This inspection took place on 15 November 2018 and was unannounced.

Laurel Bank 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 care home can accommodate up to 63 older people including people living with dementia in one purpose-built building. Accommodation is provided over three floors. At the time of inspection there were 45 people living at the home.

At the last inspection April 2018, the home was rated as requires improvement. Prior to this inspection in October 2017 the service was rated as inadequate. Following this inspection, the service is still rated requires improvement due to concerns around medication, staffing levels and lack of robust quality audits.

There was a registered manager in post. 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.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. However, there had been some recent issues in relation to staffing levels.

Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were not all up to date. This meant care plans did not always detail what care and support people wanted and needed.

Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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.

People’s healthcare needs were being met and medicines were being stored and managed safely. However, there were concerns around the storage of topical medicines.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they took action to make improvements.

We found the provider’s quality monitoring systems were not always working as well as they should be. Some of the concerns we found at our inspection should have been identified through a robust system of checks.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Laurel Bank Care Home offers care and support to people with a variety of care needs and has a residential unit and a dedicated unit for people living with dementia, called the Elizabeth Unit. The accommodation is set over three floors, with a lift and outside space. The Elizabeth Unit is based on the third floor of the service. On the day of our inspection there were 46 people living at the service.

Laurel Bank Care Home 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.

Our last inspection took place on 10 and 11 July 2017 and at that time we found the service was not meeting five of the regulations we looked at. These related to safe care and treatment, person centred care, meeting nutrition and hydration needs, staffing and good governance. The service was rated ‘Inadequate’ and was placed in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care and treatment. This is reflected in the overall rating for the service which is now ‘Requires Improvement.'

There was a registered manager in post. 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.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse.

The care plans in place provided staff with information about people’s needs and preferences contained individual risk assessments which identified specific risks to people’s health and general well-being, such as falls, mobility, nutrition and skin integrity. However, some care records we looked at required updating.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us there were now clear lines of communication and accountability within the home and they were kept informed of any changes in policies and procedures or anything that might affect people’s care and treatment.

Improvements had been made to the way people’s dietary needs were catered for and people’s mealtimes experience. People told us they generally enjoyed the food and we saw a wide range of food and drinks were available and people’s weight was monitored to ensure they had sufficient to eat and drink.

Private accommodation and communal areas of the home were well maintained and provided people with a pleasant, comfortable and safe environment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA). This helped to make sure people’s rights were protected.

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to comp

Our inspection of Laurel Bank Care Home took place on 10 July 2017. The inspection was unannounced.

Laurel Bank offers care and support to people with a variety of care needs and has a residential unit and a dedicated unit for people living with dementia, called the Elizabeth Unit. The accommodation is set over three floor, with a lift and outside space. The Elizabeth Unit is based on the third floor of the service. On the day of our inspection there were 62 people living at the service.

A registered manager was in post. 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.

Assessments to mitigate risks to people were in place. However, these were not always up to date or reflective of people's current needs.

Safeguarding processes were in place and staff understood how to keep people safe.

Although the service had a dependency tool in place to determine safe staff numbers, people, relatives, staff and health care professionals told us they had concerns about staffing levels. Call bells were not always answered in a timely manner. Staff appeared rushed and many interactions between staff and people were task orientated.

Safe recruitment procedures were generally in place to ensure staff were suitable to work with vulnerable people. Some staff training needed to be updated and we saw evidence of poor moving and handling practice.

We saw and people told us staff were caring but did not have time to talk or spend meaningful time with them. Regular staff knew people's care and support needs well, although staff who had been put on shift from another service did not. Some staff did not knock before entering people's bedrooms although most staff showed they respected people's privacy and dignity.

Medicines were not always managed safely. Although people generally received their medicines as prescribed we observed staff had not always ensured people had taken their prescribed medicines or taken appropriate actions when discarded medicines were discovered.

The service was mostly working within the legal principles of the Mental Capacity Act. More robust documentation needed to be in place regarding best interest decisions, consent and conditions relating to Deprivation of Liberty Safeguards (DoLS). However, a recent quality assurance audit had made recommendations for all covert medicines were reviewed to ensure appropriate paperwork was in place.

