This unannounced comprehensive inspection took place on 22 and 27 November 2015. Lawrence House is registered to provide care and support for up to 12 people with a learning disability. At the time of the inspection there were 10 people living at the service.
There was a registered manager in post who is also the registered provider. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were positive and enthusiastic about life at Lawrence House and this was evident in our observations throughout the day. People living at the service said they really liked living there. One person said ‘‘I have lived here a very long time. This is my home. I love it here.’’ We observed caring and compassionate support being given at all times. Staff were observant about people’s changing moods and acted quickly to support people when they became distressed or upset about something. Staff had clearly developed close relationships with people and respected and celebrated their diversity. People were offered choices in all aspects of their life. Relatives were very positive about how people were being cared for. Comments included, ‘‘It is absolutely fantastic. All the staff care so much. They really look after (our relative) so well.’’ Another said ‘‘Absolutely wonderful care. I don’t want my relative to go anywhere else. This is their home, staff know them and care so much. The manager is brilliant and has said they will continue to support my relative through palliative care.’’
One healthcare professional said the service was ‘‘Exceptional in their caring approach to people.’’
People had been supported in an exceptional way at the end of their life. Over the last year several people who had lived at this service for a number of years, became ill and needed nursing care. The registered manager and staff continued to support these people even after they moved out of this home. They said ‘‘We wanted to make sure our people had the best possible care and treatment. We did not want them to be afraid and alone in hospital so we made sure one of us was around for their stay and during their final days. One healthcare professional said “ I have found the Lawrence house to be extremely caring and committed to providing a service to past and present residents…..On some occasions this additional support has meant that a person has had a very dignified and more peaceful death than they would have otherwise. I find all the staff know the clients well, are compassionate and well trained so are excellent at informing others taking over the caring role.’’
Staff were experienced and knowledgeable about how to meet people’s individual needs. Care and support was being delivered in an extremely caring and sensitive way. People were being offered choice throughout the day about when they wished to be supported to get up, how they spent their day and what drinks and meals they wished to have. Staff understood people’s different ways of communicating and were proactive in ensuring people were happy, comfortable and enjoying meaningful activities.
People’s health care needs were well met. The service had developed individualised hospital passports for people, for when they needed care and treatment outside of their own environment. One healthcare professional commended the service saying ‘‘Having taken over the care of a patient last night who is one of your residents. I felt compelled to email you to tell you how lovely and how useful her communication passport is. It really helped me give care which was appropriate and tailored to the patient. If only all residents in all homes had something similar. It also suggests that she came from a home with a caring, person focussed ethic....love it!’’
Relatives confirmed they were kept informed about any changes in people’s health or general well-being and enjoyed having regular written updates about what their relative had been doing.
Staff ensured people were eating and drinking sufficient quantities to maintain good health. Staff knew what people’s likes and dislikes were. Staff prepared meals to ensure those who were at risk of choking had the right consistency. They were conscious about ensuring meals looked appetising and people, who were on restrictive diets due to healthcare needs, did not feel they were missing out.
Staff had training, support and supervision to help them understand their role and provide care in a safe way. Staff felt their views were listened to and understood the ethos of the home. This was to provide a safe, homely environment for people to enjoy and to offer people choice in everyday life. Staff said they were valued and encouraged to learn and develop by the registered manager. Staff had access to mentoring and guidance and support from a staff liaison person.
Most people lacked capacity, and this had been fully considered in light of the 2014 supreme court ruling, covering mental capacity and the need to consider Deprivation of Liberty Safeguards (DoLS). Applications had been made in respect of people and the service was awaiting assessment and authorisation of the DoLS. Staff understood the importance of giving people choice and worked in innovative ways to ensure people had maximum choices throughout their day.
People were protected by the service having clear recruitment processes, which ensured only staff suitable to work with vulnerable people were employed. Medicines were being well managed which also helped to protect people.
There were a range of audits to ensure the environment was safe, clean and homely. Complaints were responded to in a timely way. Relatives confirmed they had confidence in the registered manager and staff team to be able to respond to their concerns and suggestions. The staff team were proactive in ensuring people’s wishes were considered and actioned.