This inspection took place on 23 and 24 July 2018. The first day was unannounced.

Our last full comprehensive inspection of this service was in July 2017. At that inspection we rated the home overall as Requires Improvement. At that inspection there were three breaches of legal requirements within the Safe and Well Led areas.

Following that inspection we received a number of concerns regarding the quality of care being provided to people. Therefore, we conducted a focused inspection in November 2017 that concentrated on the Safe and Well Led areas only where we found breaches of five regulations. This was because the provider had failed to ensure that: risks to people’s safety had been adequately managed and that people received their medicines correctly; staff had the appropriate skills and knowledge to provide people with safe care; the home and some equipment that people used was clean; robust systems were in place to assess and monitor the quality and safety of care provided to people and that certain incidents had been reported to the Care Quality Commission (CQC) as required by law. The home was therefore rated as Inadequate and placed in special measures. Services that are in special measures are kept under review and inspected again within six months from the publication of the report. We expect services to make significant improvements within this timeframe.

During this latest inspection the manager and provider demonstrated to us that improvements had been made and the home is no longer rated as inadequate overall or in any of the key questions. Therefore, this home is now out of special measures. The provider is no longer in breach of any of the regulations that we found at our inspection in November 2017. However, further improvements are needed in some areas as detailed further below.

The Laurels Care Home is a ‘care home’. The provider advertises themselves as providing specialist care to people living with dementia and who are frail. It is registered to provide care for up to 52 people and care is provided on one floor. At the time of the inspection there were 26 people living in the 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.

There was a manager at the home and they have applied to register with the CQC. 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 home is run.

People felt safe living in the home and systems were in place to protect them from the risk of abuse. Risks to people’s safety and individual needs and preferences in the main, were managed well. However, the guidance provided to staff on how to manage these risks and meet people’s individual needs and preferences was variable in its quality. This included at the end of their life.

Most people had received their medicines correctly although some had not for a short period of time which had not been identified in a timely fashion by the provider. Therefore, this requires an improvement to the provider’s current quality monitoring systems so they are more robust to identify such issues to enable the necessary action and improvement to be made. The manager told us during the inspection visit that these would be implemented immediately.

There were enough staff to keep people safe and to meet their needs. New staff working at the home had been subject to the appropriate checks before their employment began designed to check they were safe to work within care. Most of the communal areas within the home, people’s rooms and the equipment that people used was although there were some offensive odour

The Laurels Care Home is a care home that provides accommodation and personal care for up to 52 people. The provider's website describes the service as one that 'specialises in round the clock dementia care and care for frail people.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our visit the provider was supporting 29 people, the majority of who were living with dementia.

There was a registered manager working in the home. 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.’

At our last inspection in July 2017 we rated this home overall as Requires Improvement. After this inspection that overall rating has been reduced to Inadequate.

This inspection site visit took place on 27 and 29 November 2017. The first day was unannounced. It was conducted in response to concerns we had received since our last inspection in July 2017, about the quality of care people were receiving. The concerns related to staffing levels, continence care, staff training/competency, cleanliness and infection control practices and bruising that some people had sustained. As these concerns related primarily to people’s safety, we decided to inspect the following two key questions: is the service safe and is the service well-led? No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

At our last inspection in July 2017, we found three breaches of legal requirements within the safe and well-led key questions. This was because the provider had not ensured the care people received was safe or that all equipment and areas of the premises were clean. They had also failed to ensure that robust governance processes were in place to effectively assess and monitor the quality of care people received.

We asked the provider to complete an action plan to show what they would do and by when to meet these legal requirements. They told us these would be fully met by 10 October 2017. As they told us they would be meeting these requirements at the time of this inspection, we checked to see if improvements had been made. We found that the required improvements had not been made and that the provider continued to be in breach of these three legal requirements.

In addition, we found two further breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Staff understood how to reduce the risk of people experiencing abuse. However, some risks to people’s safety had not been adequately managed or reviewed to ensure that all necessary actions were being taken to keep people safe. This placed people at risk of avoidable harm.

The registered manager or provider had not effectively monitored staff practice and competency to perform their role safely. This resulted in some staff performing care tasks without first receiving the necessary training, resulting in poor care practice that placed people at risk of unsafe care.

