This inspection took place on 13 and 19 October 2017 and was announced. This was to ensure someone would be available to speak with us and show us records.

Lawreth provides care and accommodation for up to two people with a learning disability. On the day of our inspection there were two people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in September 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Lawreth.

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 started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

We carried out this inspection on 24 September 2015. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

Lawreth provides accommodation and personal care for up to two people. Nursing care is not provided. The home is a detached bungalow with three bedrooms, a lounge and kitchen. It is set in its own gardens in a residential area, near to public transport routes and local shops.

The inspection was carried out by an adult social care inspector.

There was a registered manager in place who had been in their present post at the home for over eleven years. 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.

We used a number of different methods, for example observing how people were supported to make decisions about their care to help us understand the experiences of people using the service. This was because we were unable to get peoples' direct comments about the care they received. We saw people indicating their choices and wishes to staff who were responding to their decisions and making sure they were empowered to be as independent as possible. Staff treated people with compassion and respect and we saw that they were aware of how to respect people’s privacy and dignity.

Staff engaged people using prompts such as pictures and photographs to help them express their wishes, likes and dislikes and the activities they wanted to do. We found people were engaged in their care and the running of the home. People’s care plans were very person centred and written in a way that described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for service users to understand by using of lots of pictures and symbols.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We discussed DoLS with the registered manager and looked at records. We found the registered provider was following legal requirements in relation to DoLS.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and we viewed records that showed us staff were enabled to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended training and development

activities to maintain their skills. We also viewed records that showed us there were safe and robust recruitment processes in place.

Throughout the day we saw staff interacting with people in a very caring and professional way. The registered manager and staff that we spoke with showed genuine concern for peoples’ wellbeing and it was evident that all staff knew people at the home very well. This included their personal preferences, likes and dislikes and they had used this knowledge to form very strong therapeutic relationships. We saw all of these details were recorded in people’s care plans. We found that staff worked in a variety of ways, responding to changes in expression or demeanour, to ensure people received care and support that suited their needs.

People were protected from the risk of abuse. The care staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They had undertaken training and were able to describe the different ways that people might experience abuse. Staff were able to describe what actions they would take if they witnessed or suspected abuse was taking place.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

People received a balanced diet. People at the home had specific diets and preferences and staff were very knowledgeable about these. We saw staff offered a selection of preferred meals and people chose what they wanted to eat. There were snacks and drinks available at all times as well as healthy options for people to choose from.

We saw the registered provider had policies and procedures for dealing with medicines and these were followed by staff. Medicines were securely stored and there were checks and safeguards in place to make sure people received the correct treatment.

We found that the registered provider had comprehensive systems in place for monitoring the quality of the service. This included monthly audits of all aspects of the service, such as medication and learning and development for staff, which were used to critically review the home. We also saw the views of the people using the service, their advocates and relatives were regularly sought and used to make changes. The manager produced action plans, which clearly showed when developments were planned or had taken place.

People were supported to take part in activities they were interested in and routines they preferred. Staff were constantly looking for more opportunities for people to try.

People were supported to maintain good health and had access to healthcare professionals and services for treatments where these were needed. People were supported and encouraged to have regular health checks and intensive support from staff had enabled hospital appointments and emergency treatments to take place.

We used a number of different methods, for example observing how people were cared for, to help us understand the experiences of people using the service. This was because we were unable to get people’s direct comments about the care they received.

The manager told us that most people who lived at this home found it difficult to express their overall views about the service directly. To overcome this they had used their knowledge of peoples’ preferences, behaviour and responses to organise the support that people needed in a way that was acceptable to them. The manager had also carried out surveys with peoples’ relatives and / or advocates.

The most recent survey found that everyone was happy with the service their relative received at Lawreth.

Relatives said that the homes strengths were training, dedicated staff and management, staff team work, well maintained premises, good staff ratio, good activities and holidays, and good healthcare and diets.

Relatives said,

“We are happy with the level of care our (relatives name) receives. He is happy and that is a big thing for us.”

During our visit we saw staff respected people’s privacy and dignity. They were friendly and very polite. Staff waited for people to make decisions about how they wanted their care to be organised and closely followed their gestures and directions.

One relative said, “We can sleep easy at night knowing that our relative is well cared for and happy with his life.”

They said the staff and the manager had a really good understanding of their relative’s likes and dislikes and the home supported people to have good healthcare.

One relative said, “Staff try to keep (relatives name) to a reasonable diet - but with a few treats.”

Another said, “Special equipment provided makes his life easier and also assists the well being of staff which is just as important.”

Relatives made positive comments about staff. They said things like,

“We have good communication and interaction between the staff and ourselves.”

(The home is) “Always striving to do better.”

Several relatives had made comments about the quality of the service. They said things such as,

“His quality of life is excellent.”

“Very happy with the level of service.”

“The home is very clean and very well organised.”

“We have no complaints at all.”

“Very good please continue.”

We used a number of different methods, for example observing how people were supported to make decisions about their care to help us understand the experiences of people using the service. This was because we were unable to get peoples' direct comments about the care they received.

During our visit we found people were asked for their consent before they received any care or treatment and the provider acted in accordance with their wishes.

We found care and treatment was planned and delivered in a way which ensured peoples' safety and welfare.

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse.

The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people by carrying out thorough background checks.

We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and promote their health and wellbeing.