The inspection visit took place on 19 April 2018 which was an announced comprehensive inspection. The visit was announced so we could ensure the registered manager, staff and people who used the service were available to speak with us.

The Laurels is the registered provider’s family home which provides accommodation, personal care and support for up to three people, with physical and / or learning disabilities. At the time of the inspection two people lived at the home. Both people had lived at the home for a considerable time and both they, and people that supported them, treated everyone as a family unit.

People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post who was also the registered provider. 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 provider was also the registered manager and for this inspection, we spoke with a family member who took the primary role in managing the service.

Because the registered provider lived at the service, it was a family home environment where, staff and people living at the home saw and treated everyone as equals so it was not necessary to refer to each other with a job title. ‘Family members’ was the name given to staff by people who used the service. In the report, we refer to them as staff.

At our last comprehensive inspection in April 2016, we rated the service as Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The registered manager and staff assessed risks to people’s health and welfare and care plans minimised the identified risks. However, some care plans and risk assessments required updating to demonstrate the care and support people needed and what help they needed to continue to promote their independence. We were confident staff knew people well and supported them how they wanted.

Staff knew how to keep people safe from the risk of abuse and the people they supported felt well cared for and got on with everyone in the home. There continued to be enough staff to meet people’s health needs and there continued to be flexibility in staffing levels, to make sure people received a safe, effective and responsive service.

People’s medicines were managed, stored and administered safely by each person because people continued to be supported to remain as independent as possible. People were encouraged to continue to self-medicate if safe for them to do so.

People continued to be cared for and supported by kind and compassionate staff, who knew their individual preferences whilst continuing to promote life skills and ambitions. Staff understood people’s needs and abilities and they had the skills and experiences to do this effectively.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible. The systems in the service supported this practice.

Staff ensured people received support from other health professionals to maintain and improve their physical and mental health and people were involved in how their care was delivered. The family worked well as a team to provide people with quality care and a good life experience.

The quality monitoring system required improvement so the p

This inspection took place on 12 April 2016 and was announced.

The Laurels is the registered provider’s family home which provides accommodation, personal care and support for up to three people, with physical and / or learning disabilities. At the time of the inspection two people lived at the home. Both people had lived at the home for a considerable time and both they, and people that supported them, treated everyone as a family unit.

There was a registered manager in post who was also the registered provider. 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 provider was also the registered manager and we refer to them as ‘registered manager’ in the body of this report. Both people living at the home referred to the registered manager by her first name, and one person also called her ‘mum’ because they have grown up at the home as part of the ‘family’. ‘Family members’ was the name given to staff by people who used the service who provided care and support to both people living at the home. In the report, we refer to them as staff.

Staff knew how to keep people safe from the risk of abuse. Both people told us they felt safe living at The Laurels and felt protected from abuse or poor practice. Both people felt well cared for.

The registered manager and staff assessed risks to people’s health and welfare and care plans minimised the identified risks. However, some care plans and risk assessments required improvement to ensure people received consistent support that met people’s needs. We were confident staff knew people well and supported them how they wanted.

There were enough staff to meet people’s health needs and there was flexibility in staffing levels, to make sure people continued to receive a safe, effective and responsive service from staff.

Both people self-medicated and understood their responsibilities to take their medicines at the required times. People’s medicines were managed, stored and administered safely in line with GP and pharmacist prescription instructions.

People were cared for by kind and compassionate staff, who knew their individual preferences for support and their likes and dislikes. Staff understood people’s needs and abilities and they updated each other when people’s needs had changed. Staff received training that provided them with the skills to support people effectively.

Staff understood their responsibilities to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one had a DoLS in place at the time of our inspection because both people had capacity and had no restrictions on their freedom.

People were offered or chose meals that were suitable for their individual dietary needs and met their personal preferences. Staff ensured people obtained advice and support from other health professionals to maintain and improve their physical and mental health.

People felt involved in care planning decisions and told us staff provided the care required. Care was planned to meet people’s individual needs and abilities and was provided by staff who knew them well. People were supported to pursue their interests and hobbies and live their lives how they wished, and staff supported people to remain as independent as possible.

The quality monitoring system included reviews of people’s care plans and checks on health and safety issues within the home environment. People were continually asked for their views and encouraged to discuss any concerns they had.

We visited The Laurels to follow up concerns we found when we carried out an inspection on 22 May 2014. At that inspection we set compliance actions as we had concerns the systems that monitored the quality of service were not effective. At this inspection we found improvements had been made in relation to monitoring and assessing the quality of service.

We looked at the improvements made since our last inspection. We spoke with the lead carer who was responsible for the day to care of the people who used the service. The lead carer explained to us the steps they had taken that improved the service people received.

At the time of our inspection there were two people living at the home. We were unable to speak to either of the people who used the service because they had gone out.

The provider had an effective system in place that made sure people received care and support in an environment that met their needs. We saw a range of audits had been completed that made sure people were kept safe and any potential risks to them were minimised. Where improvements were required we saw actions had been taken that led to improvements.

This inspection was completed by one inspector. The Laurels is a family home where care is provided to two people. We spoke with both people who lived at The Laurels. We spoke with the provider who was also the registered manager. In the report we refer to the provider as the registered manager. We also spoke with two members of staff who were family members that looked after both people. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and family members told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: “I feel safe here and I like it very much”.

