Archived: Laurieston Care Home for the Elderly

Laurieston Care Home for the Elderly is a residential care home providing accommodation and personal care to 12 people aged 65 and over at the time of the inspection. The service can support up to 16 people in one adapted building.

People’s experience of using this service and what we found

People were not protected from abuse or avoidable harm. Risks to people were not always safely identified, assessed and managed. Care records were not always comprehensive or up to date and therefore did not accurately reflect people's needs. The provider failed to ensure there were enough suitably competent and skilled staff on duty to meet people’s needs. Staff were not always recruited safely. Medicines were not safely managed, although regular stock checks were carried out and these records were accurate. Staff did not follow infection prevention and control procedures and had not completed up to date training in this area. PPE was not always worn correctly. The service was accessing COVID-19 testing in line with government guidance.

The service was not well-led. People did not always receive person-centred care and there was not a positive culture within the home. The provider failed to make improvements when things went wrong and the quality of the service had deteriorated since the previous inspection. Staff roles and responsibilities were not clear, and quality assurance measures were ineffective. The provider did not always comply with regulatory requirements. The service did not always engage appropriately with people, staff and professionals. We received mixed feedback from relatives about communication and atmosphere within the home. One relative told us, “I don’t feel confident or comfortable speaking to anyone” whereas another relative told us, “It is friendly and homely.” Referrals to healthcare professionals were not made in a timely manner, or at all, although the deputy manager had sought outside professional assistance before our inspection.

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

Rating at last inspection

The last rating for this service was good (published 22 December 2018).

Why we inspected

We received concerns in relation to the way people using the service were being treated by the provider. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Laurieston Care Home for the Elderly on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to providing person-centred care, safeguarding service users from abuse and improper treatment, providing safe care and treatment, good governance, recruitment and staffing.

We have identified a breach in relation to the service's regulatory requirement to notify CQC of important incidents. This will be dealt with outside the inspection process.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Laurieston care home for the elderly is located in Saltburn-by-the-Sea. The service can accommodate up to 16 older people who require residential care. This includes people who live with a dementia. At the time of inspection, there were 11 people using the service.

At our last inspection on 19 March 2016, we rated the service as good. At this inspection we found the evidence continued to support the rating of good and 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.

Staff supported people to live in a safe environment; staff understood the procedures to follow to protect people from abuse and harm. Risks were continually assessed, although some risk assessment records needed to be amended to provide the information needed to support staff. Planed fire drills had taken place. The fire risk assessment was out of date. Accidents and incidents were reviewed and there was evidence that lessons had been learned. Staff were recruited safely and there were always enough staff on duty. People’s medicines were safely managed. Water temperatures were low; however, these were addressed during inspection. The service was clean.

Staff understood and followed recognised guidance for caring for older people. Staff were supported with regular reviews and training to do this. People were supported with their nutritional and healthcare needs. Recommendations from health professionals had been followed. An improvement plan was in place to continue to update the environment. 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.

People told us they were happy with the care and support they received from staff which was dignified at all times. People were involved in all aspects of their care and staff knew how to access local advocacy services for people.

People received person-centred care from experienced staff who knew their needs well. Staff were responsive when people’s needs changed and action was taken to seek support. Care records were in the process of being updated but did provide the information needed. People were involved in regular activities and the service was well known in the local community. No complaints had been received since the last inspection.

The registered manager and staff worked as a team to provide the right support for people. Quality assurance systems were in place, however needed to be more formally recorded. Information was shared with people, their relatives and staff and any areas identified for action had been addressed. The staff at the service were transparent during inspection and when working with other health and social care professionals. Notifications had been submitted when required.

Further information is in the detailed findings below.

Laurieston Care Home is a residential care home located in Saltburn by the Sea. It is conveniently situated for easy access to all local amenities and public transport including the railway station. Accommodation is provided in ten single and three double bedrooms. Two rooms have en-suite facilities and the others have a wash hand basin. There is a large lounge with two separate seating areas and a dining room. To the rear of the property is a court yard and to the front of the property is an accessible garden with seating arrangements.

There was a registered manager in place and they are also the registered provider. 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 told us that staff worked hard and supported them to continue to lead fulfilling lifestyles. We found that a range of stimulating and engaging activities were provided at the home.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. The registered provider had closely considered people’s needs and ensured that one senior and two to three care staff were on duty during the day for the 16 people using the service and a senior carer and a care staff member on duty overnight. The registered provider lived at the back of the home and staff told us they could contact them at any point to assist them whether this was night or day.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care.

The majority of people had the capacity to make decisions but where people experienced difficulties we saw that staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and, when appropriate, had requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had ensured capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice.

We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained detailed information about how each person should be supported. We found that risk assessments were detailed. They contained person specific actions to reduce or prevent the highlighted risk.

We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. The manager had ensured people were supported to access independent advocate. People and relatives we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them. People we spoke with did not raise any complaints or concerns about the service.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home and saw that audits of infection control practices were completed.

