Laurieston Care home for the elderly is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Laurieston care home for the elderly is located in Saltburn-by-the-Sea. The service can accommodate up to 16 older people who require residential care. This includes people who live with a dementia. At the time of inspection, there were 11 people using the service.

At our last inspection on 19 March 2016, we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff supported people to live in a safe environment; staff understood the procedures to follow to protect people from abuse and harm. Risks were continually assessed, although some risk assessment records needed to be amended to provide the information needed to support staff. Planed fire drills had taken place. The fire risk assessment was out of date. Accidents and incidents were reviewed and there was evidence that lessons had been learned. Staff were recruited safely and there were always enough staff on duty. People’s medicines were safely managed. Water temperatures were low; however, these were addressed during inspection. The service was clean.

Staff understood and followed recognised guidance for caring for older people. Staff were supported with regular reviews and training to do this. People were supported with their nutritional and healthcare needs. Recommendations from health professionals had been followed. An improvement plan was in place to continue to update the environment. 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 told us they were happy with the care and support they received from staff which was dignified at all times. People were involved in all aspects of their care and staff knew how to access local advocacy services for people.

People received person-centred care from experienced staff who knew their needs well. Staff were responsive when people’s needs changed and action was taken to seek support. Care records were in the process of being updated but did provide the information needed. People were involved in regular activities and the service was well known in the local community. No complaints had been received since the last inspection.

The registered manager and staff worked as a team to provide the right support for people. Quality assurance systems were in place, however needed to be more formally recorded. Information was shared with people, their relatives and staff and any areas identified for action had been addressed. The staff at the service were transparent during inspection and when working with other health and social care professionals. Notifications had been submitted when required.

Further information is in the detailed findings below.

This inspection took place on 19, 22 and 23 March 2016 and was unannounced. This meant that the provider did not know we would be visiting. The service had not previously been inspected.

Laurieston Care Home is a residential care home located in Saltburn by the Sea. It is conveniently situated for easy access to all local amenities and public transport including the railway station. Accommodation is provided in ten single and three double bedrooms. Two rooms have en-suite facilities and the others have a wash hand basin. There is a large lounge with two separate seating areas and a dining room. To the rear of the property is a court yard and to the front of the property is an accessible garden with seating arrangements.

There was a registered manager in place and they are also the registered provider. 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 told us that staff worked hard and supported them to continue to lead fulfilling lifestyles. We found that a range of stimulating and engaging activities were provided at the home.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider had closely considered people’s needs and ensured that one senior and two to three care staff were on duty during the day for the 16 people using the service and a senior carer and a care staff member on duty overnight. The registered provider lived at the back of the home and staff told us they could contact them at any point to assist them whether this was night or day.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care.

The majority of people had the capacity to make decisions but where people experienced difficulties we saw that staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and, when appropriate, had requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had ensured capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice.

We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs

At our last inspection in April 2013 we found that the way staff stored and handling of medicines was not in line with the expected practices. We found that medicines that are liable to misuse, called controlled drugs, were not stored securely in line with the Misuse of Drugs (Safe Custody) Regulation 2007. We saw that records were not kept of the fridge and room temperatures on a daily basis. We found that the drug storage room and cupboard were cluttered with things other than medication.

We wrote to the provider and asked them to make improvements. The provider wrote to us and told us that they had taken action to address the concerns. At this inspection we reviewed the actions the provider had implemented.

We spoke with the provider and a senior carer and discussed the management of medicines in the home. We found that the provider had ensured medicines were now managed safely and all our concerns had been resolved.

We spoke with five people who used the service and the relatives of two people living at Laurieston Care Home. All the people we spoke with were very satisfied with the service they received. One person told us, “They look after me well here I cannot complain.” A relative we spoke with told us “I am very happy with the care my relative receives. We looked for the right home for a long time and this is just right.”

The people we spoke with confirmed that they had been involved in discussions about their care and support needs. People told us they were able to make their own day to day decisions and lifestyle choices. One person we spoke with told us,” I can do what I want to do and staff always ask me what I want.”

The five people we spoke with and the two relatives told us that on the whole there was sufficient staff on duty. One relative we spoke with told us, “The staff are always cheerful, they take people out even on the train in their wheelchairs.” We spoke with two members of staff who told us they felt the staffing was adequate and if extra staffing was required they contacted the manager.

We observed staff interacting well with people and supporting them which

had a positive impact on their wellbeing.

We reviewed the medication and found that arrangements were not in place to protect people against the risks associated with storage of medicines.

The quality of the service was monitored and reviewed on a regular basis.