The staff we spoke with understood the procedures to follow to ensure people were safe. Staff were able to tell us the different ways people might experience abuse that could place them at risk. Staff knew what their responsibilities were and what steps to take if they suspected abuse had taken place. We found that one member of staff had received training in safeguarding vulnerable adults. The registered manager told us they would arrange further training for the other member of staff. After the inspection, we received confirmation that appropriate training had been arranged.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We were told that no DoLS applications had been made for the people they currently provided care for. Staff were able to describe when an application should be considered and they knew who to contact if this was required.

At our last inspection in October 2013 we found improvements to care plans were required and the storage of records. At this inspection we found improvements had been made that addressed previous concerns. The registered manager acknowledged further improvements were still required and gave us assurances they would continue to improve their records system. The registered manager told us: “We are proud of the care we provide but the records have always let us down”.

We saw people’s records had been updated and reflected people’s current health needs. We saw risk assessments were in place and provided guidance for staff to follow.

Is the service effective?

People had an individual care plan which explained what their needs were. Risk assessments had been reviewed and identified any changes in risks. We found one care plan required further improvements to make sure the person received the appropriate support as their behaviours had changed over time.

People had access to health care professionals and the provider had sought specialist support when required.

At the previous inspection we found staff had not received training in certain areas to help support people effectively. At this inspection we found one staff member had received training in moving and handling, safeguarding vulnerable adults, mental capacity and infection control. The registered manager gave us their assurances they would take immediate action to request training for the other staff member. After this inspection, the registered manager confirmed they had arranged training for another member of staff. This meant people would be supported by staff that had received relevant and appropriate training to individual’s needs.

Is the service caring?

People were supported by staff that provided care at people’s preferred pace. Staff were patient, attentive and responded appropriately to people’s requests. Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

People told us: “Staff help provide emotional support because they can tell when I get anxious”. Another person we spoke with said: “I am cared for very well and feel supported by the family”.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors and psychiatrists.

People were supported to participate in activities inside and outside of the home.

People told us they were able to raise any concerns they had, although both people we spoke with were satisfied with the service they received.

Staff told us they had regular planned meetings and informal meetings to discuss the care provided. Staff told us they regularly supported each other when providing care.

Is the service well led?

The service worked alongside other health care professionals and agencies to make sure people received the care they required.

The service did not have an effective system in place that assured them of the quality of service they provided. The registered manager did not complete regular checks or have evidence that people’s views had been sought and actions taken to improve the service. We have asked the registered manager to tell us what they are going to do to monitor and improve the quality of the service people receive.

We carried out this inspection to check on the care and welfare of people using this service. During our inspection we spoke with the registered manager and her daughter in law who provides administration support.

We spoke with both people who used the service. Both spoke positively about life at the Laurels. They told us they made their own choices and managed their own needs. We saw they had choices and their independence was encouraged.

We looked at how staff were supported and found that no formal staff training had been undertaken in 2012 or 2013 . One person who worked part-time had received training for a role they had with another company. At the 2012 inspection of this service we identified that staff had not attended training to ensure that they were suitably skilled. This meant that staff had not been supported to develop their skills to support them whilst caring for the two people who used the service.

We looked at how people's records had been managed and stored. We found that people's care plans and risk assessments had not been reviewed. People’s records had been kept in a broken filing cabinet. This meant that people’s records were not up to date and had been stored in a non-secure location.

We looked at the provider’s complaints process. We saw a system in place to assist people using the service raise a complaint. The two people living at the home said they would feel comfortable approaching the provider with any concerns they had.

We carried out this review to check on the care and welfare of people using this service. No concerns have been raised about The Laurels since our last visit to this service. During our inspection we spoke with the registered manager and her daughter who provides administration support.

We spoke with one person using the service who spoke positively about their life at the Laurels. This person told us they made their own choices and managed their own needs. We saw people had choices and their independence was encouraged as much as possible. We were told that people had jobs to do around the house such as helping to prepare meals, tidy their rooms and look after the pets.

We reviewed five regulations during the inspection. We identified some areas for the provider to consider. One of these areas related to staff training. This was because there was no evidence of ongoing staff training having been undertaken during the past two years to ensure staff were suitably skilled to undertake their role. The home did not have a specific training policy or training plan in place which identified the training required by staff to maintain their skills whilst working at the home.

The care plans we saw had not been reviewed as these people's needs had not changed. We were told that changes in people's care plans had been communicated to their care worker. Although risk assessments had been reviewed no changes if any were identified within the risk assessment evaluation.

We carried out this review to check on the care and welfare of people using this service and to identify whether previous standards have been maintained. No concerns have been raised about The Laurels since our last visit to this service.

We arrived at the home at midday and were greeted by one of the people who lives there. One other person was on the premises at the time of our arrival and the third person arrived later. We met all three people who spoke positively about their life at the Laurels.

We saw that everyone was friendly and helpful towards each other, offering to make drinks and chatting. People said that they have a choice in everything, one person said that their bedroom had recently been re-decorated and they had chosen the wallpaper and bedcover. They said that they liked their room.

People told us about their hobbies and interests and how they generally spend their time. We noted that people have a choice and their independence is encouraged as much as possible. We were told that people have jobs to do around the house such as helping to prepare meals, tidy their rooms and look after the pets. One person told us that there are going to be a lot of people in the home on Christmas day for lunch which is going to be nice.

People had affectionate nicknames for each other including one for the owner of the home. Everyone appeared to be at ease at the home and we were told "its like one big family."