Loring Hall

Loring Hall is a residential care home providing personal and nursing care to 12 people with learning disabilities. The service can support up to 16 people in one building across three floors.

The service is a large home, bigger than most domestic style properties and larger than current best practice guidance. However, the size of the service having a negative impact on people has been reduced by the provider's focus on ensuring that people receive person-centred support which promotes choice, inclusion, control and independence. The service has been developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives.

People’s experience of using this service and what we found

People were protected from the risk of abuse. Risks to people had been assessed and were managed safely. There were sufficient staff to safely meet people’s needs. Staff knew to report any incidents or accidents and the registered manager reviewed incident records to look for trends and reduce the risk of repeat occurrence. People’s medicines were securely stored and safely administered. The provider followed safe recruitment practices. Staff were aware of the action to take to reduce the risk of infection.

Staff were supported in their roles through regular training, supervision and an annual appraisal of their performance. People had access to a range of healthcare services and staff worked with other agencies to ensure people received consistent and effective support. Staff sought people’s consent when offering them support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to maintain a balanced diet and told us they enjoyed the food on offer at the service. Staff treated people with dignity and respected their privacy. People were involved in making decisions about the support they received. Staff were caring and compassionate in their approach.

People’s needs were assessed before they moved into the home. They were involved in the planning of their care. People’s care plans reflected their individual needs and preferences. Staff were aware of the details of people’s care plans and supported them accordingly. People took part in a range of activities which they enjoyed and were supported to maintain the relationships that were important to them. The provider had a complaints procedure in place and people confirmed they knew how to make a complaint.

Staff spoke positively about the registered manager and the working culture at the service. The provider had systems in place for monitor the quality and safety of the service and sought to make improvements where any issues were identified. The registered manager understood the responsibilities of their role. Staff told us they worked well as a team and received a high level of support from the registered manager. The provider sought people’s views on the service through regular residents and key worker meetings.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 September 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had 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.

At our last inspection in June 2017 we found a breach of regulations because the provider’s systems for monitoring the quality and safety of the service were not operated effectively in order to drive service improvements and ensure people’s safety. We also found improvement was required to ensure people’s medicines were safely managed and because people’s care plans had not always been reviewed regularly, in line with the provider’s policy. Following that inspection, we received an action plan from the provider telling us how they would address the issues in respect of the regulatory breach.

At this inspection we found that, whilst the provider had addressed some of the issues identified at the last inspection, they had not sufficiently addressed the issues in respect of the regulatory breach. The provider’s systems for monitoring quality and mitigating risks to people were not effective. Medicines audits had not been carried out on a regular basis and the process used to check in new stocks of people’s medicines failed to identify issues in the recording of people’s medicines. The systems used for monitoring people’s risk assessments did not always drive improvements where they were needed. The provider’s systems for monitoring areas including incidents and accidents, and people’s weights were not operated in a way that enabled them to have oversight of people’s conditions over time to ensure they were receiving safe and effective support.

We also found that people’s medicines were not safely managed. Staff had not always signed people’s Medicines Administration Records (MARs) to confirm whether people had taken their medicines as prescribed. There was not always sufficient guidance in place for staff on medicines people had been prescribed to take ‘as required’. Medicines disposal records showed that two people had missed doses of their prescribed medicines but there was no further information available regarding when these doses had been missed and these issues had not been followed up.

Additionally, the registered manager had displayed the rating from the previous inspection in the home and had submitted notifications about certain events to CQC, but had not been aware to submit notifications where people were subject to Deprivation of Liberty Safeguards (DoLS) authorisations, as required by the current regulations.

You can see what action we have told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Risks to people had been assessed but improvement was required to ensure risk assessments were updated promptly following any changes in the support people require to remain safe. Staff were supported in their roles through an induction and regular training, but improvement was required to ensure staff consistently received training specific to people’s individual needs, and to ensure they were supported through regular supervision.

Staff sought people's consent when offering them support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, where people had DoLS authorisations in place, improvement was required to ensure the service consistently met the requirements of any conditions which had been placed on them. The provider sought people’s views on the running of the service through resident’s and keyworker meetings.

