The inspection took place on 9 July 2018 and was unannounced. The last inspection took place on 18 June 2015. This was a focused inspection to follow up on a breach of regulation identified in December 2015 following a comprehensive inspection. The breach was in respect of Regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014. At the focused inspection we found this breach was met and the service was rated as Good.

The Laurels Care Home 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 Laurels Care Home is a care home close to Congleton town centre. Originally a private house it has been renovated and extended to provide care to older people. It is a two-storey building and people live on both floors. Access between floors is via two passenger lifts or the stairs.

At the time of the inspection 33 people were living at The Laurels Care Home.

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.

During this inspection we found the provider was in breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breach related to staffing. Our observations showed that at different times of the day there were not enough staff on duty to ensure people received the support they needed to ensure their safety and well-being. Considering our findings, we have also made a recommendation regarding more robust monitoring at management level of the staffing arrangements in the home to ensure consistent staffing numbers are maintained.

Our observations showed when staff were supporting people they were attentive and tried to make people as comfortable as they could. Their time was limited as the home was busy however when assisting people they took time to understand people’s different ways of communicating and to respond appropriately to their requests. Relatives were complementary regarding the attitude of staff who were described as caring and patient in their approach. People told us they liked the staff team and they were polite and respectful.

Staff had a good understanding of people's individual care needs and appropriate referrals to external healthcare professionals took place. Guidance and advice that was provided was being followed; this meant that people’s overall health and well-being was being safely and effectively supported. Feedback from health and social care professionals who had input into the service was positive.

Systems were in place and followed to recruit staff and check they were suitable to work with vulnerable people.

We found the environment to be clean and free from any odour. Staff had access to protective clothing such as, gloves and aprons to support the control of infection.

The premises and equipment were subject to safety checks to ensure they were safe and well maintained. The premises was kept in good decorative order and there were some adaptations to promote a dementia friendly environment. The registered manager was aware that further work was needed in this area to fully support people with dementia. For example, more signage throughout the home to aid people's orientation.

People’s medication was safely managed and they received it on time and as prescribed. Staff were trained and deemed competent to administer medicines.

Staff had a good understanding of people's individual care needs and appropriate referrals to external healthcare professionals took place. Guidance and advice that was provided was being fol

We carried out an unannounced comprehensive inspection of this service on 15 December 2014 at which a breach of legal requirements was identified. We found the home needed further development in training their staff in the Mental Capacity Act 2005 [MCA]. We also identified issues around their understanding of how to support people when they lacked capacity, including the implementation of DNACPR (do not attempt resuscitation orders). Records lacked evidence that people living at the home or their representatives had signed to consent with the orders in place which had been signed by the GP.

After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. In addition to this we have also received further clarification from external professionals working in end of life care regarding the completion of DNACPR’s which clearly state that the decision is a medical one and relatives should not be asked to make the decision unless they have power of attorney. This clarification confirmed that our initial findings were incorrect.

We undertook a focused inspection on the 18 June 2015 to check the action plan that had been completed and to confirm that the home now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Laurels Care Home’ on our website at www.cqc.org.uk’

The Laurels Care Home 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.

The Laurels is a care home close to Congleton town centre. Originally a private house it has been renovated and extended to provide care to older people. It is a two-storey building and people live on both floors. Access between floors is via two passenger lifts or the stairs.

At our focused inspection on the 18 June 2015, we found that the provider had followed the action plan they had sent us and that the issues had been addressed.

This inspection took place on the 15 December 2014 and was unannounced.

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

The Laurels is a care home close to Congleton town centre. Originally a private house it has been renovated and extended to provide care to older people. It has 32 single bedrooms and two shared rooms. It is a two-storey building and people live on both floors. Access between floors is via two passenger lifts or the stairs. The home had 32 people living there at the time of our inspection.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty (DoLS) to report on what we find.

We found the home needed further development in training their staff and in their understanding of how to support people when they lacked capacity, including the implementation of DNCPR (do not attempt resuscitation orders.) Records lacked evidence that people living at the home or their representatives had signed to agree with the orders in place which had been signed by the GP.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. which corresponds to regulation 11 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.

