This inspection took place on 13 July 2018 and was unannounced. The Laurel is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Laurel is one of two care homes located in two semi-detached houses run by Optimal Care. It provides care and support for up to five people with learning disabilities

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. The service believed that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our previous inspection in June 2016 we had rated the service Good. At this inspection we found the service remained Good, however, the provider had improved to Outstanding in the Responsive domain.

We received some extremely positive feedback about the service. People and their relatives told us the quality of the care and support provided by The Laurel surpassed all their expectations.

People received safe care from staff who had been appropriately trained to protect people and identify signs of abuse. Staff understood their responsibilities to report any concerns and followed the provider's policies in relation to safeguarding and whistleblowing. Robust recruitment procedures helped to ensure only suitable staff were employed at the service.

Risks were assessed, managed and reviewed to help ensure people's safety. There were enough staff to keep people safe. Medicines were administered as prescribed.

People’s rights were recognised, respected and promoted. Staff had a good understanding of the Mental Capacity Act 2005 and we saw people’s consent was sought routinely. Staff were knowledgeable about the rights of people to make their own choices. This was reflected in the way the care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support.

People and relatives were delighted with the kindness and thoughtfulness of staff. People we talked to consistently referred to the registered managers and staff as kind and caring people. They told us they valued their relationships with the staff who supported them and the support provided often exceeded what they had requested. Empowering people to communicate and express their needs was an area of strength within the service, as staff had a deep understanding of people's preferred communication methods.

The service was extremely responsive to people’s needs and wishes even if the support people needed proved to exceed their contracted hours. People told us that staff went over and above the call of duty and people said this made a profound difference to their lives.

The service provided excellent care and support to people enabling them to live fulfilled and meaningful lives. People and their relatives spoke overwhelmingly positively of the support, guidance and healthcare interventions people had received. Activities and people's daily routines were personalised and tailored to people's particular choices and interests. People were supported to develop their skills and pursue their hobbies and interests. People benefited from consistent support, good teamwork of staff, good planning and delivery of person-centred care.

People felt consulted and listened to about how their care would be

The Laurel is one of two care homes located in two semi-detached houses run by Optimal Care. It provides care and support for up to five people with learning disabilities.

This inspection took place on 6 April 2016 and was announced. At the previous inspection carried out on 28 February 2014, the registered provider had been assessed to be compliant with the regulations.

The home had two registered managers in place who were responsible for the five locations owned and run by the provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

The testing of fire equipment had not always been carried out in accordance with the provider’s policy. There were gaps in weekly fire alarms and three monthly emergency light checks. However, the registered manager took immediate action to put these checks in place.

People and their relatives told us they felt safe using the service. Staff demonstrated they understood the importance of keeping people safe. They were aware of their responsibilities for reporting any concerns regarding potential abuse. Risks to people's health and welfare had been assessed and support plans gave staff clear instructions on how to minimise the identified risks. As a result, staff knew how to ensure people’s safety.

Accidents and incidents were appropriately recorded and analysed for any trends. People were protected against the risks associated with unsafe use and management of medicines.

There were sufficient numbers of staff on duty to meet the needs of people who use the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks in the course of the recruitment process. Staff were suitably trained and relevant training sessions were planned for any due or overdue training. Staff received regular supervisions and appraisals.

The management and care staff were trained in and understood the principles of the Mental Capacity Act 2005 [MCA] and promoted a least restrictive approach in dealing with each person provided with care.

Staff had access to induction and on-going training, supervision and appraisal. This ensured staff had the skills and knowledge to support people using the service safely and effectively.

People's health needs were monitored and people were referred to external healthcare professionals if such a need was identified.

People who use the service and their family members were complimentary about the standard of care at The Laurel. Staff treated people with dignity and respect and helped to maintain people's independence by encouraging them to care for themselves where possible.

Care records showed that people's needs were assessed before they moved into the service and care plans were written in a person-centred way.

Activities were arranged with people who use the service and were planned to meet their preferences and interests. People were supported to meet their social care needs.

The service regularly used community services and facilities and had links with other local organisations.

Staff felt supported by the manager and were confident to raise any concerns if they needed to do it. People who use the service, family members and staff were regularly consulted about the quality of the service.

The service had a complaints procedure in place, which was available in an 'easy-to-read' version to help people understand how to raise any concerns they might have.

The registered manager promoted an open culture and involved all people in running the service. There was good communication between staff members who were encouraged to share their ideas to make improvements to the service.

Staff members said they liked working in the home

People who lived in the home we spoke with told us they were well cared for. We were told the staff treated people with respect and were friendly and professional. People told us that The Laurel was a safe place to live.

People were supported to be fully involved in the planning and reviewing of their care and support. People’s independence was promoted and supported.

The home had safe procedures in place to administer medication and the staff were appropriately trained to carry out this responsibility.

The home ensured that there were sufficient staffing provided on duty to meet people’s needs.

There were safe procedures in place for the recruitment of staff. Appropriate checks were completed before people were appointed. People who lived in the home were involved in the recruitment process for new staff.

People who lived in the home told us they enjoyed living there and were well treated by the staff and manager. We were told people were treated with respect and had their privacy and dignity respected.

People told us they received the required support to undertake activities in the community and were encouraged and supported to maintain their independence. People told us they were involved in the planning and reviewing of their care and support and enjoyed having a key-worker to work with. We were told that The Laurel was a safe place to live.

We found that people's care and support needs were well met and that detailed and up to date care plans were in place.

We found that the home correctly stored and administered medication and that appropriate training was provided for staff before they undertook this responsibility.

The home had the required recruitment procedures and pre-employment checks in place for staff.

People live in a comfortable home where every effort is made to support and protect them. A range of activities and entertainment were available to them.

One person told us they were “safe and happy”. Others were keen to show us their rooms and talk about their hobbies and possessions. Two of the people were excited about their forthcoming holiday and were keen to talk about their experience when they returned from a short trip into town.