People’s medicines were poorly managed. Accurate records had not been kept and therefore, the provider could not give themselves assurance through their existing auditing

This inspection took place on 18 and 19 July 2017 and was unannounced. The Laurels Care Home is a care home that provides accommodation and personal care for up to 52 people. The provider's website describes the service as one that 'specialises in round the clock dementia care and care for frail people.' At the time of our visit, there were 31 people living in the home, the majority of who were living with dementia.

A registered manager was 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.

Our previous inspection carried out in January 2017 identified six breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the home as Inadequate, placed it in special measures and told the provider they could not admit any new people to the service. We also told them that they had to regularly send us evidence of how they monitored risks to people in respect of not eating and drinking, developing pressure ulcers, choking and falls.

At this inspection we found that some improvements had been made. However, further improvements are still required and the provider remains in breach of two of the previous Regulations. These are in respect of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a new breach in respect of Regulation 15. We have now rated the home as Requires Improvement.

People had been placed at risk of avoidable harm. Not all risks to people’s safety had been adequately assessed or actions taken to mitigate an identified risk. Communication to staff in relation to risks to some people’s safety had not always been effective resulting in poor practice.

The monitoring of staff practice to ensure they were competent to perform their role safely had not been regularly assessed. Some areas of the home and some equipment people used was unclean. Not all of the provider’s current systems to monitor the quality and safety of the service were effective at identifying and mitigating risk to people’s safety.

The provider had ensured that systems were in place to protect people from the risk of abuse and most people had received their medicines correctly and when they needed them. However, the provider had not ensured that the number of staff they deemed were necessary to meet people’s needs, were consistently in place. This sometimes impacted on the staff’s ability to provide people with individualised care.

People received sufficient amounts of food and drink people to meet their individual needs. They were supported to maintain and improve their health. People had access to activities that supported their own hobbies and interests. These also provided them with stimulation and improved their wellbeing.

The staff were kind, caring and treated people with dignity and respect. They asked people for their consent and acted in people’s best interests if they were unable to consent to their care. Staff offered people choice and involved them in making decisions about their care. However, the caring approach of the service was not consistent with some people experiencing unclean equipment, having to wait for staff assistance when they needed it and being exposed to some potential harm.

People were listened to and any concerns they raised were investigated and learnt from. People and staff were involved in driving improvement within the home and had regularly been asked for their suggestions and feedback which had been acted upon.

The registered manager was keen to improve the quality of care people received. They were open and told us that further improvements were needed. Any issues we raised with them were immediately d

This comprehensive inspection took place on 10 and 13 January 2017 and was unannounced.

The Laurels Care Home is a care home that provides accommodation and personal care for up to 52 people. The provider’s website describes the service as one that ‘specialises in round the clock dementia care and care for frail people.’ At the time of our visit, there were 41 people living in the home, the majority of who were living with dementia.

There was a manager registered with the Care Quality Commission (CQC) as is required. 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 and associated Regulations about how the home is run. Following our inspection in September 2016, the registered manager stepped down from their post within the home but did not de-register with the CQC. The head of care took over the running of the home as the manager but they subsequently left their employment in December 2016. The previous registered manager who was working as the deputy manager in the interim resumed managing the home. At this inspection, a director of the provider (who will be referred to in the report as ‘the provider’), told us this arrangement was temporary until a new manager started on 16 January 2017.

At our last inspection on 28 September 2016 which had been a focussed inspection in response to concerns we had received, we asked the provider to take action to make improvements in respect of the quality of care that was provided to people. At this inspection, we found that the necessary

improvements had not all been made. This resulted in six breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take at the back of the report.

There were not enough staff working in the home to keep people safe and to meet their preferences. This also impacted on people receiving adequate stimulation to enhance their wellbeing and reducing the risk of them experiencing abuse. In most cases, risks to people’s individual safety had been assessed but actions had not always been taken to mitigate these risks. Some people had therefore experienced poor care or had been put at risk of harm.

Some areas of the home and equipment people used were unclean and not all risks in relation to the safety of the premises had been assessed.