There were sufficient staff deployed at the service to safely meet people’s needs. The provider followed safe recruitment practices. People were protected from the risk of abuse because staff received safeguarding training and were aware of the action to take if they suspected abuse had occurred. Staff worked in ways which protected people from the risk of infection.

People’s needs were assessed to ensure the service’s suitability. The assessments were used as the basis on which people’s care plans were developed. Care plans reflected people’s individual needs and preferences. Staff supported people to maintain a balanced diet and people told us they were happy with the meals on offer at the service. People had access to a range of healthcare services when required. The provider sought to ensure people received joined up care when moving between different services.

People were treated with dignity and their privacy was respected. Staff treated people with care and consideration. People were involved in making decisions about their care and treatment. The provider had a complaints policy and procedure in place and people told us they knew who they would speak to if they had a complaint. The working culture in the service was positive and inclusive, and staff shared the vision of the registered manager in seeking to maximise people’s independence. People and staff spoke positively about the registered manager and the management of the service.

People had access to a range of activities in support of their need for social stimulation. Staff supported people to maintain the relationships that were important to them. The registered manager was committed to ensuring people received appropriate support at the end of their lives although none of the people living at the home required end-of-life care at the time of our inspection. The provider sought to work in partnership with other agencies and staff responded positively to feedback they received from the commissioning local authority.

We carried out this inspection to check the actions the provider told us they would take to address the breaches to meet the fundamental standards and to conduct a full comprehensive inspection of the service to cover other areas the focussed inspection would not have reviewed. As the investigation was still on-going at the time of this inspection, we have not been able to consider the evidence relating to the death of the person using the service. When the investigation is concluded, we will review the evidence and consider what further action, if any, CQC may need to take.

Loring Hall provides accommodation and personal care support for up to 16 adults with learning disabilities. At the time of this inspection, the service was providing support to 16 adults. The home had a registered manager. However, we were advised at the time of this inspection that they had tendered their resignation and were not actively managing the service. The provider was in the process of recruiting a new manager to run the home and the provider told us the ‘home manager’ would be managing the home until a new manager was recruited. 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 this inspection we found that whilst the provider had made some of the required improvements and had addressed most of the breaches previously identified, we found a new breach of regulations as the provider failed to ensure there were effective systems in place to assess, review, monitor and improve the quality and safety of the service and to maintain accurate complete and contemporaneous records. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found that although some improvements had been made to the management of medicines further improvements were required. Medicines that required refrigeration were not consistently monitored to ensure they were stored within safe temperature ranges. People’s care plans were comprehensive and holistic and we observed people received support in line with their planned care. However, not all parts of people’s care plans were regularly reviewed in line with the provider’s policy and this required improvement. People using the service and their relatives were not always provided with the opportunity to give feedback about the service to help drive improvements. Although staff received regular supervision and staff performance and development was appraised there was no formal system in place at the time of our inspection. However, the provider told us they were in the process of developing and implementing a staff appraisal system which they expected to be operational within the next few months.

There were appropriate safeguarding adults and whistle-blowing procedures in place. Systems were in place to support people where risks to their health and welfare had been identified. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs. Staff new to the home were inducted into the service appropriately and staff received training and supervision. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves.

People’s nutritional needs and preferences were met and people had access to health and social care professionals when required. People told us they were treated with kindness and respect. Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes. People were provided with information on how to make a complaint and told us the manager and staff were approachable and supportive.

Loring Hall provides accommodation and personal care support for up to 16 adults. At the time of this inspection, the service was provided to 13 adults with learning disabilities. There was a registered manager in place at the time of our inspection. 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 this inspection we found breaches of regulations because risks to people had not always been assessed and there was not always adequate guidance in place for staff on how to manage risks. We also found areas of risk relating to the environment were not always safely assessed or managed, and that people had not always received their medicines as prescribed. Medicines storage areas were not monitored to ensure medicines were stored at a safe temperature. There was insufficient guidance in place for staff on when they should administer medicines that had been prescribed as being 'as required' and records relating to the administration of people's medicines had not always been accurately maintained. We also identified a further breach of regulations because staff had not always received sufficient specialist training relevant to people's conditions. You can see what action we told the provider to take at the back of the full version of the report.