People living at the home, relatives and staff were positive about the services provided at The Laurels. We observed how staff spoke and interacted with people living at the home and found that they were respectful, kind and patient offering various choices throughout the day. The dining area offered a pleasant relaxed dining experience and staff served a choice of meals.

The majority of staff had a good understanding of the need to ensure people were supported to stay safe. They understood their safeguarding procedures and told us they would not hesitate to report any type of allegation.

Everyone was happy with the staffing levels although some relatives and people living at the home told us they were unsure how many staff they should expect to see on duty each day.

Medications were organised and regularly audited and checked to ensure safe practices were provided with the management of medications.

We found care plans to be up to date and covered lots of different topics. They had been regularly reviewed and checked by senior staff to ensure records were appropriately kept up to date. They contained guidance to enable staff to know how to support each person’s needs. Staff had a good understanding and knowledge of the people they supported.

People living at The Laurels were confident that they could raise their opinions and discuss any issues with staff. The service had a complaints procedure and most complaints that had been made were recorded with actions taken and managed in accordance with the registered provider’s procedures.

The home operated safe recruitment processes and ensured that staff employed were suitable to work with people living at The Laurels. Personnel files showed good evidence that recruitment procedures were robust to enable the management of the home to have adequate information before employing staff.

Most of the staff had received formal supervision and various training to assist them in their job roles and in their personal development. Training records and appraisals for staff needed updating to improve the accuracy of records to show what training staff had received and when staff were due refresher training.

Various audits at The Laurels were carried out on a regular basis by the manager and registered provider to help ensure that appropriate standards were maintained throughout the home. The majority of people we spoke with who lived at the home, relatives and staff were positive about the service and how it was managed.

People living in The Laurels Care Home told us that they were happy with the care and support they received and that staff looked after them very well. Comments included: “The staff are very, very, good here. Nothing is too much trouble, they help me in any way they can."

Each person living in the home had a care plan in place. These plans included details of how the person wished to receive their care and support, their personal preferences and their daily living routines.

We found that staff in the home treated people with dignity and respect and we saw care workers gently encouraging people to do things for themselves where they were able and to make choices about what they wanted to do.

We spoke with a visiting health care professional who told us that they were happy with the care and support people received and that the home kept ‘excellent records’.

On the day of our unannounced visit we found the home to be clean and fresh with no unpleasant smells detectable.

We found that systems were in place to monitor and evaluate the quality of service provided. We saw evidence to demonstrate that people using the service were consulted and had regular opportunities to discuss all aspects of their care and management of the service.

A complaints policy and procedure was in place and people received appropriate information on how to make a complaint if needed.

We spoke with five people who lived at the home who said they were happy with the care and support provided and they were looked after. They told us that staff respected their rights, their privacy and their dignity. All five people we spoke with said they felt safe. Comments included: "A real good bunch of staff” and “I’m really very happy here.” They said they had choice and were involved in the daily activities if they wished to be.

We spoke with two family members who regularly visited the service. Both relatives said that they considered the care to be good. Comments included:” They really do care” and “I’ve never seen anything that would worry me, in fact exactly the opposite. It really is very good here.”

We also looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care they had agreed with the service. We noted that two entries in care records were not clearly written.

We saw that there were procedures in place that were followed to ensure that staff were recruited effectively and records were kept of this process. A comprehensive and documented induction procedure was in place to support newly recruited staff.

We found that systems were in place to monitor the quality of the service provided. We saw evidence to demonstrate that people were regularly consulted about all aspects of their care and the facilities at the home.

The people who were able to say told us that they were being treated well by the staff members supporting them and that they were involved in all aspects of their care. A visiting family member said, “I cannot speak highly enough, they always make me feel welcome. I looked at other homes, this just felt right”.

People said that they were happy living in the home. One person told us, “I could not be in a better place; they look after me very well”. Another person said, “Things are fine here”.

They were also positive about the quality of the manager and staff at the home. Comments included; “The staff are very good and always respect my dignity”, “You don’t hear people raising their voices”, “The manager has a lot of humanity”, The staff are very good, they are pleasant at all times and I can have a laugh with them”.

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, “Patients’ notes are always to hand and if we need a staff member to accompany us they always do”.

During a discussion with Cheshire East Council’s contracting team prior to our visit they told us that they did not have any concerns about the home.