Laburnum Cottage

About the service

Laburnum Cottage is a residential care home, providing accommodation and personal care to seven people with different health and care needs at the time of the inspection. The service specialises in the care for people with autism and/or learning disabilities, as well as people with mental health conditions. Laburnum Cottage is one of the provider’s several homes on the New Hall campus in Fazakerley, a short walk away from local shops and public transport.

People’s experience of using this service

Right Support

Some people’s individual risk assessments were not always reflective of the support they were receiving and did not always take additional measures to keep people safe putting people at risk of harm. Some audits and checks did were not always robust enough to identify when some improvements were needed to records. People received safe care and they were supported by staff who knew how to protect them from harm. Staff supported people to take their prescribed medicines and to access healthcare services when needed. Recruitment of staff was safe and robust. People could choose how they wanted to spend their time, whether they wanted to be in their own flats or in communal areas with other people.

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.

Right Care

People had dedicated 1-1 time to ensure opportunities for social engagement took place. There was a relaxed atmosphere in the home. Staff spoke and engaged with people respectfully. Personal care was delivered in people’s own flats, to ensure privacy and dignity. People were involved in choices around their care and support.

Right Culture

Staff advocated for people to ensure they had equal access to services, such as employment or education. Staff told us they liked working at the home, and enjoyed supporting people.

Rating at last inspection

The last rating for this service was good (published 30 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about incidents at the service and staffing levels. A decision was made for us to inspect and examine those risks.

This inspection was a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement, that is based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Laburnum Cottage on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Laburnum Cottage is a residential care home, providing accommodation and personal care to seven people with different health and care needs at the time of the inspection. The service specialises in the care for people with autism and/or learning disabilities, as well as people with mental health conditions. Laburnum Cottage is one of the provider’s several homes on the New Hall campus in Fazakerley, a short walk away from local shops and public transport.

People’s experience of using this service:

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

Under each key question we ask about the service, we found some very positive examples, but also some development needs. We identified issues with regards to notifying the Care Quality Commission (CQC) of certain events. Some planning and learning aspects to promote consistent, safe care required development. This meant we rated Well-Led as Requires Improvement on this inspection. However, the service continued to meet the characteristics of good in most areas we looked at.

People felt safe living at the service. People told us staff were supportive and helped them to be more independent. One person said, “When I moved in I thought they will kick me out after two days, but they did not. They never stopped believing in me.” People told us they were happy living at Laburnum Cottage.

People and the staff team were actively involved in the design and delivery of care. Although Laburnum Cottage is part of a campus-style setup, staff supported people to get involved in the community. People told us staff encouraged them to try new things, which made a difference to their quality of life. Care was person-centred and promoted people’s independence. Good outcomes were achieved with a view to people moving into their own tenancies.

The registered manager led a warm, caring and compassionate culture by being a good role model to their team. We heard good examples of how the service embraced and promoted people’s equality and diversity. People told us they liked the staff team. Managers were well respected by people living at the service and the staff. There were enough staff to meet people’s needs and staff were flexible around people’s wishes. Staff felt well supported. Staff told us everyone worked well together to provide a good service for people with at times complex needs.

Rating at last inspection:

At the last inspection we rated the service as Good (30 September 2016).

Why we inspected:

This was a planned inspection that was scheduled based on the previous rating. We inspected to check whether the service had sustained its Good rating.

Follow up:

We will follow up on this inspection through ongoing monitoring of the service, through conversations and notifications.

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

Laburnum Cottage is a residential service which provides accommodation and personal care for a maximum of six people with complex health and care needs. At the time of the inspection six people were living at the home. The accommodation consists of six self-contained flats and a shared kitchen and lounge.

A registered manager was in post. However they were in the process of transferring to a new location and the manager of the home was in the process of applying to become the new 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.

At the previous inspection we identified concerns relating to the currency and accuracy of risk assessment documentation. At this inspection we looked at risk assessments for two different people and found that improvements had been made immediately following the previous inspection. These improvements had been maintained.

At the previous inspection we identified that the home’s policy and procedure relating to missing person’s did not accurately reflect current practice. We looked specifically at the procedure and saw that it had been revised appropriately.

People told us that they felt safe living at Laburnum Cottage.

Accidents and incidents were recorded in appropriate detail and assessed by the manager. The manager was required to submit a copy of the information to the provider. The information was then analysed to identify patterns and triggers.

The home had sufficient staff to meet the needs of the people living there. People received different levels of support based on their needs and the activities that they were involved in. Staff were recruited safely subject the completion of appropriate checks.

People’s medicines were stored and administered in accordance with good practice. We spot-checked Medicine Administration Record (MAR) sheets and stock levels. Each of the MAR sheets had been completed correctly. Stock levels tallied with the figures recorded on the MAR sheets.

Staff had the skills and knowledge to meet the needs of the people living at the home and were well supported. They spoke positively about the training that was available.

Applications to deprive people of their liberty had been submitted appropriately and in accordance with the Mental Capacity Act 2005 and had been made in people’s best-interests.

People living at the home were actively involved in choices about food and drink and had free access to the shared kitchen. Each person also had a well-equipped kitchen in their own flat.

People were supported to maintain good health by accessing a range of community services. We also saw evidence of health action plans which detailed a range of healthcare needs and other important information.

Throughout the inspection we observed staff interacting with people living at the home in a manner which was kind, compassionate and caring. We saw that staff involved people in discussions and decisions about their own care and in general conversation. We saw that people had choice and control over their life and that staff responded to them expressing choice in a positive and supportive manner.

The majority of people were actively involved in assessment and review processes. We saw that a number of people had signed their care records and other important documents to indicate their involvement and agreement.

At the previous inspection we identified a concern relating to the completeness and accuracy of person-centred plans. At this inspection we saw that people’s plans were sufficiently detailed to inform staff of people’s needs and preferences and had been regularly reviewed.

The home had a complaints procedure and a complaints book available to people living at the home and visitors. Each of the care records that we saw also contained a copy of the complaints procedure. The records that we saw indicated that no formal complaints had been received in the previous 12 months.

The home had been developed with input from the people living there, their relatives and the staff team. Communication between staff, relatives and the manager was open and regular. We saw evidence that staff meetings had taken place throughout 2016.

The manager and other members of staff that we spoke with described the home’s values in similar terms. Each said that the home promoted people’s independence and kept them safe. We saw that these values were applied in communication with the people living at the home and in the delivery of care and support.

Staff were clearly motivated to do their jobs and enjoyed working at the home. Staff understood their roles and demonstrated that they knew what was expected of them.

The manager had a clear understanding of the need to monitor quality and safety through regular audits. They undertook regular monitoring of; care records, medicines and the physical environment and addressed issues as they arose.