Laural House is a residential care home for two people with a learning disability and other mental health needs. They live in a two-storey town house, with an outhouse used for storage and laundry. People receive 24-hour support.

Rating at last inspection.

At our last inspection, we rated the service Good. 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.

Why the service is rated good.

Personalised care had transformed people’s lives. Previous emotional distress, demonstrated through physical and verbal aggression, had been reduced to the point where people were relaxed and happy, learning skills and enjoying activities in the community. The need for physical intervention, to provide acceptable levels of care, was no longer necessary.

Staff had the detailed information they needed to set goals with people and meet them. An understanding by staff of people’s communication helped them provide support and care, because they knew what people wanted.

Staff treated people with respect and kindness. One person’s family said, “Staff have a very positive, accepting attitude.” People’s privacy was upheld and diversity supported.

People were safe from abuse and harm. Recruitment ensured only staff suitable to work with vulnerable adults were employed. Staffing arrangements ensured skilled and competent staff, in sufficient numbers to keep people safe, cared for people.

Staff managed people’s medicines safely on their behalf and there were arrangements in place, and under review, to ensure hygienic practices.

People benefitted from a homely environment, which had been adapted according to individual needs. Health care needs were under constant review and people’s health had improved. Staff worked in accordance with professional advice to keep people safe. External professionals said the service deserved “High praise.” People received a varied and nutritious diet, which met their preferences.

Staff upheld people’s legal rights. This included gaining their consent to care and treatment and upholding the principles of the Mental Capacity Act 2005.

Staff felt well supported and praised the service management. Audits, and monitoring, carried out in-house and through the provider, ensured staff could identify and rectify any problems. People, their families, and others were encouraged to offer their thoughts and ideas. People’s family members felt no need to make a complaint. The Care Quality Commission had not received any complaints about the service.

The registered manager was meeting their legal responsibilities.

This inspection took place on 21 January 2016 and was unannounced.

The service provides accommodation and support for up to two people with a learning disability, autistic spectrum condition or associated mental health needs. At the time of the inspection there were two people living in the home with complex care needs. People had very limited verbal communication skills due to speech and language difficulties associated with their conditions. Both people were dependent on staff for many of their personal care and other support needs. People also needed staff support to go out into the community to keep them safe from avoidable harm or abuse.

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 registered manager was on leave on the day of the inspection. We met the senior support worker on duty and one of the provider’s company directors, who visited during the day. We were told the service philosophy was to identify each person’s individual needs and to respond to those needs effectively. The aim was to support people to achieve the best quality of life possible within their individual capabilities and needs. One relative said “They are giving [person’s name] an excellent quality of life”. Another person’s relative said “I think [person’s name] is in good hands, they couldn’t do better”.

People had choice and control over their daily routines and staff respected and acted on the decisions people made. Where people lacked the mental capacity to make certain decisions about their care and welfare the provider knew how to protect people’s rights.

Staff assisted people in a discrete and respectful manner throughout our inspection. Staff were regularly assessed by management to ensure they supported people safely and competently. When necessary, people were supported to access relevant external healthcare professionals.

There were sufficient numbers of staff to meet people’s needs and to keep them safe. Staff received training to ensure they had the necessary knowledge and skills to provide effective care and support. The service employed a small team of permanent staff who were knowledgeable about people’s preferences and behaviours.

Systems were in place to ensure people received their medicines safely. Checks were carried out to ensure the correct medicines were administered to the right people at the right time.

People were supported to visit relatives, access the community and participate in social or leisure activities of their choice on a regular basis.

People, relatives and staff all commented on how approachable and supportive the provider’s management team were. They said they could approach any of the managers for help or advice whenever needed.

The provider had an effective quality assurance system which ensured the service maintained good standards of care and promoted continuing improvements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service caring?

We observed staff treated each individual with dignity and respect. They spoke to people in a polite, friendly and caring manner. Staff said they always knocked on people’s doors and asked permission before entering their rooms. People were allowed their own space but staff were on hand when they were needed.

People who lived in the home told us they received good care and support and the staff treated them well. One person said “I get on well with everyone. No one treats me badly and nothing is worrying me at the moment”. The other person said “The staff are nice. I haven’t really got any problems. I would speak to someone if I had”.

Is the service responsive?

People told us they were able to make their own daily living choices about things such as clothes, meal choices and activities. One person said “I go out and about shopping and to clubs. I like cleaning, TV and music”. The other person said “I go walking and to the shops quite a lot. I also like sewing and knitting”. The manager said both individuals were involved in planning their own weekly menus and doing a weekly food shop.

Each person had a choices section in their care plan. This detailed their preferences regarding personal care routines, clothing, food, leisure and other social activities.

The manager said people who lived in the home sometimes lacked sufficient mental capacity to make certain important decisions. In these cases other professionals and representatives were consulted and decisions were made on their behalf. We saw evidence of ‘best interests’ decisions in people’s care plans.

Is the service safe?

This was a small home caring for two people with a learning disability and other mental health needs. Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. We could see the people who lived in the home sometimes displayed challenging behaviours. Care plans contained risk assessments and de-escalation plans identifying triggers and actions staff could take to minimise these risks.

Staff received relevant training and the provider had policies in place to protect people from the risk of abuse. Staff knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns. The manager said they always carried out relevant employment and criminal record checks when staff were recruited. These steps helped protect people from the risk of abuse.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the home had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the manager was aware when an application should be made and the procedures to follow. This helped ensure that people’s human rights were protected.

There were arrangements in place to deal with foreseeable emergencies. The provider had an emergency evacuation plan and a medical emergency policy in place. The provider carried out monthly in-house checks of the environment, fire safety and other risk areas. We also saw records of monthly fire drills.

Is the service effective?

People were supported to live their lives in a way that suited their personal needs. Each person’s keyworker had regular one to one discussions with them about their activities and choices. Notes of these discussions were recorded in people’s care plans. This helped the service to plan ways of supporting people to improve their quality of life.

People were able to look after most of their own personal care needs. On occasions they sometimes asked staff to assist them but they were encouraged to be as independent as they were able. Staff demonstrated a good understanding of each person’s support needs and how they should be met.

We spoke with a visiting health professional who said the provider had been effective in substantially reducing the incidence of challenging behaviours. They attributed this to it being a small home with consistent staffing who understood the holistic needs of the people living there.

People were supported in promoting their independence and community involvement. People told us they regularly went out into the community. They told us they went out for walks, shopping, the cinema, leisure facilities and trips out to places of interest. One person who lived in the home told us “I’m looking for a job”. The manager said they might be able to find suitable voluntary work but the individual wanted paid employment which would be more difficult to arrange.

Training records showed staff were supported to gain the skills and knowledge required to provide a safe and appropriate standard of care.

Is the service well led?

This was the first inspection since the home was registered with the Care Quality Commission in January 2014. The home was run by two directors who were the joint owners. Both directors were experienced senior carers and they participated in the staffing rotas. The manager, who was one of the directors, was registered with the Care Quality Commission as the registered manager for the service.

There was a clear staffing structure in place with clear lines of reporting and accountability. A member of staff said there was a small team of supportive staff who all got on well together. They were able to report any issues or concerns directly to the provider’s directors and were confident appropriate action would be taken.

As a small care home the quality of the service was mainly monitored through discussions with people who lived in the home, their relatives and other representatives. A visiting health professional told us the home was providing an excellent service for people who had previously experienced problems living in other care settings.

We saw the provider had a comprehensive range of policies and procedures for staff to follow. The provider used an external company to draw up their policies to ensure compliance with current legislation and best practice.