There were sufficient staff on duty to meet people’s needs and people commented positively about the support they received.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were aware of the importance of consent and people were asked for their consent

before care was provided. People's needs were assessed and risk assessments were

carried out before care was provided. These were regularly reviewed so that staff were aware of the best way to provide support. The provider and manager were available on a daily basis to oversee the staff and monitor that people were being safely supported, for example in managing challenging behaviour and in travelling in the community. Health care professionals and social services were involved in people's care planning and in responding to people's concerns when needed.

There were arrangements in place to deal with emergencies and to make sure people were safe. People's health needs were included in their care planning to ensure they were healthy. Fire safety equipment and procedures were in place to ensure people would be kept safe in the event of a fire.

There were safe procedures in place to look after and administer medication and staff who were responsible for people's medication were trained for this task.

Effective recruitment procedures were in place to ensure that suitable staff were

employed, including checking their history of employment to ensure they were experienced and of good character.

Is the service caring?

We spoke with four people who used the service and observed staff working with people, and were told that the staff and manager were very caring and supportive. We saw that staff always took the time to stop and speak with people and spoke with them in a manner they best understood, speaking slowly when needed. One person said: 'I can't fault the staff here, they have always listened to me and helped me when I needed them most, to sort out my problems and to make sure I always had my family told when I needed their help.'

Is the service effective?

We saw that people's needs were assessed and a plan drawn up to meet those needs.

People told us they were happy with the plan provided. Regular reviews were made of the plan provided and people told us they were involved in the reviews. There were suitable policies in place for consent to care, management of medication and recruitment. One person told us: 'this is the best place I've lived, and the staff know how to support me well. I have learned a lot here and now have a job and feel safe and happy.'

People who used the service were consulted for their views on a regular basis. Any

changes they requested were included in a revised care plan.

New staff had been recruited and were provided with adequate support, guidance and

training to do their job.

Is the service responsive?

People we spoke with who used the service told us that the staff and manager always listen to their concerns and do something to help sort out any problems they are experiencing. People were provided with a range of enjoyable activities and changes were made when necessary to try out new activities. People's behavioural management plans were reviewed and changed when necessary in response to incidents so that best approaches to helping people to maintain their activities and interests continued to be supported.

Is the service well led?

The registered manager and owner were involved in direct care and worked with all the staff. They felt this meant they could identify any issues quickly and address them if they arose. Staff we spoke with told us that they felt the home was very well managed and that they received direction and training to allow them to support people at the home. Regular staff meetings and supervision sessions were held and staff said they felt able to raise any issues with the management openly and honestly.

People who used the service told us that they felt the manager was very good at managing the home and was always present to speak with about any concerns.

There were a range of systems in place to monitor the quality of people's care, and to make sure any concerns about staff, management or the way in which care was delivered were addressed.

Care planning and reviews took place regularly with involvement from people who used the service. However, we also found that people's ability to consent to their care had not been fully assessed, and care plans were not always signed as agreed by people who used the service or their representatives. We found that the staff understood people's care needs and how to protect them from risk and harm.

The manager ensured that care staff had appropriate training and supervision and care staff told us that the management were very supportive and listened to them when they had any concerns or ideas for improving the service. Appropriate procedures were in place to deal with minor concerns and complaints and people who used the service had been informed of their rights to complain.

We saw staff were involved with people who lived at the home, and there was clear methods of communication used, with staff taking time to listen to people and respond to their needs. We saw that staff treated people with courtesy and respect, and five people we spoke with said that the staff were very helpful and respectful and helped them to have lots of activities.

Care planning and reviews took place regularly with involvement from people, but care plans were not signed as agreed by people who used the service or their representatives.

We found that the staff understood people's care needs and how to protect them from risk and harm. Care staff were appropriately qualified and had adequate training and supervision.

Appropriate checks were being done by the provider to ensure that the quality of people's care was maintained.