to make choices about what they wanted to do. The environment of the home was clean, well maintained and the atmosphere calm and relaxed.

This inspection took place on 23 December 2014 and was unannounced. The service met the regulations we inspected at their last inspection which took place on 2 January 2014.

The home provides care and accommodation for up to seven women with learning disabilities. It is located in the Roehampton area.

There was a registered manager at the service who had only been at the service since September 2014. 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 using the service and their relatives told us they felt safe living at Laverstoke gardens. They told us that staff were caring and treated them well. People had access to a range of activities, the majority attended day centres during the day. Some people worked part time in the community.

Staff told us they had access to good training opportunities at the home and were happy with the support they received from the registered manager.

There was clear guidance for staff on how to recognise and respond to abuse and how best to support people with special dietary requirements. We saw that staff were familiar with this guidance and followed it. We found that there were sufficient staff on duty to meet people’s needs which helped to make sure people were kept safe.

Medicines, including controlled drugs were stored securely and safely. However, some aspects of medicines administration were not always safe. We saw one medicines summary that contained out of date information, we highlighted this to the manager who rectified this during the inspection. The manager had also implemented changes to the way medicines were administered to try and reduce medicines errors.

Care plans were person centred and contained easy to follow steps to help staff support people. Some aspects of the care plans were lacking detail, such as identifying goals and positive outcomes for people to work towards.

The registered manager had only been in post since September 2014 and had identified some of the shortfalls we identified during our inspection. She had implemented some positive changes for the benefit of people using the service. These included changes to the staff rota and more support for staff around safer medicines administration.