We last carried out an unannounced comprehensive inspection of this service on 25 February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this follow-up comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Laughton Croft Care Home with Nursing on our website at www.cqc.org.uk. In addition we had received information of concern about the standards of care provided at Laughton Croft Care Home with Nursing.

This inspection took place on 27 October 2016 and was unannounced.

Laughton Croft Care Home with Nursing is registered to provide accommodation and nursing and personal care for up to 36 older people and people living with either dementia, a physical disability, sensory impairment or a mental health problem. There were 21people living at the service on the day of our inspection. The service has two units; Ruby and Emerald.

The recently appointed manager had commenced the process to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the 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 February 2015 we asked the provider to take action to ensure that people were protected from the risk of infections, that people were protected from the unsafe management of medicines and that the provider operated effective systems and processes to make sure that they assessed and monitored their service. The provider sent us an action plan on 4 July 2016 and told us that these actions had been completed. On this inspection we found that the provider had made the required improvements and was no longer in breach of the legal requirements.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. One person at the time of our inspection had their freedom lawfully restricted under a DoLS authorisation and two people were waiting for a DoLS assessment.

People were protected from avoidable harm and abuse and had their risk of harm assessed. Staff were aware of the signs of abuse and knew how to escalate their concerns. There were sufficient staff on duty to keep people safe and meet their care needs. People received their medicine safely from staff that were competent to do so. People were cared for in clean and well decorated environment by staff who understood good infection control practices.

People received effective care from skilled and knowledgeable staff who received training to meet people’s care needs. Staff had received appropriate training, and understood the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and were able people were asked for their consent to care. People received a balanced and nutritious diet and drinks and snacks were provided between meals. Staff ensured that when there were changes to a person’s health that they were referred to the most appropriate healthcare professional.

People were cared for with kindness and compassions by committed and caring staff. Staff involved people and their families in decisions about their care. People were cared for by staff wh

The inspection took place on 25 February 2015 and was unannounced.

Laughton Croft Care Home with Nursing is registered to provide accommodation and personal care for up to 36 older people and people living with either dementia, a physical disability, sensory impairment, or a mental health problem. There were 27 people living at the service on the day of our inspection.

There was a registered manager in post 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 our last inspection in July 2014 we asked the provider to take action to make improvements to respecting and involving people, cleanliness and infection control, safety and suitability of the premises and how they ensured the quality of the service. The provider sent us an action plan and told us that these actions would be completed by 23 October 2014. On this inspection we found that the provider had not made all of the required improvements.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves or others. Two people living at the service had their freedom lawfully restricted under a DoLS authorisation.

Staff understood safeguarding issues and knew how to recognise and report any concerns in order to keep people safe from harm. However, people’s safety was not always maintained, because staff did not always follow safe medicine administration, storage and disposal procedures and people were at risk of not receiving their medicine. Furthermore, the provider did not ensure that the service was consistently clean and that safe infection control procedures were adhered to and people were at risk of using equipment that was not clean.

People were cared for by staff who were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities. People had their healthcare needs identified and were able to access healthcare professionals such as their GP or psychiatrist. Staff knew how to access specialist professional help when needed. However, their care plans did not always reflect any changes in their plan of care following healthcare reviews.

People and their relatives told us that staff were kind and caring and we saw some examples of good care practice. However, we found that people were not always treated with dignity and respect. People were not supported to follow their hobbies and pastimes and had little contact with the outside world.

At this inspection we found that the provider was not meeting our legal requirements for cleanliness, medicines and governance. You can see what action we told the provider to take at the back of the full version of the report.

When we visited Laughton Croft Care Home with Nursing on 10 July 2014 we identified a number of concerns. We found that there were no effective systems in place to manage and monitor the spread and control of infection or ensure that the premises and equipment used was safe and cleaned to an appropriate standard to facilitate the prevention and control of infection.

We re-visited the service on 03 September 2014 to see what improvements they had made. We spoke with three members of staff and a visitor to the home. The focus of the inspection was to answer the key question; is the service safe?

Below is a summary of what we found. The summary describes what the staff told us, what we observed and the records we looked at.

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

Is the service safe?

We found the provider had improved the standard of cleanliness in several areas of the home. We saw that bedrooms and en-suite toilets were cleaner and there were no offensive odours.

We spoke with two housekeepers who told us their role had improved and they had systems in place to record the cleaning duties they had undertaken and access to better cleaning products. They told us they felt supported in their roles.

However, we also saw more improvements were needed to improve standards in some areas such as the sluice and laundry.

The service provides care to up to 36 older people or people living with a dementia. The service is divided into two areas, Emerald unit and Ruby unit. Both areas are well provided with lounges, dining rooms and toilets.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with people using the service and the staff supporting them. We spoke with five people and two relatives. We also looked at care files.

Is the service caring?

People were supported by kind and caring staff. We saw that care and nursing staff showed patience and gave encouragement when they supported people. For example, we saw one person being supported to eat their lunch. They were not hurried and the staff member offered encouragement throughout the meal.