People’s medicines had not all been managed well and people continued to be inadequately supported to eat and drink enough to meet their individual needs. Some staff had received adequate training to perform their roles however, others had not which placed people at risk of receiving poor care. Some staff demonstrated poor care practice which placed people at risk of infections. There was a lack of evidence to support that staff care practice was regularly assessed and monitored to ensure they were competent at their role.

There continued to be a lack of effective governance and leadership in place to assess, monitor and mitigate risks in relation to people receiving poor quality care.

People were supported with their healthcare needs but staff did not always follow the advice of healthcare professionals. When people raised concerns, these had not always been taken seriously or investigated appropriately. Some people’s dignity and privacy was not upheld.

Staff sought consent from people in line with the relevant legislation and the necessary checks had been made before staff started working in the home to ensure they were eligible to work within a care setting. People and their relatives were involved in making decisions about their care as much as they wished to be.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

Services in special measures will be kept under review a

We carried out an unannounced comprehensive inspection of this service on 23 May 2016. After that inspection we received concerns in relation to how the risks associated with people not eating and drinking and developing a pressure ulcer were being managed. As a result we undertook a focused inspection on 28 September 2016 to look into those concerns. This focused inspection was also unannounced. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

The Laurels Care Home is a care home that provides accommodation and personal care for up to 52 people. The provider’s website describes the service as one that ‘specialises in round the clock dementia care and care for frail people.’ At the time of our visit, there were 45 people living in the home, the majority of whom were living with dementia.

The home had 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 and associated Regulations about how the service is run.

Risks to people’s safety had not always been assessed. Where they had been, adequate actions had not always been taken to keep people safe.

Not all people living within the home had received adequate support to ensure they received enough to eat and drink to meet their individual needs. This had resulted in some people losing a significant amount of weight.

There were a lack of effective systems in place to assess and monitor the quality of care provided to people. The provider had not followed their own policies in respect of how to meet people’s eating, drinking and pressure care needs.

The Laurels Care provides accommodation and personal care for up to 52 older people, some whom live with dementia. There are external and internal communal areas for people and their visitors to use.

We carried out an unannounced, comprehensive inspection of this service on 1 December 2014. As a result of our findings we found a breach of two legal requirements. We asked the provider to make improvements to ensure people received sufficient food and drink and that suitable arrangement were in place for obtaining lawful consent in accordance with the Mental Capacity Act 2005 (MCA). The provider’s representative wrote to us detailing how and when improvements would be made.

This unannounced inspection took place on 23 May 2016. There were 41 people receiving care at that time.

We found that sufficient improvements had been made to ensure people received enough to eat and drink. We also found that some improvements had been made towards compliance with the MCA.

The service had 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.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. Staff were trained, and supported, by the registered manager. There were sufficient staff to safely meeting people’s needs. However, staffing levels limited the choices people were able to make and how individualised their care was.

Good infection control procedures were not always followed and people were not always cared for in a hygienic and fresh smelling environment. There were systems in place to ensure people’s safety was managed effectively. Staff were aware of the procedures for reporting concerns and of how to protect people from harm.

People received their prescribed medicines appropriately and medicines were stored safely. People’s healthcare and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. The registered manager had prioritised the applications that needed to be made to the authorising agencies for people who needed these safeguards and had an action plan in place for achieving this. Staff respected people choices and decisions. Staff had received training in the MCA and DoLS, but this knowledge needed embedding.

People received care and support from staff who were kind, caring and compassionate to the people they were caring for. People had opportunities to comment on the service provided and people were involved in every day decisions about their care.

People’s care records were brief and did not provide staff with sufficient guidance to ensure consistent care to each person. Care was often task orientated. There were opportunities for people to participate in activities. However, these were limited, particularly for people who required one to one staff support.

The registered manager was supported by a staff team that included a deputy manager, team leaders, care workers, and ancillary staff. The registered manager was approachable. People and relatives were encouraged to provide feedback on the service in various ways both formally and informally. People’s views were listened to and acted on. Concerns were investigated and improvements made. However, the quality assurance system had not identified all areas where improvements were needed

This inspection took place on 1 December 2014 and was unannounced. The service complied with regulations that were checked at our last inspection.

