The Laurels Care Home is registered to provide nursing and personal care for up to 55 older people, although following conversion of some rooms there are only 50 places in single bedrooms. The home provided dementia care on the first floor and nursing care on the ground floor (although people may also have some cognitive decline on this unit). At the time of this inspection there were 50 people living in the home.

At the last comprehensive inspection in October 2015, the service was rated as Good overall. At that time we made a requirement relating to medicines. When we carried out a focused inspection in July 2016 we found improvements had been made to medicines management but we were unable to change the rating at that time. At this inspection we found the service remained Good and the improvements to medicines had been sustained.

People felt safe at the home. They were supported by staff who had been checked and vetted as suitable to work in care. There were enough staff to assist people in a timely way. People’s medicines were managed in a safe way.

Staff were well trained. People and visitors said staff were competent in their roles. People were supported to have 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 said they enjoyed good food. They were helped with their nutritional well-being and had access to health services.

People and relatives said staff were caring, helpful and friendly. They treated people with dignity and respect. People were encouraged to make their own daily decisions. A visiting healthcare professional said staff always went the extra mile to support people.

People received personalised care. Staff were knowledgeable about each person’s needs and preferences and tried to match staff to people they were familiar with. People felt there was a good range of activities, social events and trips out. Staff tried to make these meaningful for each person.

People and visitors said the home was well managed and organised. There was a registered manager who had been at the home for a few years. The registered manager and registered provider carried out checks on the quality and safety of the service. People and staff were asked for their views and their suggestions were used to continuously improve the service.

The service met all relevant fundamental standards we inspect against.

Further information is in the detailed findings below.

We carried out a comprehensive inspection of this service on 27 October 2015. At that time we found the provider had breached a regulation about the management of medicines. This was because the provider’s arrangements with a pharmacy had meant people’s medicines had not been delivered to the home in a timely way. Some people had no stock of their medicines for up to four days. This meant people medicines were not managed in a safe way. The provider sent us a plan showing what actions would be taken to address this.

We undertook this focused inspection to check that the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to those requirements. 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

We found the provider had met the assurances in their action plan. There had been improvements to the arrangements the provider had with the pharmacy for medicines to be delivered and this meant people's medicines did not run out of stock.

During this inspection we spoke with 11 people who used the service and five relatives. We also spoke with four visiting healthcare professionals including a GP, community matron and district nurses.

Some people who were using the service had dementia care needs which meant they were unable to tell us their views. We used a number of different methods to help us understand their experiences.

We considered all the evidence we 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?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People were supported by calm and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw people were supported to enjoy their meals at their own pace. We saw staff spent time chatting with people about their interests in a warm and engaging manner.

The people who were able to tell us about the service they received described staff as “lovely”, “very helpful” and “kind”. A visiting healthcare professional told us, “I find the staff are patient and tolerant. They always take their time with people.”

In discussions staff were knowledgeable about people’s individual needs and preferences and were respectful of their diverse needs. Our observations of the care provided and discussions with people showed us that individual wishes for care and support were taken into account.

Is the service responsive?

There was a visible staff presence throughout the home so that staff could support and supervise people when needed. Staff spent time with people in the lounges so they could make sure people got support whenever they needed it.

People told us they could join in a range of activities if they wanted. The daily activities included group events and others that met people’s individual interests.

People and visitors told us they could approach the staff about any “niggles” and could raise any complaints with the manager at any time if they wanted to discuss anything. The people and relatives we spoke with during this inspection felt their views were listened to.

Is the service safe?

People and visitors described the home as “safe” and “welcoming”. Health care visitors told they had “no concerns” about the care provided, and one health care professional told us, “It’s safe and people are well looked after. I’ve never had any concerns about it.”

People were treated with respect and dignity by the staff. The premises were safe, well maintained and clean. People felt their accommodation was kept “very clean”. One health visitor commented, “People’s personal hygiene is very good when we visit and the building is always clean too.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager understood the home’s responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily unless it was in their best interests. The manager was aware of the recent court ruling regarding DoLS in care settings, and training from the local authority was planned for the near future.

Is the service effective?

People all had an individual care plan which set out their care needs. People felt the service met their needs. People who were able to comment told us the care they received was “very good” and “smashing”. A visiting family member told us, “My relative has settled really well and he’s well looked after.”

A visiting GP told us, “The home now has quicker access to a range of other health services, like dietitians and the falls clinic, and it utilises these for people whenever appropriate.”

Is the service well-led?

The home had a registered manager who had been managing the home for 18 months. People and visitors told us they were asked for their views about the service and had confidence in the way the home was run.

