About the service:

The Laurels Nursing Home is a care home. It is registered to provide residential care for up to 30 older adults who have needs associated with dementia and a broad range of medical conditions. At the time of our inspection, ten people were receiving support at the service.

People’s experience of using this service:

•Improvements were needed to ensure people received their medicines as required.

•The arrangements for monitoring the safety of the environment needed to be further strengthened.

•Although staff were kind and caring this was based upon the approach of individual staff and not fully promoted by the culture of the organisation.

•People did not always receive services which were responsive to their needs as they had not always been supported to have access to person centred, meaningful activities.

•People felt safe and there were systems and processes in place to minimise the risk of abuse. Accidents and incidents were reviewed and analysed to try to prevent future incidents. Safe recruitment practices were followed.

•Staff received training and had the skills knowledge needed to perform their roles effectively.

•People were enabled to have choice and control of their lives and staff supported people in the least restrictive way possible. People had access to advocacy services if they required these.

•People and their relatives were involved in reviewing their care and making any necessary changes.

•A process was in place which ensured complaints could be raised and there were systems in place to respond to complaints.

•Following our last inspection, the acting manager and operations manager had been proactive in identifying areas for improvement at the service. Improvements were underway to strengthen auditing systems and work had started to better involve people who used the service and staff in the running of the service.

Rating at last inspection:

The Laurels Nursing Home was last inspected on 24, 25 and 30 July 2018 (report published 4 October 2018) and was rated as inadequate overall.

Why we inspected:

This was a planned inspection based on previous rating. At this inspection the service met the characteristics of requires improvement in all of the areas we inspected. More information is in the detailed findings below.

Enforcement:

We found one breach of the Care Quality Commission (Registration) Regulations 2009.This was because the provider had failed to notify us of issues relating to the safety and welfare of people living in the home.

We have taken action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. You can see what action we have taken at the end of the full version of this report.

We found other areas in which further improvement was required to ensure people received the safe, effective, caring and responsive service they were entitled to expect.

Follow up:

We have asked the registered provider to send us an action plan telling us what steps they are taking to make the improvements identified as needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality care is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This unannounced inspection took place on 24, 25 and 30 July 2018. The Laurels Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages 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 accommodates up to 30 people over two floors. On the first day of our visit there were 15 people at the service and one person in hospital, and on the second and third day of our visit 14 people were using the service and one person in hospital.

There was a registered manager for the service present throughout our visit. 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 our inspection we found the provider to be in breach of a number of regulations 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. 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.

People were not always protected from risks associated with their care and support. Risks associated with falls had not been robustly assessed and there was a lack of adequate safety measures in place to reduce the risks of falls. Risks relating to the environment had not been addressed by the provider. People were not always supported by sufficient amounts of staff, and staff were not always recruited safely. People could not be assured that the management of medicines was safe. The environment people lived in and equipment used was clean.

Staff at the service were not always supported with up to date training for their roles. Although staff ensured people received support to manage their health needs. When moving between services the care and support people required was not always made available for health professionals.

People were not always supported with their nutritional needs, people’s weights were not always monitored effectively and staff did not always know the different diets people required.

The principles of the Mental Capacity Act were not always followed to ensure people had the maximum choice and control of their lives.

People were supported by a caring staff group. However, their views and choices around their care was not always considered and adhered to.

People did not always receive personalised and individualised care as their care plans did not contain sufficient information on their needs and preferences related to their care including end of life care. There was a lack of social activities to stimulate and interest people, and when people made complaints the concerns raised were not always followed up.

The service was not well led. Systems in place to monitor and improve the quality and safety of the service were not effective and this placed people at risk of harm. Service provision was not robustly monitored and effective action was not always taken in response to serious issues identified. There was a lack of over sight of the service from the provider which had resulted in poor care for people who lived there.

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 and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Our inspection took place on the 25th of July 2017 and was unannounced. During our last inspection we found the provider to be in breach of a number of regulations of the Health and Social Care Act 2008. At this inspection we found the provider had made improvements to the service and were no longer in breach of the regulations.

The Laurels care home provides accommodation and personal care for up to 30 people. On the days of our inspection there were 13 people using the service. The service had a registered manager 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.

The registered manager had worked to improve the management of individual and environmental risks to people who lived at the service. There were sufficient suitably trained staff in place to manage people’s needs. Their medicines were managed safely and staff showed a good understanding of their role in protecting people from possible abuse.

People were supported by staff who had received the necessary training for their role. The service was following the principles of the Mental Capacity Act 2005 and where people’s mental capacity was in doubt appropriate assessments had been made to ensure any decisions made were in their best interests. The service had also made appropriate applications for Deprivation of Liberty Safeguards (DoLS) so people in their care had not been deprived of their liberty unlawfully.

People’s nutritional and health needs were managed by staff who showed an understanding of people’s individual needs.

People were cared for by staff who showed them respected and concern for their privacy and dignity. People and their relatives were also involved with the development and reviews of their care plans.

People’s care plans contained person centred and individualised care, with the majority of the care plans giving staff good information on their care requirements. However people were not supported to undertake regular social activities and were often bored. The outside amenities required improvements to allow people to safely access the outside areas for social activities.

People were aware of who and how to complain about any issues they had with the service and the registered manager responded and dealt with any complaints made to them. People who used the service, relatives and staff were supported by the registered manager who was visible and approachable. The service was undertaking a range of quality audits to monitor the quality of the service.

This inspection took place on the 20 and 21 March 2017 and was unannounced. The Laurels Nursing Home provides accommodation and personal care for up to 30 people. On the days of our inspection there were 16 people using the service

At the time of our inspection there was no registered manager in post as the last registered manager had left the service in December 2016. However the present manager had applied to the Care Quality Commission to register as manager at the service.