Some people's care plans contained detailed and person centred information. However, other people's care records and assessments did not reflect people's up to date care and support needs.

People had a sufficient choice and a variety of food. Arrangements were in place to meet people’s specific individual needs. Where required, referrals were made to the GP, community matron or dietician and measures put in place including monitoring food intake and prescribing nutritious supplements. However, some people's nutritional care plans and screening tools required updating to reflect current needs and better evidence of food and fluid intake was required.

People had access to health care professionals.

A wide range of activities were on offer according to people's choice although these were mainly based around the residential unit.

Complaints were documented with actions and analysis. However, some people and relatives told us they were concerned how their concerns would be treated if issues were raised.

A range of quality assurance processes were in place. However, these needed to be more robust to identify issues found at inspection.

Feedback was mixed about staff morale and the approachability of the management team.

Regular staff and residents meetings were held, which were used to help make

As part of our inspection we looked at how medication administration records and information in care notes for people living in the service supported the safe handling of their medicines. People were not protected against the risks associated with medicines because the provider had not ensured that its staff were correctly administering medicines in accordance with a prescriber's directions. Furthermore, records about medicines were not always accurate and the process set out in the provider's medicines policy was not being followed.

We set out to answer our five questions:

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 observations during

the inspection, discussions with people using the service, the staff supporting them and

looking at records.

Is the service safe?

We looked at the arrangements for handling medicines. We checked the records and a sample of medicines for people who lived in Laurel Bank. We spoke with the manager and senior staff. Overall we found some improvements were required to help make sure medicines are handled safely.

The people we spoke with told us they felt safe in the home and staff look after them. People have to be let in by staff to access the building so checks can be made. The service had a policy that all staff are to have a Disclosure and Barring Service (DBS) check prior to starting work. Staff told us they were familiar with the safeguarding procedure and would report if they saw anything.

Is the service caring?

People told us they were supported by kind and patient staff. Staff told us they offer encouragement for people to remain as independent as possible. We looked through peoples plans of care and saw their preferences, interests and aspirations had been taken into account and people received their support in line with their care plan. People using the service had completed an annual service survey. Where shortfalls or concerns were raised, these were addressed.

Is the service responsive?

People knew how to make a complaint if they needed too and felt it would be actioned. We looked at complaints received and found action had been taken and feedback given to the complainant. We looked at audits conducted by the service and found areas where there were shortfalls had been addressed. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service effective?

We found people's health and care needs were assessed with them and people had been involved in writing their plans of care. People told us they have their needs met and if they want anything they can ask for it. We spoke with staff who told us residents have their needs met. We observed people ask for support and staff assisted straight away when requested.

Is the service well-led?

We saw the service worked well with other agencies and professionals to ensure people received their care in a joined up way. One professional visiting the service told us communication was good and directions left for staff were followed. The service had a quality assurance system in place and concerns on audits were addressed promptly. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

If you wish to see the evidence supporting our summary please read the full report.

People who used the service were protected against inappropriate documentation and unsafe storage of confidential paperwork. We found staff were aware of the companies policy on storage and disposal. Documents included appropriate information and were stored in line with their policies.

We carried out this inspection to follow up two compliance actions we made in April 2013. These related to meeting people's nutritional needs and the management of medicines.

On this inspection while we saw the systems in place for recording and administering medication had been improved and the service was now meeting people’s nutritional needs. However, we found the records and reports completed by staff did not always provide accurate and up to date information and did not reflect the care and support people received.

The manager confirmed the service had applied to the Care Quality Commission (CQC) for a change in registration and no longer provided nursing care or employed qualified nurses. Details of the type of service and the regulated activities the service is registered to provide seen on page 2 of this report will be amended on completion of the change of registration.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. People who were able to tell us of their experience of living at Laurel Bank told us they were happy living at the home.

The purpose of the inspection was to carry out a scheduled inspection and to review an area of concern which had been raised with the Commission in relation to the care and welfare of the people living at Laurel Bank Care Home.

We talked to eight people who used the service and six relatives. Seven people who used the service said staff were approachable and did treat them with respect and one person commented that the staff “did not have time”. Three people explained they could make choices about their day to day lives such as what time they wanted to get up or go to bed or if they wanted to take part in the activities in the home. Seven people told us they were satisfied with the care and treatment they had received.

