About the service: Lauren Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates up to 48 people and 46 people were living at the home at the time of our inspection.

People’s experience of using this service:

People had their needs assessed prior to living at the home. They had comprehensive care plans that reflected their individual needs, preferences and routines. Care plans were reviewed regularly. Staff knew people well and had developed positive relationships with them. People told us staff understood their needs and were kind, caring and compassionate.

Safe recruitment procedures were followed and staff had all undertaken an induction along with training relevant to their role with refresher updates. Staff received support from the management team. The staff and management team worked closely with health and social care professionals and had also developed community links.

Risks to people had been clearly identified and guidance was in pace to ensure that staff could minimise the risk. People were protected from the risk of harm and abuse. Staff felt confident to raise any concerns about abuse and had undertaken training.

Staff had access to and understood the importance of personal protective equipment (PPE). An infection control policy and procedures was in place and staff had undertaken training in this area.

People had access to a variety of activities within the home and in the local community. People spoke positively about the activities that had participated in. People were encouraged to maintain contact with relatives and friends.

Medication was managed safely by trained and competent staff. Medicines policies and procedures were available for staff along with best practice guidance.

People’s privacy and dignity was respected and their independence promoted where possible. People told us their views were regularly sought regarding staff, meals, activities and environment.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. Staff understood and respected people’s right to make their own decisions where possible, and encouraged people to make decisions about the care they received. Mental capacity assessments and best interest decisions were completed in line with the MCA.

Rating at last inspection: At the last inspection the service was rated Good (Report published October 2016).

Why we inspected: This was a planned inspection based on the rating of the last inspection.

Follow up: We will continue to monitor all intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection was carried out on the 26 September 2016 and was unannounced.

Lauren Court Residential Care Home is registered to provide personal care for up to 48 older people. The service consists of single room en-suite accommodation located over two floors. The service is located in the Blacon area of Chester, close to the local shops and other community facilities. At the time of our inspection the service was supporting 36 people.

The service does not currently have 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. The service had a manager in place who has recently applied to the Care Quality Commission to become the registered manager’s.

We last inspected this service in April 2014 and we found that the registered provider met all the regulations we reviewed.

People said they were happy with the service that they received and that they felt safe. Staff had a good understanding of how to protect people from the risk of harm or abuse. The registered provider had clear policies and procedures in place for reporting any concerns they had about the safety and wellbeing of people they supported.

Individual risk assessments were completed to ensure people supported, relevant others and staff were protected from the risk of harm.

There were sufficient levels of suitably trained staff to support people and ensure they received care and support in a safe and timely way. When new staff were appointed robust recruitment checks were carried out to make sure they were suitable to work with vulnerable people.

The service was accessible, clean and safe and staff were able to describe their responsibilities for ensuring people were protected against any environmental hazards. Fire safety and all other relevant Health and Safety checks were appropriately completed by a competent person.

Medication was well managed at the service. People received their medication as prescribed and staff had completed competency training in the administration and management of medication. Medication administration records (MARs) were appropriately signed and coded for people’s prescribed medication.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had a good knowledge and understanding of the Mental Capacity Act 2005 and of their role and responsibility linked to this. Staff understood the key principles of the MCA 2005.

People were supported by staff who had received appropriate training and support. All staff received training to enable them to fulfil their roles which included essential subjects such as moving and handling, safeguarding people and medication training. Staff were also supported through supervisions

People told us that staff always treated them with kindness and respect. They told us that staff were mindful of their privacy and dignity and encouraged them to maintain their independence.

A thorough pre-admission assessment was completed to ensure the service could meet people's individual needs. People’s needs were assessed and planned for and staff had personalised information about how best to meet people’s needs. People’s wishes, preferences and beliefs were reflected in their care plans.

The registered providers complaints procedure was accessible to people and relevant others. Family members told us that their complaints were acted upon. Records we viewed confirmed this.

The registered provider maintained robust, effective quality assurance systems to ensure that all aspects of service provision were regularly reviewed and maintained to a good standard. We were notified as required about incidents and

This inspection was carried out by one inspector.

Below is a summary of the findings. The summary is based on information from the local authority, observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced risk and helped the service to continually improve.

Risk assessments were also completed for the environment and working practices and individual risk assessments were completed for each person who used the service.

People were given their medicines at the times they needed them in a safe way.

Records were kept securely.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. People said that the plans reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, "It's very nice and I'm well looked after", "It's marvellous" and "The staff are very kind and helpful". A relative said, "It meets all our expectations".

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People took part in a range of activities in and outside the home on a regular basis. The activities were planned in consultation with the people who used the service.