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.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager shared information with the local authority when needed.

People who used the service were not always protected from risks to their safety as some people had not had the risks assessed when they were admitted to the service and the risk assessments in place for some people did not reflect their current needs.

Staffing levels did not always meet the needs of people and there were times when people who required supervision were left unsupervised for long periods of time. Although people were given their medicines safely the storage of medicines were not always managed safely. Staff were given training to assist them in their roles

The principles of the Mental Capacity Act were not always followed as people had been deprived of their liberty without the required authorisation to do so. There was a lack of mental capacity assessments and best interests meetings for people who may lack capacity to ensure the care they received was appropriate for their needs

People were not always protected from the risks of inadequate nutrition and although referrals to health care professionals were undertaken the information from the health professionals was not always recorded in their care plans.

There were times when people were not treated in a caring and respectful manner and staff did not always engage with people when given the opportunity. People, who used the service, or their representatives, were not always encouraged to contribute to the planning of their care.

People did not receive person centred care as the care records did not give adequate or up to date information required for individualised care. People were not supported to undertake social activities to prevent them becoming isolated or bored.

People felt they could raise complaints and concerns to the manager who would deal with them in a satisfactory way.

Staff did not receive regular supervision and observation of their practice to monitor the quality of the care they gave to people.

Systems in the service that were meant to monitor and identify improvements were not effective and records were not always maintained and completed in full. This lack of effective governance led to some people not receiving safe and consistent care.

This resulted in us finding multiple breaches in regulations and negative outcomes for some people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

The Laurels Nursing Home provides care for up to 22 older people, some of whom may experience needs related to memory loss associated with conditions such as dementia. There were 21 people living in the service at the time of our inspection.

The registered provider had an established 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves.

The registered provider had processes in place which ensured when needed, they acted in accordance with the Mental Capacity Act, 2005 DoLS. At the time of the inspection one person who lived at the service was subject to an authorised DoLS.

Staff knew how to recognise and report any concerns so that people were kept safe from harm and background checks had been completed by the registered provider before new staff were appointed.

Staff had been supported to assist people in a person centred way. They provided care as set out in each person’s care record and we found this helped to reduce the risk incorrect care being given. There were clear arrangements in place for ordering, storing, administering and disposing of medicines.

People were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink. People also had access to a range of healthcare professionals when they required more specialist help.

Staff understood people’s needs, wishes and preferences and they had been trained to provide effective and safe care which met people’s individual needs. People were treated with kindness, compassion and respect. We saw examples when staff respected people’s privacy.

People were able to see their friends and families when they wanted. There were no restrictions on when people could visit the service and visitors were made welcome by the staff in the home. People and their relatives had been consulted about the care they wanted to be provided. Staff supported the choices people made about their care and people were offered the opportunity to pursue and maintain their interests and hobbies. The home had well established links with local community groups which benefited people who lived in the service.

There were systems in place for handling and resolving complaints. People we spoke with and their relatives were aware of how to raise any concerns they may have. The home was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The registered manager and the registered provider had systems in place to enable them to continually assess and monitor the quality of the services they provided.

We looked at four care plans for people who used the service. These were personalised and provided detailed guidance about how people’s needs should be met. Records showed each part of the care plan had been reviewed monthly.

People’s rooms were personalised and people were surrounded by their own possessions. We were told by members of staff that all the furniture in people’s room was new; we observed this was the case.

The home employed a chef who told us meals were prepared based upon people’s preferences. The chef showed us a book in which they recorded what people had liked and disliked at each meal.

Following lunch, people commented on quality of the meal. One person said, “It was really nice, always is.”

We looked around the home and observed a good overall standard of cleanliness. We saw people’s rooms were clean and communal areas were clean and tidy. The provider may wish to note two people’s rooms had a strong mal odour.

We looked at the rotas for the period May-July 2013. We were unable to identify gaps in the staffing provision. We were able to confirm the number of staff included on the rota was the same as the amount on duty on the day of our inspection.

One person who lived at the home told us,” The staff are good, really good, I like them a lot.”

We visited the home to follow up improvements since our last visit in September 2012.

We found improvements had been made to the quality and accuracy of the care records. These now clearly demonstrated the support people received to meet their personal hygiene needs. We spoke with two people who told us they were satisfied with the care they had received.

During our inspection we spoke with four people who used the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about their care. Some of the comments included, "I'm quite satisfied with everything, I've no complaints" and "Very homely place wouldn’t want to go anywhere else."

People living in the home, confirmed they felt safe and said they liked the staff who looked after them. One person said, "It's very safe, staff are very kind and look after us very well." Another person told us, "Staff are very caring. If you want something they are there, night staff are the same.”

During our visit we spoke with six people living in the home, four relatives and two visiting health care professionals.

People we spoke with were positive about the care and support they received. They told us they liked living at the home and confirmed they were supported to make choices and decisions about the care they received. They told us they were assisted to be as independent as possible. Comments included: "It's a home from home, the staff just fit in with you,” “I like it here, I spend my time as I like" and “They encourage me to do what I can for myself, but they are always there if I need a bit more help.”

People said they would like more to do as there was no programme of activities they could take part in. Comments included: ”There’s nothing to occupy me during the day” and ”It's a long day, every day is the same"

They also told us that they liked the staff who cared for them. Comments included: "Staff do a lovely job, very nice people" and "Lovely staff, no faulting them at all."

People told us they knew who to raise any concerns with. One person told us "I would see the matron."

We spoke with some relatives who were visiting at the time of our inspection and they were generally positive about the care provided at the home. They told us the staff were friendly and helpful. We received some more negative comments about the lack of activity provision in the home. One person said, "Nothing really takes place on a day to day basis, it would be good if they could be more occupied."