Laurieston House 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 home is registered to provide accommodation and personal care for up to 12 older people in the main building and in three self-contained bungalows in the grounds. At the time of the inspection eight people were living at the service. People who use the service are referred to as 'residents' throughout the report at their request.

The inspection took place on 12 and 15 October 2018. The first day was unannounced.

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. The registered manager was also the provider.

At the previous inspection on 20 February 2016 the service was rated as Good. At this inspection we found that the service Requires Improvement. This is the first time the service has been rated Requires Improvement.

The service was not always assessing people’s capacity to consent to aspects of their care. Although some residents had a diagnosis of dementia, capacity assessments had not been regularly reviewed. No Deprivation of Liberty Safeguards (DoLS) applications had been made despite some residents being deprived of their liberty. Best interest decisions had been made but the documentation in place did not detail how decisions had been reached, whether less restrictive options had been considered or who had been involved in the decision making process. Residents were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice

Quality assurance audits were carried out. However these did not include audits of care plans or mental capacity assessments and DoLS which meant the issues we identified above had not been identified by the provider.

Residents said they felt safe at the service. Staff understood their responsibilities to keep the residents safe. Risk assessments had been carried out. Safe recruitment practise was followed and there was enough staff on duty to meet resident’s needs. Medicines were managed safely.

Staff were trained to carry out their roles and had regular supervision sessions. Residents were supported to have enough to eat and drink. Residents told us the food was “excellent.” Residents had access to ongoing healthcare.

The residents told us staff were kind and caring and we observed many positive interactions between residents and staff. There was a relaxed and friendly atmosphere. The registered manager regularly sought feedback from residents.

Care plans were person centred. Policies and procedures did not always reflect current best practise. Residents had access to a range of activities and regularly accessed the local community.

Residents, their relatives and staff spoke highly of the registered manager. The provider’s values were embedded in the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20 February 2016 and was unannounced. The inspection was undertaken by one inspector. Prior to the inspection we looked at all information available to us. This included looking at any notifications submitted by the service. Notifications are information about specific events that the provider is required to tell us about.

As part of our inspection we reviewed the care records for three people living in the home and also looked at staff records to see how they were trained and supported. We made observations of the care people received. This was because they were unable to tell us verbally of their experience of living in the home. We spoke with three members of staff. We looked at other records relating to the running of the home which included audits, staff supervision and training records and meeting minutes.

During the day we spoke with five people who lived in the home. We also observed the care of people who were not able to verbalise their experience of living in the home. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We observed that people living in the home looked well cared for. One person said, "I'm lucky to live here, they really care about us and look after us so well".

There were effective systems in place to reduce the risk and spread of infection. We found the home smelt fresh and was clean throughout. The home had schedules in place which listed the areas of the home to be cleaned and which included the cleaning of fixtures and fittings.

We spoke with a senior care worker who explained the home's system for the management of medicines.There were appropriate arrangements in place in relation to obtaining, recording, handling, dispensing, disposal and the safe administration of medicines. We inspected all areas of the home and found it had been adequately maintained and provided a comfortable environment. The home had consulted with people about their wishes, for example people had been asked to give their suggestions of items to put in the new back garden, some responded with, 'Windmills', 'A Bird Table' and 'Nice smelling plants and fauna'.

People said they were happy living in the home and with the support they received from staff. Relatives were very positive about the care people received.

We observed staff treating people with sensitivity and respect. Staff listened and responded to people, supporting them to make decisions and choices about their lifestyles.

People had access to a range of day and evening activities which they participated in, such as, knitting, puzzles, reading and bingo. One person told us how they had been to the theatre twice in the last month which they had really enjoyed. People told us they regularly went shopping with staff or to the local garden centre and trips to the seaside were a favourite.

Relatives told us how the home informed them of any changes for people and sought support from them with making decisions about care and treatment. People told us they were involved in their care planning and said staff would always ask permission. One person said, “I am very involved, nothing is done without me understanding what is happening, the staff are very respectful and wouldn’t presume to do anything without my consent”.

We spoke with a person who told us they had regular visitors. The person said they were “very happy” at the home, that the food was “very good” and there were “marvelous staff”. Another person said that they were in regular contact with relatives by telephone.

One person’s relative said that they were very pleased with the choice of home and felt very welcome when visiting. They said they particularly liked that it was small and “not like an institution” adding that the person was settled there.

Another relative confirmed this saying they had also liked the home because it was “small and personal” and that staff did not wear uniforms. They said it was like ‘home’ and commented on the “low staff turnover”.

People told us about their recent trip to Weston super Mare.