The inspection took place on 4 December 2018 and was unannounced which meant the people living at Laureate Court and the staff working there didn’t know we were visiting.

The service was previously inspected in July 2017, the service was given an overall rating of good.

Laureate Court is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation for up to 74 older people in one adapted building, including people living with dementia. It is situated on the outskirts of Rotherham. It is close to the local hospital and bus routes. At the time of our visit there were 63 people using the service.

At the time of our inspection there was a registered manager in post. 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.

Since our last inspection the provider had made changes in the management team, there was a new registered manager, a clinical lead and new nursing staff.

We found the systems in place to monitor the service. However, the management team carrying out the audits were new and although they had identified some areas of concern, we found some issues had not been identified in a timely way. The systems required further embedding into practice and improvements sustained by the new management team.

There were systems in place to manage medication administration and predominantly these were followed. However, we found staff had not always followed the procedures and it had not been identified through the audit system.

Risks associated with people’s care were identified. However, the documented management of the risks did not always give sufficient detail to ensure people’s safety.

There was a dependency tool in place to determine the care hours required to meet people’s needs. However, we found from observation, talking with staff and relatives that on two units there were insufficient staff available to support people who used the service in a timely manner.

The environment of the service in two units had been improved and was to a good standard. However, we found areas of the service that was not well maintained and not kept clean. People were not always protected against the risk of infections.

People were safeguarded from the risk of abuse. Staff confirmed they received training in this subject and could explain what actions they would take if they suspected abuse.

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. Staff received the training and support required for them to carry out their roles effectively. People received support from healthcare professionals when required and their advice was followed.

People were supported to maintain a healthy and balanced diet which included their choices and preferences.

We observed staff were kind, caring and considerate. Staff respected people’s privacy and dignity and involved them in their care and support.

The service was responsive to people’s needs and staff were very knowledgeable about how to support people in line with their preferences. However, care records did not always contain current information required to assist staff in how to support people. People were involved in social activities and enjoyed a range of social events.

The provider had a complaints procedure which was available if people wanted to raise concerns. Complaints were dealt with appropriately and used to improve the service.

Furthe

The inspection was carried out on 29 June 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. The service was previously inspected in November 2016 and was rated requires improvement, it had previously been rated inadequate in June 2016 and was placed in special measures. At our inspection in November 2016 we found that there was not enough improvement to take the provider out of special measures as we identified four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Laureate Court' on our website at www.cqc.org.uk.'

At this inspection we found that improvements had been made and we have taken the service out of special measures.

Laureate Court provides residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units; Byron and Shelly both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 41 people using the service, 19 people receiving nursing care and 22 people in receipt of residential care, including people living with dementia.

At our last inspection there had been changes in the way staff were deployed due to the temporary closure of the Byron unit. This unit was still closed at this inspection. The unit was being refurbished. Therefore there were still only two out of three units open at the time of our inspection.

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.

The provider had a safeguarding policy in place and staff were aware of the procedures to follow to safeguard people from abuse.

Risks were identified and managed so that people avoided injury or harm. The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people's care needs. However, there was not sufficient staff to be able to meet peoples social needs. Recruitment systems were followed to ensure staff were suitable to support people.

Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we identified some improvements could be made and the records were not always accurate.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found the requirements of the act were being met.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People received adequate nutrition and hydration to maintain their health and wellbeing. The premises was being refurbished and improved at the time of our inspection to be able to meet the needs of the people who used the service.

Staff recruitment processes were robust. We found all the required pre-employment checks had been carried out. Staff received supervision and an annual appraisal of their work. Staff told us they felt supported in their role.

We found staff approached people in a kindly manner and were respectful. People and their relatives told us staff were kind and very caring. Staff demonstrated a good awareness of how they respected people’s preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s indivi

The inspection took place on 16 and 17 November 2016 and was unannounced on the first day. This was the fourth rated inspection for this service which had previously been rated inadequate in June 2016 and was placed in special measures. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Laureate Court’ on our website at www.cqc.org.uk.’

Laureate Court providers residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units, Byron and Shelly both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 48 people using the service, 20 people receiving nursing care and 28 people in receipt of residential care.

There had been recent changes in the way staff were deployed due to the temporary closure of the Byron unit. This was due to a planned refurbishment. Therefore there were only two out of three units open at the time of our inspection.

The service did not have 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. A manager had been appointed by the provider in January 2016. This person had left the service and another manager was in place who had commenced their employment with the organisation approximately four weeks prior to our inspection. This person was present throughout the inspection.

During this inspection we looked to see if improvements had been made and embedded in to practice from our last inspection. We found insufficient progress had been made. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Systems were in place to ensure people received their medications in a safe and timely way from staff who were appropriately trained. However, we identified some areas that could be further improved. People were not protected against the risks associated with infection prevention and control as safe procedures were not followed.

People who used the service, and their relatives we spoke with, told us they were happy with how care and support was provided at the home. All people we spoke with told us the staff were very good and they felt safe.

At our inspection of November 2016 we found improvements had been made in staffing levels and staff worked together better as a team. However, we found that the deployment of staff was not always effective to ensure people’s needs were met.