The home referred people to other health and social care services to make sure people received their care in a joined up way and their health was maintained at an optimum level for them.

Is the service well-led?

The home had a quality assurance system in place that helped the quality of the service to continuously improve.

People using the service, their relatives and friends completed an annual satisfaction survey and the registered manager met with them regularly to ask if they had any concerns or suggestions for improvement.

We visited Lauren Court on 6th November 2013 in response to concerns raised by Cheshire West and Chester's Adult Safeguarding Unit around the management of the risks from falls, staff training and the management of medication. We found that improvements were needed to care planning and delivery, the management of medication, the quality assurance systems, training provided to staff and the equipment provided to reduce the risks of falls. We carried out this visit to ensure these improvements had been made.

We found that appropriate action had been taken to improve the information provided to staff around supporting people to minimise the risks of falls.

An assessment of the home environment had been undertaken and communal areas and bedrooms made safer with the provision of equipment to promote people's independence and reduce the risks from falls.

The quality assurance systems had been revised to enable shortfalls in the management of falls to be identified.

Staff had been provided with training around falls management.

There had been an improvement to the management of medication. However, we found further improvements were necessary to ensure prescription creams were safely managed.

We visited Lauren Court in response to concerns raised by Cheshire West and Chester Adult Safeguarding Unit following their investigation around the care and support provided to a person who used the service. The concerns were around the management of the risks of falls. The operation of equipment to alert staff that people needed assistance (call bells). Staff response times to call bells, staff training in first aid and the management of medication.

We found that improvements were needed to care planning and delivery to ensure the people who used the service were appropriately supported and protected from the risks of falls.

The management of medication needed improvement to ensure that the people who used the service were safely supported.

We found that a thorough assessment of the home environment and the equipment provided was needed to ensure appropriate equipment was in place to reduce the risk of falls and support people’s independence.

The quality assurance systems needed to be revised to ensure that they were sufficiently robust to identify shortfalls in the home’s operation.

We spoke to five people who used the service. Four said staff were available when needed. One person said that they sometimes had to wait when they needed assistance. We spoke to two relatives who said that there were always staff available if needed. One said there was sometimes a delay in staff answering the door at weekends.

We spoke to six people who used the service. They said they were well looked after and happy with the service they received. They were very positive about the staff who supported them. They said that the staff were attentive and gave them the support they needed. Some comments made were:-

“The staff are very nice, they will do anything for you.”

“I get the help I need. The staff are very caring.”

“I’m happy here. It’s a very nice place to be.”

We spoke to one senior carer, one carer, two domestic staff and one cook. All said that a good standard of care and support was provided at the service.

During our visit we made observations that indicated staff were attentive and had a caring attitude towards the people who used the service. Staff were observed to be friendly and respectful.

We found that people had been assessed before they began to use the service and they had care plans that identified their needs and any risks to their well-being.

People had their nutrition and hydration needs appropriately met. People were cared for in a clean, hygienic environment.

Quality assurance systems were in place to ensure people received safe, appropriate care, treatment and support and to ensure that staff were suitable to work at the service.

We spoke to four people who used the service. They said they were well looked after and happy with the service they received. They were positive about the staff that supported them. Some comments made were: -

“The staff are very friendly. It’s as near as can be to home.”

”I cannot fault the service. The staff are very good.”

“The food is very good. The home is very clean and the staff are very nice.”

There were practices in place to ensure that the people who used the service were consulted and that their views were obtained.

Records showed that people had been assessed before they began to use the service and they had a care plan in place which gave clear guidance to staff on the support they needed.

We found that the home was clean and well presented.

There were sufficient staff available to meet the needs of the people who used the service.

There was a system in place to ensure that complaints were effectively managed.

We asked Cheshire West and Chester Council for information about how the service operated. No information of concern was reported by Cheshire West and Chester Council.

A visitor whose friend had recently moved into the home said; “We were very fortunate to find Lauren Court, my friend is very happy and the staff are lovely”. This person also spoke positively about how well the home was being managed.

The people using the service who were able to tell us said that they were happy living in the home. Comments included; “The staff members are very good”, “The staff are very good and try and do as much as they can for you”, “They are calm people who don’t rush you, I am very comfortable”, “The staff are very kind and friendly, the manager is very good and you can talk to her”, “The staff always treat me with respect”, “The staff are very friendly and I don’t have any issues. I would speak to my family if there was”.

We spoke to a visiting district nurse who told us that there was good communication with the home and they kept her and her colleagues informed of any issues that arose. She also said, “The quality of care is fine”.