The Laurels Care Home provides accommodation and personal care for up to 51 older people, some of whom may be living with dementia. At the time of our inspection there were 46 people living at the home.

The provider of the service had a registered manager in place, as required by law. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People said that they felt safe in the home and staff knew what they needed to report if they had any concerns someone may be being abused. Medicines were not always administered in a timely way.

People did not always receive sufficient amounts to eat and drink to meet their needs. Decisions about people’s care and treatment were not made in accordance with the Mental Capacity Act 2005. One person’s rights in relation to the Deprivation of Liberty Safeguards were potentially compromised because of the level of supervision to which they were subjected.

Staff had access to training, relevant qualifications and support to enable them to care for people. However, district nursing staff were not confident their advice about supporting people was consistently followed.

People said that staff treated them with kindness and our observations confirmed this. We saw that staff offered people comfort and reassurance when this was needed.

People had access to health professionals when they became unwell and staff sought advice promptly when their needs changed. Most people felt that activities met their interests and preferences and that there were regular opportunities to engage in something they enjoyed. People had confidence in raising concerns with members of staff and relatives knew how to make a complaint if they needed to.

There were systems in place to monitor the quality and safety of the service people received and to consult with people for their views. Staff were motivated and committed to meeting people’s needs.

We have made recommendations about assessment and prevention of falls, catheter care and pressure ulcer prevention. We have also made a recommendation about environmental design for people living with dementia.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations have been replaced by 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 this report.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People are treated with respect and dignity by staff. They told us that they liked living at The Laurels Care Home. People were consulted and involved in planning their care. The care and support needs of people had been assessed and reviewed to ensure they were provided with the care and support they needed.

Staff were trained and knew how to provide care and support to people. This meant that the staff members employed had the qualifications and skills needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS) to ensure that people who could not make decisions for themselves were protected. Policies and procedures were held. Staff had been trained and knew when a DoLS application was needed. The manager told us that there had been no reason for a DoLS application to be made. The manager showed us that they knew how to submit a DoLS application.

Is the service effective?

People’s health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person living at the service told us. “It is nice here and the staff are lovely.” Staff had received suitable training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff provided them with the care and assistance they required. Our observations confirmed this. A relative told us, “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Care and risk assessments had been written and regularly reviewed. The care and support provided was adjusted to meet the needs of each person. Changes in a person’s care and support had also been recorded in their plans of care. A record was held of people’s preferences, interests and diverse needs so that these could be respected by staff. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People received the individual support they needed and had access to a range of planned activities

Is the service well led?

Staff spoken with had an understanding of the ethos of the home. People said that they felt listened to when they made a suggestion or raised their concerns. They told us that the manager and staff were approachable and that the service was well organised. The records we looked at and our observations confirmed this.

We were told that staff members obtained people’s consent before supporting them with care or treatment. Care records recorded some decisions that people were not able to make for themselves, although not all of the required information was recorded. They had already identified this and arranged for staff members to have training.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required. One person told us that their meals were, "Always very nice".

The home and grounds were appropriately maintained. Equipment was properly checked and serviced on a regular basis. There were no offensive smells during our inspection, although this had been mentioned in the annual survey and in one of the provider visit reports.

Staff rotas and training information showed there were enough staff members and that training had been kept up to date. People using the service and said there were enough staff available to meet their needs.

Systems were in place to regularly check and monitor the way the service was run.

During our inspection of 13 September 2012 people told us they felt well cared for at The Laurels. Staff were, 'Very nice' and the home was always kept very clean and tidy. One person told us, "It's so nice to be looked after here, I like being idle for a change".

People spoken with told us they could make their own decisions as to what they wanted to do during the day and what choice of food they would like to eat and where they would like to eat it. People told us that staff always listened to them and treated them with respect.

We spoke to several people during our visit and received a range of positive comments. One person told us that they felt "Very lucky to live at The Laurels and that the staff are always "Chirpy and kind." People told us that they found the service clean and tidy.

One relative told us that they were very happy with the care that their relative received and stated that "I know they are safe here." Another person told us that they could join in making cakes or tidying up to help the staff."

People told us that the manager is always available to raise any concerns or issues that they may have. A relative spoke very positively about how welcome they were made to feel when their relative first moved into the service.