This was an unannounced inspection that took place on 9, 10 and 12 May 2017.

Laurel Dene is a nursing home providing care and support for up to 99 older people, who may have dementia. The service is located in the Hampton area of west London and owned and managed by CARE UK.

The home 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 and associated Regulations about how the service is run.

In March 2015, the area of safe required improvement with a recommendation that the home reviewed its staffing numbers and the method used to calculate the staffing numbers required. The home had carried out this review at this inspection. The other areas of effective, caring, responsive and well-led were rated good and there was an overall rating of good.

People and their relatives told us that this was a nice place to live and staff provided good support and care that was delivered in a respectful way. People were given the opportunity to do what they wanted and joined in the activities provided if they wished.

The staff team made the home’s atmosphere warm, welcoming and inclusive. Visitors during the inspection told us that they were made welcome, but sometimes there were communication issues. They felt that the home provided a safe environment for people to live and work in, although sometimes it could be a little impersonal. This depended upon who the staff on duty were. The home was well maintained and clean. The décor was currently acceptable although it could be better focussed on the needs of people in the dementia areas.

There were up to date records kept and the care plans contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties appropriately.

Most staff knew the people they worked with including their likes, dislikes, routines and preferences, although sometimes they were more focussed on getting tasks done, due to time constrictions. This varied depending upon people’s needs and the time of the day. The home had worked hard to reduce the use of agency staff, by recruiting permanent staff. During our visit depending on which unit, most people received the same attentive service and everyone was treated equally, although there was a task rather than person prioritisation, on some units. However, even when the prioritisation was task orientated, staff carried out their duties in a kind and caring way. Staff had appropriate skills, qualifications and were focussed on providing individualised care and support in a professional, friendly and compassionate way. Whilst professional they were generally accessible to people using the service and their relatives. However it was noted that communication between different floors was intermittent and we did see one unit try to contact another for 10 minutes without the internal phone being answered. This was not an isolated incident, although may arise from staff being busy.

Staff said they had access to good training, support and career advancement.

People were protected from nutrition and hydration associated risks with balanced diets that also met their likes and preferences. They said the choice of meals and quality of the food provided was very good. People were encouraged to discuss health needs with staff and had access to community based health care professionals, if they required them. People, we saw, were generally prompted to eat their lunch or drink in a timely manner.

The home’s management team were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

This was an unannounced inspection that took place on 17 March 2015.

Laurel Dene is a nursing home providing care and support for up to ninety nine older people, who may have dementia. The service is owned and managed by Care UK.

The home 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 and associated Regulations about how the service is run.

In June 2013, our inspection found that the home met the regulations we inspected against. At this inspection the home met the regulations.

People and their relatives told us the home provided a good service and they enjoyed living there, although some told us that some areas such as the laundry and staffing levels could be improved. Other people were satisfied with the staffing levels and laundry service provided. The staff team were caring, attentive and provided the care and support they needed in a friendly and kind way. The home provided an atmosphere that was enjoyable and people said it was a nice to live.

We recommend that the home reviews its staffing numbers and the method used to calculate the number of staff required.

The records were comprehensive and kept up to date. They contained clearly recorded, fully completed, and regularly reviewed information. This enabled staff to perform their duties well. People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, as required. They were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. Relatives were positive about the choice and quality of food available.

The home was well maintained, furnished, clean and provided a safe environment for people to live and work in.

The staff we spoke with were very knowledgeable about the people they worked with and field they worked in. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. Staff said they had access to good support and career advancement.

Relatives said the management team at the home, were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

We spoke with thirty one people who use the service, three relatives, eighteen members of staff and the manager, deputy and clinical lead during this unannounced inspection.

People told us: "it’s good here", "you can do what you want" "we are treated well" and "there’s lots of laughter". Comments about the food were positive and included "the food is good", "not bad" and "we get enough to eat here". Feedback about staff was positive with people saying "staff are kind", "staff give me the help I need", "staff are wonderful" and "staff are very good

Family members said "staff are good", "staff are approachable", "my relative has settled in well" and "we can see improvements in our relative's enthusiasm to communicate". Visitors were made welcome, offered drinks and kept informed of any changes.

Staff said "this is a very friendly place to work", "it's lovely here", "staff work well together" and "we give people the respect they need”. Staff told us they knew people and how to meet their needs and provided good care. Staff had the training and support they needed to do their job.

There was a relaxed and calm atmosphere at Laurel Dene. Staff took time to provide appropriate care and support to individuals. Some bedroom doors had pictures on to help people identify their room. Bedrooms had been personalised with people's photographs and belongings.

We spoke with eighteen people who use the service, one visitor, six members of staff, the deputy manager and administrator during our visit to Laurel Dene.

People told us they like living at Laurel Dene, one person said this was because "I do not have to worry about anything because the washing, cleaning and meals are all done for us and if you don’t like the food on offer they will prepare something else". We saw that some people had bought small items of furniture, photographs and belongings when they moved in and some people said that this helped them settle and feel at home.

People made positive comments about the food, saying "we can choose what we eat", "lunch was good", "it's usually like this", "I like the food" and "we have enough to eat".

We received mixed comments about the level of activities provided, one person told us "my relative takes me out regularly and I can walk down to the local shops when I need to", "I generally spend time on my own, I am happy with my company doing my own thing", "there are things to do, although they are not always things I am interested in", "I enjoy painting and art and crafts", "I like talking with staff" and "I am happy when my family visit". One person said they did not join in with activities due to their visual impairment.

Comments about staff included "staff are very nice", "staff listen when I ask for things or want to talk", "staff are helpful", "I get on well with staff" and "they are lovely".

People who live at the home told us that they were happy there. They said that they were well cared for and that the staff were friendly and supportive. One person said, ‘this home is perfect’. Another person told us, ‘the staff are the best and everyone is kind and caring’.

People told us that the home was well maintained and that they had were able to do the things they wanted. They told us that they had their needs met and that they were able to make choices about their lives.