Laurel Mount provides accommodation for up to 34 people who require nursing or residential care. The home is situated in large gardens with accommodation spread over two floors. It is located in a residential area of Keighley in West Yorkshire.

The inspection was unannounced and took place on the 5 May 2017. On the date of the inspection there were 25 people living in the home.

At the last inspection in February 2016 we rated the provider ‘requires improvement’ in the ‘effective’ and ‘responsive’ domains and overall. This was because of issues identified with training, nutritional and general care planning. At this inspection we found improvements had been made.

People, relatives and health professionals praised the home and the standard of care provided. People valued the person centred approach practiced by the home and the warm and friendly environment created by the registered manager and the staff team.

Medicines were managed in a safe and proper way and people received their medicines as prescribed when they needed them.

There were enough staff on duty to ensure people received prompt care and support and were appropriately supervised. Staff were recruited safely to help ensure they were of suitable character to work with vulnerable people.

Risks to people’s health and safety were assessed and risk assessments were subject to regular review. People said they felt safe in the home and staff understood how to keep people safe.

The premises was warm, homely and well maintained to ensure it remained safe and appropriate for its use. We identified the dining facilities could be improved to make the dining experience more positive.

People said staff had the right skills and knowledge to care for them. There was a low turnover of staff which allowed staff to develop a good understanding of the people they were caring for. Staff received regular training and support.

The service was acting within the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest processes were followed where people lacked capacity.

People had access a range of nutritious food that met their individual needs and requirements. Action was taken to protect people from the risk of malnutrition.

Healthcare needs were assessed and the service worked with a multidisciplinary team to meet people’s needs.

People said staff were kind and caring and treated them well. Staff had developed good positive relationships with people and knew them well.

People said they felt listened to by staff. We found a warm, inclusive and person centred atmosphere within the home.

People’s care needs were assessed and appropriate care provided to people in line with their assessed needs. People’s preferences were taken into account during care planning and delivery.

People had access to activities and social opportunities. An activities co-ordinator was employed who undertook a range of activities within the home.

People and relatives were very satisfied with the service. People said the registered manager dealt with any minor issues in a positive and thoughtful way. A system was in place to log, investigate and respond to complaints.

An experienced registered manager was in place who was dedicated to providing high quality care and ensuring continuous improvement of the service.

People, relatives and health professionals all said the service was well led. Staff said morale was good and the team worked well together.

A system of audits and checks were undertaken to ensure the service operated safely and effectively. People’s feedback was used to make improvements to the service.

Laurel Mount provides accommodation for up to 34 people who require nursing care. The home is situated in large gardens with accommodation spread over two floors. It is located in Keighley in West Yorkshire.

The inspection was unannounced and took place on 1 February 2016.

A registered manager was 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.

People who used the service and relatives all told us the home provided appropriate care that met people’s individual needs. They all said people were treated well and that people were safe in the home.

Medicines were managed safely. People received their medicines at the time they needed them and appropriate records were kept.

Staff understood how to identify and act on allegations of abuse. Safeguarding procedures were in place and we saw evidence they had been followed to keep people safe. People told us they felt safe in the company of staff and did not raise any concerns.

The premises were safely managed. It was decorated to a high standard with ongoing refurbishment to replace areas of tired décor. Appropriate checks on safety systems such as gas and fire took place.

There were sufficient staff employed to ensure a good level of care and support was provided to people. Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.

People told us staff had appropriate skill and knowledge to care for them and staff displayed a good knowledge of the people they were caring for. Staff received a range of training; however the provision of refresher training lacked structure which meant people received training updates at inconsistent intervals.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Improvements were required to evidence that the service was fully acting within the legal framework of the Mental Capacity Act (MCA) with regards to making best interest decisions.

People spoke positively about the food at the home. We saw menus ensured a variety of food was provided. Staff were attentive to ensure people had a positive dining experience and were kept sufficiently hydrated throughout the day and their mealtime nutritional input supplemented by snacks. However nutritional screening was not always correctly completed which meant there was a risk that appropriate action was not taken t following weight loss.

People had access to a range of health professionals to help ensure their healthcare needs were met by the service.

Staff treated people well displaying a high level of dignity and respect. It was clear staff and the registered manager had developed strong relationships with people and were dedicated to providing attentive care.

Information was present on people’s likes, dislikes and preferences and staff knew these preferences well.

People told us the service met their individual needs. We saw examples of care and support delivered in line with people’s plans of care. However we found some care plans were not present or sufficiently robust. This meant there was a risk of inconsistent care and support being provided.

People were provided with a range of activities and social opportunities.

A system was in place to record and respond to complaints. People we spoke with told us they were highly satisfied with the service and did not raise any concerns or complaints.

People and staff told us the service was well managed. They said there was a nice and friendly atmosphere in the home and the registered manager was visible and involved in care and support.

Systems were in place to monitor the quality of the service and help ensure continuous improvement of t

We spoke with the registered manager and reviewed documentation which related to staff recruitment. We found the provider operated effective recruitment procedures which ensured people employed were suitable for the role.

During the inspection we spoke with six people who used the service and four relatives. People spoke very positively about the home and its staff. Their comments included:

“ Absolutely fantastic.Staff are so nice and helpful. I couldn’t be any more pleased. Everything is perfect.”

“This is a lovely place, staff are all lovely and talk with you and the food is wonderful.”

“I think everyone here is looked after so well.”

“I have been here over nine years, they care for me well, I have no concerns.”

“Really good, family atmosphere. I would definitely recommend this place.”

We found staff respected people and ensured consent was gained before they helped with care or treatment.

We found appropriate arrangements were in place to ensure the safety and welfare of people who used the service.

However, we found robust recruitment processes were not in place to ensure staff employed by the service were suitable for the role. We found a member of staff had started work before the necessary checks were completed.

Effective procedures were in place to ensure people's comments, suggestions and complaints were recorded and acted on.

We spoke with four people who live at the home. They told us they can make decisions about what they did. One person said “I love it here; I can do exactly as I like because it is my home”.

People told us they were happy with the care they received. They said staff were kind and gave them the support they needed. One person said “I never want to live anywhere else; staff know exactly what I need”.

We spoke with two relatives during our visit. They told us they were involved in making decisions about their relatives care and treatment. One person said “Laurel Mount is a well run home and the care that staff deliver is superb”.

We spoke with two members of staff during our visit. They told us they felt supported and had the necessary skills to meet people’s needs. One staff member said “I love working here, I wouldn’t want to work anywhere else”.