The Laurels Care Centre provides nursing care for up to 63 people, some of whom have dementia. The home is accessible to people who use wheelchairs, built over three floors and is based in the London Borough of Lambeth. At the time of the inspection there were 40 people using the service.

At the last inspection, the service was rated Good. At this inspection we found the service remained good.

People were protected against the risk of harm and abuse as staff received on-going training in safeguarding. Staff were able to identify, report and escalate any suspected abuse and told us they would whistleblow should their concerns not be acted on. The service had developed risk management plans that gave staff the guidance on how to safely respond to identified risks. Risk management plans were reviewed regularly.

People were protected against an unsafe environment. The service had systems and processes in place that monitored the environment and issues identified were acted on in a timely manner.

The service employed sufficient numbers of suitably vetted staff to keep people safe. Staff were supported to reflect on their working practices through supervisions and appraisals.

People received their medicines in line with good practice and as prescribed. Records confirmed the storage, administration, recording and disposal of medicines was managed in a way that kept people safe.

Staff received training to effectively meet people’s needs. Staff confirmed training received enabled them to carry out their roles and responsibilities in line with the providers policies.

People had their consent to care and treatment sought prior to it being delivered. People were encouraged and supported to make decisions about their care, by staff that gave them information in a way they understood. People’s decisions were respected.

People were supported to access food and drink that met their dietary needs and requirements. The service employed two chefs that were aware of people’s dietary needs and ensured people’s specific requirements were catered to.

People received care and support from staff who were compassionate and treated them with dignity and respect. People’s cultural and religious needs were supported, encouraged and respected.

People’s care and support was person centred and tailored to their individual needs and wishes. Care plans were comprehensive and gave staff clear guidance on how to meet people’s needs. Care plans were regularly reviewed and where possible people and their relatives were encouraged to participate in the development of their care plan.

People were supported to access activities that met their needs and preferences. The service employed an activities coordinator and encouraged people to engage with activities.

The service had a system in place to monitor and respond to concerns and complaints raised, in a timely manner. People and their relatives we spoke with knew how to raise a complaint and felt confident action would be taken to address their concerns.

The service carried out regular audits to monitor and improve the service provision. Issues identified during the audits were actioned and lessons learnt to minimise repeat incidents. Quality assurance questionnaires were sent to people, their relative and staff to gather their views.

The registered manager encouraged and sought partnership working from other healthcare professionals. Records confirmed where guidance and support was given through partnership working, this was then implemented in to the service delivery.

The Laurels Care Centre Limited is registered to provide nursing care for up to 63 people. The home is accessible to people who use wheelchairs and parking is available. A lift allows access to all floors of the building.

When we visited 43 people were living at the home, some of whom had dementia. The home is split into three units, at the time of our visit two of these were in use and one was closed.

The home has a manager who was appointed in July 2016. He has applied to the Care Quality Commission to become the 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 2008 and associated Regulations about how the service is run.

A comprehensive inspection of the home took place in January 2016 when we found two breaches of regulations. A focused inspection was held on 8 June 2016 to follow up these breaches. We found some improvements had been made however the provider continued to fail to meet all the standards of the regulations. We found one continued breach and three new breaches of regulations. The home was rated as ‘requires improvement’. You can read the reports from our last inspections, by selecting the 'all reports' link for The Laurels Care Centre on our website at www.cqc.org.uk.

At this inspection on 30 November 2016 we looked at the areas of concern identified at the last inspections. We found improvements had been made in all of the areas in which we previously had concerns and we did not find any breaches of regulation.

Communal areas on the first floor were clean and hygienic because furniture and flooring had been replaced. This meant people spent time in a pleasant environment which was clean and fresh. People were treated by staff in a way that maintained their dignity and privacy. Staff had received relevant training and we had no concerns in this area. Staff had also received training in dementia awareness. The interaction we saw between people and staff was respectful, kind and warm. The home’s CQC rating was displayed as required at the home and on their website.

The new manager had identified areas for improvement in the home and was addressing them. People and staff were positive about the home and felt changes were being made to improve the quality of care.

The inspection was carried out on 8 June 2016 and was unannounced.

The Laurels Care Centre Limited is registered to provide nursing care for up to 63 people. The home has three units, two of which provide care for people who have dementia. The third unit provides care for people with general nursing needs. The home is accessible to people who use wheelchairs and parking is available. A lift allows access to all floors of the building. When we visited 54 people were using the service.

The previously appointed registered manager left the home in May 2016. The deputy manager has been managing the service in the absence of a permanent post holder. 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 was last inspected on 11 and 19 January 2016. At that inspection we found two breaches of regulations. They related to safe care and treatment and the need for the provider to establish systems to monitor and mitigate the risks to people in the home. We also made a recommendation about staff being provided with advice and guidance about how to assist people properly at mealtimes. This was a focused inspection to follow up progress on these issues.

