Dolphin Homes, the provider, delivers care and support for adults with learning difficulties, behaviour which challenges others, physical disabilities and complex health needs, autism and Asperger's syndrome. The Laurels provides care and support for up to seven people with complex health needs and a learning disability and / or a physical disability.

People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. This inspection took place on 7 and 9 January 2019 when there were seven people using the service.

The service 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.

The Laurels had been developed and designed in line with the values that underpin

Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service lived as ordinary a life as any citizen. People were given choices and their independence and participation within the local community was being encouraged and enabled.

At our last inspection we rated the service as overall good. At this inspection, we found some areas where improvements were needed and one breach of the fundamental standards. We have now rated the service as requires improvement.

The provider’s governance and quality assurance systems were not being fully effective at monitoring the quality and safety of the service. We found a number of areas where records relating to people’s care, and to the management of the service, were not complete, accurate and up to date.

Where people were unable to make more complex decisions about their care and support, staff had not always demonstrated how they were acting in accordance with the MCA 2005.

Whilst staff knew how to support people in a way that minimised identified risks, records relating to this were not always accurate. Similar concerns were found in relation to medicines records. We were concerned this could impact on people’s safety.

Overall, the design and layout of the premises met people’s needs, but further action was needed to ensure that all aspects of the premises were well maintained and in a good state of repair.

There were sufficient numbers of staff to meet people’s needs.

Staff followed infection control guidance and the home was visibly clean.

Incidents and accidents were investigated and remedial actions taken in response.

Health and safety checks were carried out to ensure the safety of the building and equipment within it, but we have made a recommendation about window restrictors.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

Staff understood their responsibility to raise concerns and report on incidents and accidents.

Staff received the training and support they required to meet people's individual needs. Staff worked well with external health care professionals and people were supported to access health services when required.

People were treated with dignity and respect and staff were kind and caring in their interactions with people. People received care that was centred on them as an individual.

People were supported to follow their interests and take part in social activities both within the home and within the community.

Relatives were confident they could raise concerns or complaints and these would be dealt with.

We have made a recommendation about developing end of life support planning for people using the service.

Relati

The inspection took place on the 25 April 2016. The inspection was unannounced.

Dolphin Homes, the provider, is a specialist care provider delivering care and support for adults with learning difficulties, behaviour which challenges others, physical disabilities and complex health needs, autism and Asperger's syndrome. The Laurels provides care and support for up to seven people with a learning disability and / or a physical disability. People’s rooms were arranged over two floors with both stairs and a lift available to access the first floor. Each room had its own ensuite wet room. There was a bathroom, but this was not in use. Where necessary people’s room were fitted with overhead hoists to assist with moving and handling tasks. In addition the home had a lounge and conservatory, a kitchen and separate dining room, a laundry and a staff office. The home had a large garden to the rear and parking to the front.

The service 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 and associated Regulations about how the service is run.

Although the people living at The Laurels were unable to communicate with us, we observed that they appeared relaxed and comfortable in the presence of the staff that were supporting them.

Care records included guidance for staff to safely support people. People had risk assessments and risk reduction measures were in place although we did note that body maps could be more effectively used to document and plan for how skin damage was responded to.

Arrangements were in place to help manage people’s medicines safely, although we noted that medicines audits could be more effectively used to help identify administration errors and allow mitigating actions to be taken to prevent further errors.

Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.

Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff received a suitable induction which involved learning about the needs of people using the service and key policies and procedures. Staff were supported to provide appropriate care to people because they were trained, supervised and appraised.

The provider and registered manager understood their responsibilities with regards to the Mental Capacity Act (MCA) 2005 and improvements were underway which when embedded will ensure that mental capacity assessments are fully documented.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were either in place or had been applied for.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration.

Staff had a good knowledge and understanding of the people they were supporting. Staff were able to give us detailed examples of people’s likes and dislikes which demonstrated they knew them well.

People were supported to take part in a range of activities and make choices about how they spent their time.

Relatives and staff spoke positively about the registered manager. There was an open and transparent culture within the service and the engagement and involvement of people and staff was encouraged and their feedback was used to drive improvements. There were systems in place to assess and monitor the quality and safety of the service and to ens

We observed care given to people over the course of our visit and spoke with staff and the manager. We looked at care records for three people and also looked at staff and management records.

On the day of our inspection one person was away on holiday and one person was admitted to hospital due to illness. We saw how staff supported the individual by arranging for the GP to visit and liaise with ambulance services. The manager arranged staff to support the person for their admission into hospital.

The people who we saw on the day of our inspection communicated non-verbally and by gestures and signs. Staff were aware of the common signs they used to say yes or no. This way of giving consent was clearly recorded in people's care records.

People's care needs had been assessed and care plans showed how those needs were being supported. Where necessary risk assessments were in place to ensure the safety and welfare of the person.

We looked at how medicines were administered and stored. We found the service used a pharmacy supplied system which all staff had been trained to use. One member of staff said: "I like using the medicines system as I know exactly what tablets to give and at what time. We have all received training and the manager checks our competency every year."

The manager talked with us about their recruitment process. We found all staff were checked appropriately before commencing work in the service.

The provider carried out a quality monitoring audit every three months. We found this covered a wide range of areas and gave the manager a number of actions they could follow to improve the service.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. Observation during the inspection showed staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas watching television and interacting with each other in the sensory room. During our inspection we observed people spending time in their bedrooms listening to their choice of music and watching DVDs. We also saw people being involved with cooking in the kitchen with staff members.

Throughout the day we observed staff maintaining the security of the building and people looked relaxed and comfortable with the staff supporting them.

During the inspection we observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.

People told us they liked living at the home. They got on well with staff. Staff understood their wishes and did all they could to support them. They told that staff helped with their daily routines and personal care needs in the manner they preferred. Staff supported them in their choice of leisure and social activities.