Laurel Leaf Support Limited

Updated 25 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 November 2018 and was an announced inspection carried out by one inspector. Prior to the inspection we sent out quality questionnaires and we received feedback from three people, one staff member and three external professionals.

We told the provider two days before our visit that we would be coming. We did this because the registered manager is sometimes out of the office supporting staff or visiting people who use the service. We needed to be sure that someone would be in the office.

Before the inspection we reviewed the information we held about the service and the service provider. The registered provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law.

On the day of our inspection we carried out the office visit and we spoke with the registered manager, the quality and safety officer and one staff member. We looked at two people’s care records and medicine administration records (MAR). We reviewed a range of records relating to the management of the service. These included two staff files and provider’s quality assurance audits. We also met with two people that used the service at the Activity Room situated next to the office. After our inspection we contacted a number of external professionals and one relative to obtain further feedback about the service.

Updated 25 December 2018

We inspected Laurel Leaf Support Limited on 22 November 2018 and the inspection was announced.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in Witney area. It provides a service to adults and younger adults living with various learning disabilities, autistic spectrum disorder or sensory impairment. On the day of the inspection the service was supporting four people.

There was a registered manager in place who was also the 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.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good in Safe, Effective and Caring domains. There was overwhelming evidence available that demonstrated further improvements had been made that met the criteria for an Outstanding rating in the Responsive domain. The significant improvements of people's experiences were achieved because of excellent leadership provided by the management. We therefore also rated the Well-led domain as Outstanding and the service was rated Outstanding overall.

The registered manager had a personal experience of a close family member living with a severe learning disability for whom the service was originally set up. This had enabled the provider to have an invaluable insight of what quality of support they wanted to provide to people. We found the provider had an imaginative vision and they ensured innovative ways of putting people at the centre of the service delivery. Because of this the service was very much led by the people and people had exceptional opportunities created for them.

The provider’s governance was well-embedded and there were effective assurance systems that ensured ongoing compliance. The provider welcomed any form of input and since our last inspection they created a new post for a quality and safety officer to provide an additional layer of auditing. They saw any feedback as an opportunity to reflect and further improve the quality of the service for people. The team continuously looked for and created innovative ideas on how to have a positive influence on people’s lives and how to adapt the service delivery to the changing needs of people receiving support.

People, relatives and professionals were extremely positive about the service. People referred to the registered manager as ‘my friend’. People’s relatives spoke about the registered manager highly and told us the staff “listened to people and clearly put people's needs first”. External professionals were equally complimentary. Comments from professionals included, “I am impressed with how Laurel Leaf is run. I would, and do, highly recommend them to other service users and their families”, “I would be happy for them to care for anyone I know” and “I would recommend them without hesitation as being responsive, safe, effective, caring and well-led. The well-led element is especially strong”.

Staff remained positive about the team work and support they received from the registered manager and about the empowering culture that was promoted by the service. Staff complimented the training provision and the support received from the senior team. There was a high level of satisfaction and a sense of pride of working at the service demonstrated by the team.

People received care and support that in words of their relatives and professionals was ‘life changing’. We had feedback that reflected that even when people themselves felt they had no opportunities and lost their confidence with the perseverance and encouragement of Laurel Leaf staff they flourished. One professional said one person, “Was now in a better (place) than we could have hoped for”. One relative said about another person, “They've done a great job of getting [person] to where [person] is now”.

The team recognised the importance of people being an important part of the local community. The provider created additional opportunities that enhanced people’s wellbeing and reduced the risk of social isolation. People had opportunities to socialise at the specially created activity room situated next to the provider’s office’s where they could enjoy company of other people. They were able for example to develop computer skills and general day to day life skills such as cooking.

The provider’s passion to deliver exceptional care and their drive for excellence had been recognised and since our last inspection they were nominated for various awards by people. The provider won the following: The Great British Care Awards (South) in “The Putting People First - Personalisation Award” category and The Dignity in Care Award run by Age UK.

The registered manager ensured people knew how to raise any concerns. They developed a bespoke ‘lap tray’ with re-attachable 'emojis' (pictures of smiley, sad, neutral and other, faces) that could be used to aid communication with people. No one we spoke with said they ever needed to raise any concerns.

The service continued to provide safe care to people. Staff received training in safeguarding adults and understood their responsibilities to report any concerns. The provider followed safe recruitment processes that included completing checks to make sure new staff were safe to work with people at risk. Risks to people's safety and well-being were managed through an in-depth management process that covers all aspects of people’s lives, conditions and activities. There were sufficient staff deployed. Medicines were managed well and people received their medicines as prescribed.

People continued to receive effective support from staff that had the right skills and training to carry out their roles well. Staff had opportunities to attend team meetings and they were well supported. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and the service supported this practice. People were supported to maintain good health and meet their nutritional and dietary needs.

The service remained caring. People benefited from caring relationships with staff. Staff referred to people with dignity and respect. People were supported to remain independent. The provider had good processes in place to maintain confidentiality and records were kept securely.