The inspection took place on 4 and 5 December 2017 and was unannounced. The Laurels provides care and accommodation for up to six people with learning disabilities.

At the last inspection in July 2015 the service was rated Good overall. However it was Requires Improvement in Safe. This was because people had not been assessed regarding the safe management of their medicines when they handled and administered their own medicines. Risk assessments were not always carried out and recorded in sufficient detail when people went out in the community with staff.

At this inspection we found the service Good in all areas.

Why the service is rated good:

Suitable risk assessments for people who self-medicate were now in place. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to enable people to retain as much independence as possible.

People were supported to maintain good health through regular access to external health and social care professionals, such as the local GP surgery for health check-ups. This helped to ensure people’s health and wellbeing was monitored.

The service did not have a manager who is registered with the Care Quality Commission. However a new manager had been employed. 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. The current manager is currently in the process of registering.

We met and spoke to all six people during our visit. People when asked if they felt safe said they did. One said; “Yes I feel safe because staff are here with me.” A relative said; “Yes definitely safe there.” Another said; “We have no concerns over […] being safe and well cared for here.” One staff member said; “We are proud that we put people first here.”

Staff had completed safeguarding training and all had a good knowledge of what constituted abuse and how to report any concerns they had. Staff understood what action needed to be taken to protect people against harm and were confident any incidents or allegations would be fully investigated.

People had sufficient staff available to meet their needs. Staff had completed the company’s mandatory training and had the right skills and knowledge to meet people’s needs. New staff completed an Induction programme when they started work and staff competency was assessed. Staff also completed the Care Certificate (A nationally recognised training course for staff new to care) if they did not have any formal care qualifications. Staff confirmed that as part of their training they discussed the Equality and Diversity policy of the company. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people.

All significant events and incidences were documented and analysed. Evaluations of any incidents were used to help make improvements and help keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from relatives, professionals and staff.

People lived in a service which had been designed and adapted to meet their needs. People lived in an environment that was mostly clean and hygienic. However a hall carpet was in a poor state of repair. The environment had been assessed to ensure it was safe and meet people’s needs. The service was monitored by the manager and provider to help ensure its ongoing quality and safety. The provider

The inspection took place on 28 July 2015 and was unannounced.

The Laurels provides care and accommodation for up to six people with a learning disability. At the time of the inspection there were six people living at the home who were aged 33 to 63 years. The people living there had medium levels of need; they were able to be independent but required support and guidance from staff at all times. The home is a detached house with gardens which people used. Each person had their own bedroom which they had personalised with their own belongings. Communal areas consisted of a kitchen-dining room and a lounge. The home had a staff team of three full time and two part time staff as well as the registered manager.

The home had 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.

People were supported to be independent and risk assessments were used to ensure people were safe when independent. There were omissions in the risk assessments. For example, we found the provider had not followed its own risk assessment procedure when people handled their own medicines. We also found one person was supported by staff when they went out but this was not recorded in a care plan.

People knew what to do if they had any concerns about their well-being or safety. Procedures were in place for staff to review people’ safety. Relatives said they considered people were safe at the home. Staff were aware of safeguarding adults procedures and their responsibilities to report any concerns they had. Health and social care professionals said staff reported any concerns to them and that people received safe care.

Sufficient numbers of staff were provided to meet people‘s needs. Pre-employment checks were made on newly appointed staff so that only people who were suitable to provide care were employed.

People told us they were supported by staff who knew their needs and preferences. Staff had access to a range of relevant training courses and said they were supported in their work.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). There were policies and procedures regarding the assessment of people who may not have capacity to consent to their care and the registered manager knew when these procedures needed to be used.

People were involved in choosing and cooking their meals. This was done with the support and guidance of staff so people had a healthy diet. None of the people who lived at the home had any special dietary requirements.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks.

People benefitted from friendly relationships with the staff and we observed people were comfortable with individual staff members. Staff had a positive attitude about their work and the welfare of people. They were committed to supporting people to have meaningful and fulfilled lives. People were treated by with respect and their privacy acknowledged.

People were fully involved in planning their care and showed us their care plans and how these reflected what they wanted to do. Staff listened to what people had to say and care and support was tailored to meet each person’s needs and preferences. Each person had a daily programme which reflected their needs and what they wanted. This included attending work, developing independent living skills, social outings and holidays.

The complaints procedure was available in the home and was in a format that could be easily understood by people. A record was made of any complaints along with details of how they were investigated and responded to.

The staff team were motivated and showed a commitment to promoting people’s rights as well as treated them as individuals. People were empowered to make decisions about their own lives and to contribute to the development of the service.

A number of audit tools were used to check on the effectiveness, safety and quality of the service. This included seeking the views of people and staff. The audits were completed by the registered manager and checked by the regional manager.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.