Housing 21 - Laurel Gardens

Housing 21 – Laurel Gardens provides care and support to adults living in specialist 'extra care' housing living with dementia, mental health, learning disabilities, physical disability and sensory impairments. At the time of our inspection visit there were 36 people receiving care. The service consists of 70 two-bedroom flats and bungalows.

People's experience of the service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right 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 involved in their risk assessments and safety care planning arrangements. This helped to ensure people received the support they wanted. People were supported to receive their medicines safely from staff who had received training in safe medicines practices.

Right Care

There were enough staff to meet people's packages of care. People said staff arrived when they expected them and did everything that was required of them. Staff understood their role in safeguarding people from the risks of abuse or discrimination and their responsibility to record and report any concerns. The provider had a clear management structure that monitored the quality of care to drive improvements in service delivery.

Right Culture

People and relatives told us the registered manager and senior staff were visible in the home and were very approachable. People were invited to complete surveys and provide feedback on the quality of the care they received and make suggestions to develop the service further. Staff told us they enjoyed working at Laurel Gardens and valued their role in supporting people to live as independently as possible. Staff told us there was a 'no blame' culture in the service and learning was shared to improve outcomes for people.

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 January 2020) and there was a breach of regulations.

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 inspection was prompted by a review of the information we held about this service and to follow up on action we told the provider to take at the last inspection.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Housing 21 – Laurel Gardens 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.

Housing 21 – Laurel Gardens provides care and support to adults living in specialist ‘extra care’ housing living with dementia, mental health, learning disabilities, physical disability and sensory impairments. At the time of our inspection visit there were 39 people receiving care. The service consists of 70 two-bedroom flats and bungalows. The flats are spread over two floors of a large building with some communal services.

People’s experience of using this service

There had been significant changes at the service and a new management team was put in place between August to November 2019. The new manager had reviewed the service and was in the process of taking action to make improvements they had identified. The manager was open and honest, and worked in partnership with outside agencies to improve people’s support.

Quality assurance checks were not up to date and had not identified issues such as gaps in care planning.

Some people waited for support from staff. Staff told us they regularly worked additional shifts to cover staff vacancies. There were concerns around staffing levels, particularly at weekends, when senior staff covered shifts, to ensure people’s needs were met.

Care plans were in the process of being reviewed and updated because there were some gaps in assessment of risk to people’s safety and guidance for staff. People said they were involved in planning their care. People and their families understood how to complain if they wanted to.

People felt safe using the service. Staff managed the risks to people’s health, safety and well-being and understood how to recognise and report abuse. However, some risks to people’s safety had not been fully assessed.

People were supported to have enough to eat and drink to maintain their well-being. They were supported with their medicines and to obtain advice from healthcare professionals when required.

Staff had training to meet people’s needs. Staff recruitment processes included background checks to review their suitability to work with vulnerable adults.

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 treated with dignity and their independence was promoted wherever possible. They were encouraged to take part in activities which interested them and helped build a community spirit within the service.

Rating at last inspection

The last inspection was a comprehensive inspection. The service was rated Good in Safe, Effective, Caring and Responsive and Require Improvement in Well Led. It was rated Good overall (report published 14 July 2017). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

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

Laurel Gardens provides an extra care service of personal care and support to people within a complex of flats. Staff provide care at pre-arranged times and people have access to call bells for staff to respond whenever additional help is required. People have access to communal facilities, including a lounge and a restaurant which offers hot and cold meals daily. At the time of our visit the service was providing care and support to 70 people.

The service had a 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.

People told us they felt safe, and that they could raise concerns with staff at any time. Staff were trained in safeguarding people, and we saw that they understood what action they should take in order to protect people from abuse. Staff were supported in doing so by access to the provider’s policies and procedures. Systems were used to minimise risks to people’s safety, and staff knew how to support people safely, through access to accurate and regularly updated risk assessments.

People were supported with their medicines by staff who were trained to do so, and had been assessed as competent. Medicines were given in a timely way and as prescribed. Regular audits took place, which helped to ensure medicines were given effectively. However, these audits had not identified recording errors for one person. Rapid and effective action was taken by the registered manager to ensure this was rectified. There were enough staff to meet people’s needs.

Checks were carried out prior to staff starting work to ensure their suitability to support people. Staff received appropriate training, support and guidance through regular supervision meetings, which helped to give them the skills, knowledge and understanding to meet the needs of people.

Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and supported people in line with the principles of the Act. Staff were aware of the need to seek informed consent from people wherever possible.

People told us that staff were respectful and treated them with dignity and respect. They also told us that staff supported them to be as independent as possible and respected their right to privacy. People told us they could choose what to eat and drink, and that they were supported to prepare their own meals where required.

People had access to healthcare professionals whenever necessary, and we saw that the care and support provided by staff was in line with healthcare professionals’ advice. People’s care records were written in a way which helped staff to deliver personalised care. People were fully involved in deciding how their care and support was delivered, and they felt able to raise concerns about their support with staff and the manager if they were not happy with it.

People told us they were able to raise any concerns with the registered manager, and that these concerns would be listened to and responded to effectively, and in a timely way. People told us that staff and the management team were responsive and approachable. Some systems used to monitor the quality of the support provided were not always effective, and action had not always been taken as a result.