The Laurels Nursing Home is a residential care home. 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. The Laurels Nursing home cares for up to 52 older people, who have nursing needs, including poor mobility, strokes, Parkinson's disease, diabetes, and people who were receiving end of life care. They also provide emergency respite for people who have live-in care at home. There were 44 people living in the home during our inspection. Accommodation was provided over two floors with communal areas on each floor.

Our last inspection on 10 February 2017 was a focused inspection to check the service was meeting the legal requirements following a breach from the previous comprehensive inspection on 25 and 26 November 2015. The breach was in relation to medicines not being managed safely. At the focused inspection we found improvements had been made and the provider had met the legal requirements with regards to the management of medicines; and we rated the service as good.

At this inspection we found that the service continued to support the rating of good overall and was rated good in each of the five questions we ask. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People felt safe. There were policies and systems in place to safeguard people, assess risks and manage them, and to manage people’s medicines safely. There were enough suitably recruited and trained staff to meet people’s needs. People were protected by the prevention and control of infection. Accident and incident records were closely monitored and actions were taken to ensure lessons were learnt.

People were supported to have maximum 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. Staff supported people to be as independent as possible. People’s needs were met, including support with eating and drinking and accessing healthcare. The provider ensured there were systems in place to ensure staff had the right training, qualifications, support and supervision to do their job.

The management team consisted of the ‘Matron’ (registered manager) and the nurses. They promoted a caring and positive culture. Staff protected people’s privacy and dignity and people were consulted, informed and involved with their care. People, relatives and staff were engaged in the service and visitors were welcomed. People could raise concerns and the provider managed complaints and feedback received from people and their relatives. People received person centred care which met their needs, were supported to engage in activities they liked and were supported well at the end of their life.

The provider had systems in place to promote continuous learning. The registered manager had good oversight of the quality and safety of the service and risks. Regulatory requirements were understood and managed.

Further information is in the detailed findings below.

We inspected The Laurels on the 10 February 2017. The Laurels provides accommodation and nursing care for up to 52 older people, who require personal support and for those that have nursing needs, including poor mobility, strokes, Parkinson’s disease, diabetes, and people who were receiving end of life care. The maximum people to be accommodated was 48 as some rooms were doubles and would be used only for couples or for those who want to share. There were 47 people living in the home during our inspection.

The original building has recently been added to with a purpose built extension to provide a safe comfortable environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over two floors with communal areas on each floor.

The Laurels Nursing Home is owned by The Laurels Nursing Home (Hastings) Ltd and the organisation has one other care home in the South East.

At the last inspection in November 2015 we found the 'safe' question required improvement. The management of people's medicines needed to be improved to ensure that people received their prescribed medicines and care plans needed to reflect people's changing needs. We received an action plan from the provider that told us how they were to meet the breach of regulation by January 2016.

This unannounced focused inspection on the 10 February 2017 was to look specifically at the ‘safe’ question and we found that that they had now met the breach of regulation previously found.

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 and associated Regulations about how the service is run.

The registered manager was nominated in 2016 for the Great British Care Awards and was shortlisted for the regional Registered Care Home Manager Award.

People told us they felt safe living at the Laurels Nursing Home. Comments included, “Very safe and cared for,” and “Always plenty of staff to help us.” Staff told us, “We have really good staffing levels so we don’t rush and can provide safe care and treatment.

This inspection found that people were protected against the risks of unsafe medicine management. The staff were following current and relevant medicines guidance. We found that previous issues with how medicines were managed and recorded had been monitored and significantly improved.

Care plans and risk assessments were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people's changing needs. This had ensured that people received safe care and treatment.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding adults training and understood their responsibilities to report any unsafe care. Recruitment checks were carried out to ensure suitable staff were employed to work at the home and there were sufficient staff to meet people's needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

We found sufficient staffing levels were in place to provide support people required. This included staff supporting people with one to one support and to attend hospital appointments. We saw staff members could undertake tasks without feeling rushed when supporting people. Staff also told us they had time to spend with people and that was promoted by the registered manager.

The home was clean and well presented. Risks associated with the cleanliness of the environment and equipment had been ide

We saw that the home was undergoing a building extension. There are plans for an additional 24 rooms.

We spoke with eight people who used the service and two of their relatives. One person told us, "It is a lovely place to live."

We spoke with nine members of staff. One told us, "I really enjoy working here."

We observed staff caring for people with dignity and respect.

We looked at five care plans. We saw that they reflected the care that was being provided.

There were systems in place to identify areas of the home that required maintenance.

We looked at three staff files. The home had suitable staff recruitment procedures in place.

We saw that the home had an effective complaints procedure.

During our visit we spoke with three people who lived at the home, one relative and three staff members.

All the people we spoke with said they enjoyed living at The Laurels. One person told us “I’m very pleased I’ve come here. There’s a lot to do, yesterday I was down for the activities but today I think I’ll just stay in my room. It’s very good food too, I’m very happy here.” People told us staff treated them with dignity and respect and asked permission before carrying out personal care. The staff we spoke with were knowledgeable about people’s needs and what support they required.

One relative told us “I have 100% confidence in the staff. The care the staff have given (my relative) has directly helped her recovery. I’ve never witnessed staff not knocking on doors. They’re always considerate.”

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.

We inspected The Laurels on the 25 and 26 November 2015.

The Laurels provides accommodation and nursing care for up to 52 older people, who require personal support and for those that have nursing needs, including poor mobility, strokes, Parkinson’s disease, diabetes, and people who were receiving end of life care. The maximum people to be accommodated was 48 as some rooms were doubles and would be used for couples or for those who want to share. There were 44 people living in the home during our inspection.

The original building has recently been added to with a purpose built extension to provide a safe comfortable environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over two floors with communal areas on each floor.

The Laurels Nursing Home is owned by The Laurels Nursing Home (Hastings) Ltd and the organisation has one other care home in the South East.

We last inspected the home in September 2013 and no concerns were identified.

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 and associated Regulations about how the service is run.

People commented they felt safe living at the Laurels Nursing Home. One person told us, “I feel safe and I’m happy here.” Another person said, “I came here as I wasn’t safe at home, I’m safe here.” However the management of medicines was unsafe and placed people at risk. Some people’s essential prescribed medicines were out of stock for up to seven days with no action plan put in place to protect their health.

Whilst care plans and risk assessments for people were in place, not all were reflective of peoples’ current needs and therefore not up to date. However when we spoke with the staff, they knew people very well and were knowledgeable of changes to peoples’ needs.

People and staff felt staffing levels were sufficient to meet the needs of the people they supported. One person told us, “Always lots of staff around.” A staff member said, “We are really well staffed and this is a reason I stay here, I don’t feel pressured and I can do my job well.”

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff.

There was a focus on providing care and support that focused on the need of the person whilst supporting their individuality and identity. The management team told us, “Our staffing levels and the loyalty of our staff means we can give people the time they need, by staff that know them well.” We were also told, “We try to ensure that our residents lead the life they want.”

Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the management team who were visible and approachable.

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

People told us they were happy living at the Laurels Nursing Home. One person told us, “I’ve been here since last year, and I’m glad I came, I like the staff and I have made friends.” Staff spoke highly about the people they supported and spoke with pride and compassion when talking about people. People’s privacy and dignity was respected and staff recognised that dignity was individual and should be based on what each person wants.

The provider had processes to support staff to carry out their roles safely and effectively. Staff were encouraged to take further qualifications to develop their careers.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings (handovers) were held after each shift to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management team was very good; and were always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. Audits were undertaken regularly, including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

We found a breach 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 this report.