We visited the service and talked with three people who lived at the home and three members of staff. People commented, "The staff are just so lovely and pleasant and I feel safe here.", "There are just so many things to do", and "I get out and about to visit friends and family." A person spoken with said "I like it here, staff look after me." Another person said "The staff know me well and are lovely."

People told us that the staff are kind and said "The girls are lovely and look after me well." A relative said she was very happy with the home and she was always made to feel very welcome. People who used the service and their families told us they were involved with their care plans. They told us that they were happy with the home and would speak to the manager if they had any concerns

Our inspection was carried out over two days. During our inspection we looked at care records, records relating to the operation of the home and records relating to the staff who worked at the home. We also carried out observations, spoke with staff and people who used the service. Where it was appropriate to do so we also spoke with relatives of people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This is a summary of what we found -

Is the service caring?

We found that people were cared for by kind and attentive staff. We saw that care staff had a good knowledge and understanding of the care needs of people who lived at the home. Interactions between staff and people who lived at the home were caring and respectful. We observed that where people became distressed or were feeling unwell staff took time to offer reassurance and speak with those individuals about what was concerning them.

Is the service responsive?

People's care and support needs had been assessed and care plans were in place that contained an accurate record of the care and support that people wanted to receive. We saw that where people's care needs had changed these were re-assessed and plans of care were updated. Throughout our visits to the home we saw that where people required input from other healthcare professionals this was arranged and co-ordinated by staff without delay. For example we observed staff calling local GP practices to arrange home visits after someone complained of feeling unwell. We also saw staff interactions and communication with other visiting healthcare professionals such as district nurses.

Is the service safe?

We saw that the registered manager had carried out a number of risk assessments in relation to ensuring the safety of both people who lived at the home, staff and visitors. We spoke with people who lived at the home and they told us that they felt safe at the home. We found that care records were up to date and contained an accurate record of the assessed needs of individuals. This meant that care could be planned and delivered safely and effectively.

We found that the registered manager carried out regular audits to ensure the safety of people who lived at the home and these included reviewing safety throughout the premises. This meant that any potential risks were identified and action taken to mitigate the risk to people's safety.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS apply to ‘care homes and hospitals’. At our inspection we found that nobody living at the home was subjected to any DoLS.

Is the service effective?

People we spoke with throughout our inspection visits told us they were happy with the home. From our observations we saw that people who used the service laughed and joked with staff and that there was a very relaxed atmosphere. We found that people had their individual care and support needs met, that where input from healthcare professionals was required the home took appropriate action to ensure people had their care needs met.

We found that care was delivered by staff who had received appropriate training and who were supported to obtain further professional development in their individual roles.

Is the service well led?

The provider had a quality assurance system in place that monitored and assessed the provision of the service that they provided on a regular basis. We found that the registered manager worked alongside stakeholders including the local authority and carried out monthly audits and checklists of the service. Monthly audits were carried out to identify areas for improvement and action was taken in response to these findings.

People who used the service were given the opportunity to express their views on the service at regular 'resident' meetings.

The provider had developed a process to handle and investigate any complaints about the service. The service had not received any complaints in the last 12 months and as such it was not possible to review the effectiveness of the process.

What people told us?

Throughout our inspection visits we spoke with five people who used the service and two relatives. People who lived used the service told us that they felt safe and comfortable living there. One person said, "Oh I feel safe here absolutely, I have no concerns in fact I am really very happy." Another person said, "I am well looked after; really I could not ask for more", and "I have other options of places I could live but I chose here, I think that says it all really."

We spoke with people about the staff that delivered care and support to them. The people we spoke with told us that they felt there were sufficient numbers of staff available at all times of the day and told us that they felt that staff had the relevant training to ensure they could meet their needs. One person said, "The staff are wonderful; anything I need and they are there; I am never made to feel like a nuisance!" Another person said, "They (the staff) are fantastic, you could not ask for better."

People we spoke with told us that they felt that the home responded to their needs. One relative we spoke with provided us with examples of actions the staff had taken when GP visits had needed to be arranged; how they had responded when their behaviours changed and how they ensured that hospital appointments were well managed. This relative told us that the management and staff within the home communicated with themselves and other healthcare professionals well. They said, "We have never had concerns, they make sure GPs are called when necessary and when appointments are made at hospital they make sure they attend. Really no concerns would not want them to live anywhere else." Another relative said, "I find them to be extremely responsive to their needs."

We spoke with people who used the service and their relatives about how they would raise concerns or make a complaint if necessary. We asked if people were aware of a complaints procedure. People told us they were unaware of any formal process but that they would speak out and raise their complaint with staff in the first instance if it was appropriate to do so.