At this inspection we found three regulations were breached. The provider had failed to address one of the previously identified breaches of regulation and establish systems to effectively mitigate the risks to people at the home. We also found that when people needed to have a record made of their food and fluid intake accurate and complete records not were kept. People’s privacy was not protected by staff. We observed an instance of a staff member showing a lack of kindness towards a person. The provider did not display at the home or on their website the rating awarded to the service at the last inspection.

We are considering the action to take in response to the breaches.

.

On the day of our visit there were 61 people living at Laurels Care Centre. We spoke with twelve people who lived at Laurels Care Centre and with nine of their relatives and or carers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with staff members and with two visiting professionals.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People were happy with the care they received, one person said: “Everything’s OK” and another person said: “The staff are lovely- they are so kind to me."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. A relative who visited every day said: "I have never seen or heard anything that worries me when I visit."

The lift had been broken since August 2013 . This meant that some people on the upper floors had not been able to go out in the community or to the garden. There were temporary arrangements so that people could leave the building if they needed to go to hospital.

There were qualified, skilled and experienced staff, however sometimes there were insufficient staff to meet people’s needs.

There was an effective system in place to assess the quality of the service.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and a colleague, joined by an “expert by experience” (people who have experience of using services and who can provide that perspective) .

We used a number of different methods to help us understand the experiences of people using the service, because a number of the people who lived at this care home had dementia. During lunch we completed a detailed observation called a, ‘short observation for inspection’ (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also gathered evidence of people’s experiences of the service by speaking to 5 relatives, and a visiting health professional.

We found that staff spoke to the people at the home with respect and warmth. They provided reassurance when people showed signs of distress.

People found mealtimes enjoyable at the home. They were uninterrupted, those requiring support with eating received this discreetly. Specialist diets, as well as religious and cultural needs were provided for appropriately.

Staff were vigilant in monitoring individual’s nutritional needs, they responded appropriately to any areas of concern and referred to relevant health professionals

One person spoken with said, "The staff are kind and gentle, they spoil me!”.

Another person spoke of the calm environment and how this had a positive benefit for people that could become distressed or disorientated, and described staff as caring and skilled.

Relatives told us that communication was good with staff; they were included in discussions about their loved ones. They told us that they were frequent visitors in the home, they found people were well cared for and had good nourishing meals.

One relative spoke of the essential qualities displayed by staff, she said, “Staff are patient, my spouse is settled, staff are brilliant, they understand the things that are important to him".

People who use the service told us that they liked the home and the staff. Many people we spoke with said that staff were caring and polite.

Relatives and friends were also positive about the care provided at the home and the helpfulness of the staff.

Health and social care professionals we contacted had no concerns about the day to day care provided in the home. One health professional told us of the increased ability of staff to meet the needs of people with dementia and those who require end of life care.

This inspection took place on 11 and 19 January 2016 and was unannounced.

Laurels Care Centre provides nursing care for up to 63 people. The home has three units two of which care for people who have dementia. The third unit provides care for people with general nursing needs. The home is accessible to people who use wheelchairs and parking is available. A lift allows access to all floors of the building. When we visited 60 people were using the service.

The service has 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 2008 and associated Regulations about how the service is run.

We last inspected the home in April 2014 and all of the regulations we looked at were met.

At this inspection, we found two breaches of regulations. They related to safe care and treatment and the need for the provider to monitor the home’s safety. We have made a recommendation about staff being provided with advice and guidance about how to assist people properly at mealtimes.

Two staff did not all know the evacuation routes to use in an emergency and this could have put people at risk. Mattresses to prevent people from developing pressure ulcers were not used correctly and cushions were in a poor condition.

Refurbishment and redecoration was planned to make improvements to the home but at our visit, there were areas that had an unpleasant odour and were unhygienic. Some information confidential to two people living at the home was on a notice board in a communal area although it should have been kept confidential.

People told us there were enough staff to meet their needs and an increase in night time staffing was agreed after our visit. People and staff got on well and we saw that they enjoyed each other’s company.

People received their medicines as prescribed and they saw health care professionals when they needed specialist advice. Staff knew how to report concerns about people’s safety.

The manager and staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The manager made applications to protect people under DoLS when this was judged appropriate. Assessments of people’s capacity to consent were made and ‘best interests’ meetings held when necessary.

People were involved in care plans and they showed how they liked to be cared for. Staff knew people’s needs and preferences and they assisted them to join in activities they enjoyed. Staff were supported and trained for their work. People got on well with staff, who were caring and protected people’s privacy and dignity.

People, their relatives and staff had opportunities to give their views about the home through completing surveys. Action was taken to make changes highlighted by people’s views. People knew how to complain and complaints were investigated and action taken to correct shortfalls.

You can see what action we told the provider to take at the back of the full version of the report.