Lawrence House is registered to provide accommodation and support for up to six people with a learning disability. There were six people living at the home when we inspected.

We last inspected this service in March 2016. We found that improvements were needed to ensure the service was safe, effective, responsive and well led. The provider was not meeting the regulations regarding consent and good governance. Following our inspection the provider sent us an action plan about what they would do to improve. This inspection in January 2017 found that the issues had been improved and rectified

At the time of this inspection there was a registered manager in post. 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.

Staff were responsive to people’s needs and delivered care in line with people’s wishes. People had care plans in place, but some of these were not current. Action to ensure the care plans were updated was in progress. People were supported to engage in activities but further development was needed to promote opportunities for activities in the community. People had access to a complaints system and the registered manager responded appropriately to concerns.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. The staffing arrangements ensured that safe levels of staffing were provided at all times of the day. People received the correct medication at the correct times. All medication was administered by staff who were trained and competent to do so.

People seemed to be calm and relaxed when we visited and indicated they were happy living there. This was confirmed by people’s relatives. We observed caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting.

Staff had received sufficient training and supervision to ensure they had up to date knowledge and skills to provide safe care. People were supported to maintain their health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

There was effective leadership from the registered manager. The provider and registered manager assessed and monitored the quality of care people received.

The inspection took place on 21 and 23 March 2016 and was unannounced. We last inspected the service in December 2013 and found it was complaint with all the regulations we looked at.

The service is registered to provide care for up to six people who have a learning disability or autistic spectrum disorder. At the time of our inspection there was not a registered manager in post. 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.

We found enough staff to cover people's basic needs but there was sometimes not enough suitably competent and experienced staff to accompany people to undertake activities in the local community, and this restricted people’s choices. Some relatives, health care professionals and staff told us of concerns about the staffing arrangements.

Safeguarding procedures were available in the home and staff we spoke with knew to report any allegation or suspicion of abuse. All medication was administered by staff who were trained to do so but some aspects of medicines management needed improvement.

People could not be certain their rights in line with the Mental Capacity Act 2005 would be identified and upheld.

People were supported to maintain good health and to access appropriate support from health professionals where needed. People were supported to eat meals which they enjoyed and which met their needs in terms of nutrition and consistency.

People were at risk of infection as staff knowledge was lacking in some areas of infection control practice.

We saw that attention was needed to the environment. There had been some delays in carrying out repairs to the home but the provider was now taking action to address this.

People told us or indicated by gestures and their body language that they were happy at this home and this was confirmed by people's relatives. We observed some caring staff practice, and staff we spoke with demonstrated a positive regard for the people they were supporting.

Whilst we received positive feedback from staff about the manager it was evident that they had insufficient time to carry out all of their responsibilities to ensure that people received the support and care they needed. The manager was responsible for the management of four services but the provider had plans to reduce this to two.

It was not evident that arrangements for checking the safety and quality of the service by the registered provider were effective.

We found the provider was in breach of Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We saw that staff members interacted well with people who lived at the home ensuring they were treated with respect and dignity. People were involved in managing daily activities of the home, such as menu planning, shopping and meal preparation. This ensured people were supported in promoting their independence and community involvement. Evidence was noted of appropriate opportunities and encouragement to support people to retain their autonomy, independence, dignity and privacy.Staff were also noted to seek consent from most people before entering bedrooms ensuring privacy and dignity.

Evidence of people’s choices and decisions relating to social pastimes was noted congruently throughout the home, during observations, on files and from photographs. People who use the service were given appropriate information and support regarding their care or treatment; this was offered in a variety of ways to encompass specific needs.

The home was clean and well maintained which means that people live in a safe and clean environment. They made some of the following comments:

"It's good" one other person was noted to confirm his opinion of the home by putting his thumb up.

Evidence of verbal re-direction was noted to good effect and staff responded appropriately to non verbal communication. During the inspection,staff were heard to be offering choices, and encouragement ensuring person centred care.

You can see our judgements on the front page of this report.

We made two visits to this home on weekdays. We met the people who lived there and several members of staff, including the manager. We spoke with the manager, staff who were on duty and a relative of someone who lived in the home. We joined people for a meal at lunchtime. Due to the specific needs and preferences of some of the people in the home, our interaction with people was limited, but we were able to observe staff interacting with people.

We saw that people’s needs had been assessed. Care and support was provided according to people’s plans. There was detailed guidance for staff to guide them when relating to people whose behaviour had posed challenges to staff at times. We saw staff interacting with people in the ways which were outlined in their behaviour plans.

People were involved in a range of activities in the home and the community. Staff encouraged people to make choices about how they spent their time. Staff told us how they supported people do the things they wanted to do. We saw staff communicating well with people and providing reassurance where needed.

There were good arrangements for the storage, administration and recording of people’s medication.

There were enough staff with sufficient skills to meet the needs of the people currently living in the home.

There were good systems for monitoring the performance of the home and for making sure that staff carried out their roles in the right way.

There were good arrangements for making sure that people who lived in, worked in and visited the building were kept as safe as possible.