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

Our observations showed most people were supported to eat and drink sufficient to maintain a balanced diet and adequate hydration. However documentation did not always support this and at times we saw some people were not adequately supported with their meals.

Staff told us they had not received regular supervision but felt supported with the new manager in post. Staff training had also been identified by the new manager as an area that required attention and they had arranged dates for training.

We saw evidence of involvement from health care professions when required. For example, we saw referrals to speech and language therapists when people presented with swallowing difficulties.

The service was a purpose built

The inspection took place on 28, 29 June and 1 July 2016 and was unannounced on the first day. This was the third rated inspection for this service which had previously been rated inadequate in November 2014. In March 2015 we carried out a focused inspection and a further comprehensive inspection took place in June 2015. We found improvements had been made, but further improvements were required to be implemented and the service was rated as requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Laureate Court’ on our website at www.cqc.org.uk.’

Laureate Court provides residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units; Byron and Shelley both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 56 people using the service, 26 people receiving nursing care and 30 people in receipt of residential care.

The service did not have 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. A manager had been appointed by the provider in January 2016. This person was present throughout the inspection.

During this inspection we looked to see if improvements had been embedded in to practice from our last inspection. We found insufficient progress had been made. We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We spoke with the manager and regional manager who told us the reason was due to the change of management company which had taken place in January 2016, and this had had an impact on progressing the service. However, the provider had remained the same.

During our inspection we observed people had to wait at times for assistance and staff were not always present in communal areas to ensure people’s safety. Staff and relatives we spoke with told us at certain times they could do with more staff to ensure people’s needs were met in a timely way and maintain their safety.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified these had not always been followed and people did not always receive their medication as prescribed.

We found some people, who were prescribed medication to be given as and when required, were given this regularly as a means to control their agitation. Other methods to monitor and manage anxiety had not been considered.

People were not protected against the risks associated with infection prevention and control. Safe procedures were not followed.

Staff we spoke with were knowledgeable about safeguarding people from abuse. They told us they would report any concerns straight away.

The provider had a system in place to ensure people were recruited in a safe way. The manager was currently working through staff files to ensure that all correct documentation was present.

Staff we spoke with told us communication was poor; there was a lack of staff meeting, supervision and leadership. Staff morale was very low which was impacting on the people who used the service.

Staff told us that they had not received much training until recently. Most training was completed via eLearning although some recent training sessions had been arranged face to face. The provider's training records showed staff training was required.

People were not always supported to eat and drink sufficient amounts to maintain a balanced diet. Some mealtimes were disorganised which led to s

We carried out an unannounced comprehensive inspection of this service on 18, 19 and 25 November 2014 in which several breaches of legal requirements were found. We also served four warning notices in relation to breaches. These were infection control and cleanliness, supporting people to eat and drink sufficient amounts, respecting people’s privacy and dignity and assessing and monitoring the quality of service provision.

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 a focused inspection on the 3 March 2015 to check that they had followed their plan and to confirm that they now met legal requirements of the warning notices. We did not look at other breaches at this inspection as the provider was still in the process of implementing their action plan and embed these improvements into practice.

This report only covers our findings in relation to the four warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Laureate Court Care Home’ on our website at www.cqc.org.uk.

Laureate Court provides accommodation and nursing care for up to 82 people who have nursing needs and people living with dementia. There were 62 people living at the home when we visited. Laureate Court is divided into three units. Keats unit provides accommodation for up to 32 people who require residential care. Byron and Shelly units provide accommodation and nursing care for up to 25 people each.

At the time of our inspection the home had a manager in post who commenced employment with the company on 18 February 2015. This person has not yet been registered with the Care Quality Commission. This service is required to have 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 a legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

We had asked the provider to be compliant with three warning notices by the 21 January 2015 and one by the 30 January 2015. At our focused inspection on the 3 March 2015, we found that the provider had met the requirements of the warning notices.

We found the provider had taken action to address the issues relating to infection control and cleanliness at our last inspection. We found the environment was clean and tidy.

We saw people who used the service were given choices and these were respected by staff. One person had requested a salad sandwich and we saw this was provided. Staff were available in the dining area during the meal and offered support in a caring and understanding way. Staff were aware of people’s dietary requirements and acted on their needs. Throughout the day we saw drinks and snacks were available and staff assisted people with their preference.

We spent time observing staff interacting with people who used the service. We found staff were kind and compassionate. We spoke with people and they told us told staff were very nice. One person said. “The staff are very kind, when I have been crying they always come and cheer me up.” We spoke with a relative who said, “I can talk to staff here and they listen. I feel confident my relative is looked after.”

We spoke with people who used the service and their relatives and were told they felt able to raise concerns. One person said, “I am sure the staff would sort out any concerns, they are very good.” Another person felt the new manager and project manager were very approachable and felt they could raise concerns if needed.

We saw audits which had been completed by the project manager. These were in areas for example; accidents and incidents, falls, weight loss, care plans, medication and complaints. Where issues had been identified an action plan was in place to resolve them. For example the audit for infection control required had identified a cleaning schedule for cleaning the laundry was required, we saw this was in place.