Relatives told us if they made any suggestions about change to the manager that they were acknowledged and changes were made.

Sometimes people’s needs were not respected. For example, the layout of some bedrooms meant that people could not access their call buzzer when they needed to call for assistance.

Is the service responsive?

The service was responsive to people’s needs. We found risk assessments and care plans reflected individual needs and preferences.

Visiting relatives told us that if their relative became unwell staff contacted their GP and informed their family.

Is the service safe?

The service was not always safe. We have concerns about the standards of cleanliness in several areas of the service. We found infection control monitoring was weak and have identified several areas of concerns such as, ensuite toilets, the sluice and the laundry.

We found that people had access to areas where they may be at risk of harm. For example, the store room and boiler room were unlocked.

The system for reporting faults was not robust and repairs to broken equipment and furniture were not carried out in a timely manner.

We saw that people were at risk of harm in some areas of the gardens from uneven paths and lawns.

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA.

Is the service effective?

We saw staff were supported to carry out their role effectively. Staff had access to training that would lead to improvements in their knowledge and understanding of peoples care needs.

Relatives we spoke with were confident that care was effective. One relative told us, “It’s absolutely brilliant. They let her have time to herself and observe from a distance”

A person who lived in the service said, “I would give it 4.9 out of five just to give them some room for improvement.”

Is the service well led?

Relatives and staff told us that the manager was approachable and would address any concerns.

We found that the quality monitoring systems were not robust. The manager did not identify and act upon the areas of concerns we identified during our inspection.

At the time of our inspection there were 26 people who used the service. As part of our inspection we spoke with two people who used the service. We also spoke with the chef, four care workers and the registered manager.

We spoke with four relatives about their views. We observed the support given by staff to people who used the service. We also looked at records, including care files for four people and carried out a tour of the building.

People's needs had been assessed and they received care, treatment and support which met their needs. We saw people being offered choices and opportunities which were respected and responded to.

One relative we spoke with said, "I can’t say anything but good things about the home. They moved (name of relative) to a different room three times to give them a better view.”

People who used the service and relatives we spoke with were complimentary about the food and people were provided with a choice of suitable and nutritious food and drink. One person told us, “The food is great and I have managed to put on weight since I came here.”

We found that effective systems were not in place to reduce the risk and spread of infection and we looked at records and found some files had information that was incomplete or missing which put people at risk of inappropriate care or treatment.

Due to the complex needs of some of the people who lived at the service we used a number of different methods to help us understand their experiences. We looked at records. These included care records and information about how the service operated.

We spoke with two people who lived at the service, two relatives, four staff members, the registered manager and the homes administrator.

One person told us, “I am feeling happy about being here. They look after me and I like the staff.” A visiting relative said, “They (staff) look after people really well in our opinion. I feel our relative is safe and well cared for.”

We also used a method of inspection called a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to understand the needs of people who we were not able to speak directly with.

We observed staff communicated with people by speaking with them sensitively, and through the use of non verbal actions. We found staff were responsive to peoples needs and people were supported sensitively with their dignity maintained. We saw this helped ensure people were able to express their feelings freely and wherever possible make their own decisions about the care and support they received.

We also found that the provider and manager monitored the service regularly and created opportunities to gain the views on the service from relatives and from people who used the service.

Due to the complex needs of some of the people using the service we used a number of different methods to help us understand their experiences. We looked at records. These included care plans, and we spoke with people who lived at the home, three visiting relatives, one relative who called the home by telephone during our visit, members of staff and the registered manager.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to understand the needs of people who could not talk with us.

We observed that staff provided sensitive support using special equipment when people needed support with moving safely, during meal times and when people were undertaking individual or group activities.

People we spoke with told us that Laughton Croft Care Home was a nice place to live. They told us that the staff team provided the support and care they needed. One person commented that, “It is a homely home. I have my room how I want it and I feel safe here.”

A relative who was visiting the home said, “I can’t fault the care they give here it is run like a family home. We visit regularly and there is always a calm and friendly atmosphere here.”

People told us that they were asked for their views about the running of the home by the manager and staff and that they felt confident taking any concerns to staff members or the manager direct if needed.

We also observed how people enjoyed food that the home provided and the social activities that the home had organised. We saw there was a range of things for people to take part in as well as opportunities for them to go out into the community with support from staff and their relatives when they chose to.

People told us they had settled in well at the home and made positive comments about the support and care they received. They said they found their rooms to be clean and comfortable and had been able to bring with them items of their own to make them more homely.

Although not all could recall whether care plans had been discussed with them, those that could and relatives we spoke with, confirmed that they knew about them and information had been discussed with them. They told us they were involved in reviews held to check whether the support and care they received was satisfactory to meet their needs and expectations.

Relatives told us they were kept well informed and would feel comfortable to raise any matters or concerns with staff.

People made complimentary comments about staff indicating that they respected their privacy, and we noticed that there was a good rapport between staff, people who live at the home and their visitors.