The provider had a system to assure the quality service it provided. The way the service was run was regularly reviewed. A range of checks were carried out including care records, medication and the dining experience for people who lived there. A regional manager carried out at least monthly visits to audit the systems and procedures at the home.

We carried out this follow up review to check what progress the service had made to the improvements we suggested following our visit in April 2013 to ensure staff were accurately updating care records about how a person’s progress was being monitored and recorded.

We spoke with the registered manager and she told us how she had involved people and their relatives in reviews about the care service.

We found that regular maintenance was carried out, and areas of the home were safe and suitable for the regulated activity.

We saw how revised documentation had been introduced since our previous visit. We saw the care plans were detailed and how they were regularly reviewed so they showed people’s well-being and described any changes in treatment.

People we spoke with told us they were happy with the care they received and liked living at the service. We spoke with relatives who confirmed they were satisfied with the care their relative received and had no concerns.

Due to their needs, some people could not offer direct comments about the care they received. People we did speak with expressed satisfaction with the care offered. Comments included: “The staff are very nice and kind. They know what help I need and come when I ring the bell for them” and “The staff look after us very well and I am quite happy living here.” We spoke to another person who told us she was not happy about living at this service. When we asked if she had spoken to the manager she said no. It was agreed for the registered manager to arrange a meeting with the person concerned to discuss their concerns.

We spoke with two people about their medicines and both said they received their medication when they needed it.

We spoke with people who use the service and with their relatives. One relative we spoke with said she had been "very impressed by the care her mother had been given”. Another relative told us “It’s never had a manager that stayed. There’s no leadership.” “It needs a strong manager. There hasn’t been a permanent manager in the five years my mum’s been living here.”

People who use the service were asked how they feel about living at the home and the staff who look after them. These comments include “the staff are "kind" and “they know how to look after me".

Service users were asked about how they feel about living in the home and if they were happy with the care they received from the staff. All of them were complimentary and made positive comments about the service and staff. These comments include “clean, nice food”, “all of the staff are very good, very kind” and “I can’t fault it at all”.

The Laurels Care Home is registered to provide nursing and personal care for up to 55 older people, although following conversion of some rooms there are only 50 bedrooms. The home provides dementia care on the first floor and nursing care on the ground floor (although people may also have some cognitive decline on this unit). At the time of this inspection there were 47 people living in the home.

The last inspection of this home was carried out on 26 June 2014. The service met the regulations we inspected against at that time.

The home had a registered manager who had been in this role at The Laurels for three years. 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 one breach of regulation which related to the management of people’s medicines. This was because the provider’s arrangements with a pharmacist meant people’s medicines had not been delivered to the home in a timely way. Some people had no stock of their medicines for up to four days.

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

People and their relatives were positive about the service. They felt the care in the home was “good” and that the home was “a safe place” to live. For example, one person commented, “I am happy in this home. The staff are so helpful and will do anything for me.” Staff were clear about how to recognise and report any suspicions of abuse.

There were enough staff on duty to support the people who lived there. The staffing levels and skill mix throughout the day and night was suitable to meet people’s needs. The provider carried out checks to make sure only suitable staff were employed.

People and relatives we spoke with felt staff had the right skills and competencies to provide the right support. One relative commented, “The staff know how to care for and communicate with my [family member].” Staff had the relevant training and support to care for people. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

Health care professionals said the staff cared for people in a competent, effective way and responded appropriately to any changes in people’s well-being. People were supported to eat and drink enough and they had choices about their meals.

People and their relatives felt the staff were “caring” and “friendly”. For example one person told us, “This is a nice place to live. The staff are caring and helpful, the food is good, and there are things to do if I want to.” People were treated with kindness, patience and dignity. Their individual choices were promoted and their privacy was respected.

Staff in all roles talked with people as they carried out their jobs in the home, including catering and housekeeping staff. A member of housekeeping staff told us, “This is people’s home and we try to make it as homely as possible.” People and relatives told us there was a good range of activities at the home, including lots of social events and pet therapy.

People had information about how to make a complaint or comment and these were acted upon.

People received personalised care. People had been individually assessed and their care was planned to make sure they got the right support to meet their specific needs. Staff were knowledgeable about people’s history as well as their likes and dislikes. A healthcare professional told us, “The staff know people’s needs very well.”

People and their relatives told us they talked with the staff and the registered manager frequently and had opportunities to comment on how it was run. Visitors described this as a “well run” home

The healthcare professionals we spoke with commented that the service was “effective and well managed”. The provider had a quality assurance programme to check the quality of the service. This meant the home continued to improve.