Although most people told us they were satisfied with the care they were getting in the home, we found there were minor issues which could impact on people. Some had been identified by the management team in the home and they had already planned to respond.

We used a number of different methods to help us understand the experiences of people who used the service. This included speaking with people who used the service, speaking with people’s relatives and friends and observing how people were cared for. During the visit we spoke with three people who used the service and three people’s visitors. People told us they were well cared for, one person said “I can’t find any fault”, they said the staff were “kind” and listened to them. Another person said “I am very satisfied” they said the staff were “very good” and they had a laugh with them. Another person said the staff were “kindness itself” and added “they take note of our disabilities”. Relatives and friends told us they were satisfied with the service, they said the manager and staff were approachable and kept them informed. They said they had no concerns about the safety of people using the service. One person described Laurel Bank as a home for people of the village which provided “good care”.

People told us they were very pleased with the standard of care and facilities provided at the home. They said the home was always clean and tidy and provided people with a pleasant, comfortable and safe environment. One person said “it is really like living in a 5* hotel with waiter service – I cannot fault the quality and standard of accommodation.”

Visitors told us they were kept informed of any significant changes in their relative’s physical or mental condition. They said that when they visited they had always been made to feel welcome and offered a cup of tea.

People told us that the meals were very good and an alternative was always available should they not like what was on the menu.

People said the staff were very friendly, approachable and kind. They said the home appeared to be well staffed and said there always seems to be a member of staff in the lounge on the dementia care unit to make to make sure people are safe and not at risk of harm.

People told us they were aware of the complaints procedure. They said that small concerns are dealt with as they arise and this means they seldom have to make a formal complaint.

The people we spoke to when we visited told us that generally they were pleased with the standard of care and facilities provided. One person said that they had moved into the home because it was easy for their family to visit and they had not been disappointed with their decision. Another person said that the home had been recommended by a friend and they were quite happy living there.

We got mixed feedback from people about the food, some people said it was good and said they enjoyed their meals, others said they thought the food is not as good as it used to be.

Most of the people we spoke to said the staff are kind and treat them well. Others said the day staff are very “nice and helpful” but had some concerns about the night staff, one person said night staff can be abrupt and often talk over her head about their personal lives. Some people told us they didn’t think there were always enough staff on duty and this meant they often had to wait when they needed help.

The people we spoke to during our visit said they had not made a complaint but said that they would approach one of the nurses if they had any concerns.

This inspection took place 10 and 20 November 2015 and was unannounced.

Laurel Bank is a purpose built home located in the village of Wilsden. Accommodation is provided over three floors in single en-suite rooms. One of the floors is dedicated to the care of people living with dementia. There are lounges and dining rooms on each floor. The home has two lifts which provide easy access to all floors. There is an enclosed garden which provides a safe place for people using the service to sit outside. The home is on a bus route and there is ample car parking.

The service had a registered manager in place. 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.

Medicines were safely managed and stored. People were supported to take their medicines at the correct time.

People told us they felt safe using the service. Staff understood their responsibility with regard tosafeguarding adults.

Risk assessments were in place. There were enough staff working at the service to meet people’s needs. Robust staff recruitment procedures were in place.

Staff were supported by the service to develop relevant skills and knowledge. Training was addressed during inspection to ensure the majority of staff were trained and competent.

People were able to make choices about their care and the service acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People were supported to eat and drink sufficient amounts and were provided with a choice of food. People’s health care needs were met and they had access to health care professionals.

People told us they were supported in a caring manner and that they were treated with respect. Staff had a good understanding of how to promote people’s dignity, privacy, choice and independence.

We saw and people told us they lots of opportunity to take part in activities and that there was always something happening in the service.

People told us they were happy with the care and support provided. The service assessed people’s needs and care plans were in place on how to meet people’s needs. Staff were knowledgeable about people’s individual needs.

The service had a complaints procedure in place and acted in accordance with the procedure.

People, relatives and staff told us they found the registered manager to be approachable and helpful.

Equipment was checked for servicing to ensure it was safe to use.

The service had various quality assurance and monitoring systems in place, some of which included seeking the views of people that used the service.