We carried out this inspection because when we visited the service on the 7 October 2013, we found that people were not cared for in a clean, hygienic environment. We also found that some quality monitoring checks had not taken place. We wrote to the provider and asked them to take action to address these issues. The provider sent us an action plan which stated they would be compliant by 30 January 2014.

We inspected the service on 25 February 2014 and found the provider to be compliant.

People were protected from the risk of infection because appropriate guidance had been followed.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

We were unable to ask the views of people resident in the home because of the level of their dementia. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed the dining room when people were having their lunch. We saw staff including people in their conversations even if they were not able to respond fully. We saw that people were given choices and that their choice was respected. We observed staff to be kind and caring in their approach.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent.

People who used the service had a care plan which was relevant to their individual needs. We spoke with relatives who were very happy with the care provided. One person said, “Nothing’s too much trouble, the staff are great.” Another person said, “I am always made to feel welcome when I visit my relative.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with said that the food was lovely and well presented.

People were not cared for in a clean and hygienic environment.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider did not have an effective system in place to regularly assess and monitor the quality of service that people receive.

We found that people who used the service gave consent to their care and treatment. The appropriate procedure was followed where people were not able to give consent. We spoke with staff and they were knowledgeable about people’s choices. We observed staff and found that people were asked what they wanted to do. Staff also explained care tasks prior to delivering the care and gave people time to respond.

We were only able to speak to some people who used the service; this was because the people living at the home were not able to communicate in a meaningful way. However during our inspection we spoke to two people who used the service. They told us that the staff were good and did the best they could. Some parts of the home had recently been decorated and one person using the service told us that he was happy with the new décor.

We spoke to two people’s relatives. They said that they were happy with the way the service was run. They were happy with the standard of care their relative received. They told us that staff kept them up to date with their relative’s welfare and consulted them about their care. Comments made included:

“I am consulted about everything”

“I am able to visit when I like and stay as long as I want to”

We carried out an unannounced comprehensive inspection of this service on 18, 19 and 25 November 2014 in which breaches of the legal requirements were found. This was because people were not protected against the risks associated with the unsafe use and management of medicines, did not receive care or treatment in accordance with their wishes and there was not always enough staff on duty to meet people’s needs. During that inspection we also issued four warning notices for beaches in relation to regulations in the areas of monitoring the quality of service, cleanliness and infection control, meeting nutritional needs, and respecting and involving people who used the service.

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 a focused inspection on 3 March 2015 to check that they had made the improvements in regard to the warning notices issued. We did not look at other breaches at this inspection as the provider was still in the process embedding these improvements into practice. At the focused inspection we found that action had been taken.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Laureate Court’ on our website at www.cqc.org.uk.’

This unannounced inspection took place on 9, 10 and 15 June 2015. Laureate Court provides accommodation and nursing care for up to 82 people who have nursing needs and people living with dementia. There were 59 people living at the home when we visited. Laureate Court is divided into three units. Keats unit provides accommodation for up to 33 people who require residential care. Byron and Shelly units provide accommodation and nursing care for up to 49 people.

At our inspection of the 9, 10 and 15 June 2014 we found that the provider had followed their plan which they had told us would be completed by the 28 February 2015 and legal requirements had been met.

There should be a registered manager for the service. 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. There was a manager employed by the service who was not registered with the Care Quality Commission. The manager had been employed at the home since February 2015. We spoke with the project manager who told us the process for registration had commenced.

We checked to see if medicines were ordered, administered, stored and disposed of safely. We looked at the MAR sheets (Medicine Administration Records) and found them to be accurate. Medication was ordered and disposed of safely and the service had a returns book for recording medicines which had been returned to the pharmacy. We looked in the medication room and found two store cupboards and a fridge storing medicines all unlocked. The meant that some medicines were at risk of inappropriate storage.

Some risk assessments did not state what the hazards were or how to minimise the risk occurring. We spoke with the project manager about this and were told that these would be reviewed as part of the care plan audits.

We found there were sufficient numbers of qualified, skilled and experience to meet the needs of people who used the service. We saw staff were available to respond to people’s needs in a timely and appropriate manner.

We spoke with staff about their understanding of protecting vulnerable adults. We found they had a good knowledge of safeguarding adults and could identify types of abuse, signs of abuse and they knew what to do if they witnessed any incidents.

We saw some care records had a generic best interest decision covering all aspects of care. This was not in line with the Mental Capacity Act 2005 which informs that best interest decisions should be time and decision specific.

People felt able to raise concerns and felt listened to. Relatives we spoke with said they would speak to staff or the management team if they had a concern.

We found that people’s health care needs were assessed. However, some care plans were not clear. People were supported to eat and drink enough to meet their nutrition and hydration needs.

We found staff were kind, caring and compassionate and understood how to communicate with and support people who had complex needs. Staff were aware of how to respect people’s privacy and dignity.

The service had several staff who were dignity champions and would address issues if they arose.