The registered provider had a range of systems to monitor and improve the quality of the service provided. We saw that the registered provider was enhancing these systems with the introduction of a computerised quality assurance system. The manager had systems in place to oversee the performance of the home and to identify any areas that needed to be developed.

We considered all the evidence we had 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?

This is a summary of what we found -

Is the service caring?

We found that people were cared for by kind and attentive staff. We saw that care staff had a good knowledge and understanding of the care needs of people who lived at the home. Interactions between staff and people who lived at the home were caring and respectful. We observed that where people became distressed or were feeling unwell staff took time to offer reassurance and speak with those individuals about what was concerning them.

Is the service responsive?

People's care and support needs had been assessed and care plans were in place that contained an accurate record of the care and support that people wanted to receive. We saw that where people's care needs had changed these were re-assessed and plans of care were updated. Throughout our visits to the home we saw that where people required input from other healthcare professionals this was arranged and co-ordinated by staff without delay. For example we observed staff calling local GP practices to arrange home visits after someone complained of feeling unwell. We also saw staff interactions and communication with other visiting healthcare professionals such as district nurses.

Is the service safe?

We saw that the registered manager had carried out a number of risk assessments in relation to ensuring the safety of both people who lived at the home, staff and visitors. We spoke with people who lived at the home and they told us that they felt safe at the home. We found that care records were up to date and contained an accurate record of the assessed needs of individuals. This meant that care could be planned and delivered safely and effectively.

We found that the registered manager carried out regular audits to ensure the safety of people who lived at the home and these included reviewing safety throughout the premises. This meant that any potential risks were identified and action taken to mitigate the risk to people's safety.

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. The DoLS apply to 'care homes and hospitals'. At our inspection we found that nobody living at the home was subjected to any DoLS.

Is the service effective?

People we spoke with throughout our inspection visits told us they were happy with the home. From our observations we saw that people who used the service laughed and joked with staff and that there was a very relaxed atmosphere. We found that people had their individual care and support needs met, that where input from healthcare professionals was required the home took appropriate action to ensure people had their care needs met.

We found that care was delivered by staff who had received appropriate training and who were supported to obtain further professional development in their individual roles.

Is the service well led?

The provider had a quality assurance system in place that monitored and assessed the provision of the service that they provided on a regular basis. We found that the registered manager worked alongside stakeholders including the local authority and carried out monthly audits and checklists of the service. Monthly audits were carried out to identify areas for improvement and action was taken in response to these findings.

People who used the service were given the opportunity to express their views on the service at regular 'resident' meetings.

The provider had developed a process to handle and investigate any complaints about the service. The service had not received any complaints in the last 12 months and as such it was not possible to review the effectiveness of the process.

What people told us?

Throughout our inspection visits we spoke with five people who used the service and two relatives. People who lived used the service told us that they felt safe and comfortable living there. One person said, "Oh I feel safe here absolutely, I have no concerns in fact I am really very happy." Another person said, "I am well looked after; really I could not ask for more", and "I have other options of places I could live but I chose here, I think that says it all really."

We spoke with people about the staff that delivered care and support to them. The people we spoke with told us that they felt there were sufficient numbers of staff available at all times of the day and told us that they felt that staff had the relevant training to ensure they could meet their needs. One person said, "The staff are wonderful; anything I need and they are there; I am never made to feel like a nuisance!" Another person said, "They (the staff) are fantastic, you could not ask for better."

People we spoke with told us that they felt that the home responded to their needs. One relative we spoke with provided us with examples of actions the staff had taken when GP visits had needed to be arranged; how they had responded when their behaviours changed and how they ensured that hospital appointments were well managed. This relative told us that the management and staff within the home communicated with themselves and other healthcare professionals well. They said, "We have never had concerns, they make sure GPs are called when necessary and when appointments are made at hospital they make sure they attend. Really no concerns would not want them to live anywhere else." Another relative said, "I find them to be extremely responsive to their needs."

We spoke with people who used the service and their relatives about how they would raise concerns or make a complaint if necessary. We asked if people were aware of a complaints procedure. People told us they were unaware of any formal process but that they would speak out and raise their complaint with staff in the first instance if it was appropriate to do so.

We wrote to the provider and asked them to make improvements. The provider wrote to us and told us that they had taken action to address the concerns. At this inspection we reviewed the actions the provider had implemented.

We spoke with the provider and a senior carer and discussed the management of medicines in the home. We found that the provider had ensured medicines were now managed safely and all our concerns had been resolved.

The people we spoke with confirmed that they had been involved in discussions about their care and support needs. People told us they were able to make their own day to day decisions and lifestyle choices. One person we spoke with told us,' I can do what I want to do and staff always ask me what I want.'

The five people we spoke with and the two relatives told us that on the whole there was sufficient staff on duty. One relative we spoke with told us, 'The staff are always cheerful, they take people out even on the train in their wheelchairs.' We spoke with two members of staff who told us they felt the staffing was adequate and if extra staffing was required they contacted the manager.

We observed staff interacting well with people and supporting them which

had a positive impact on their wellbeing.

We reviewed the medication and found that arrangements were not in place to protect people against the risks associated with storage of medicines.

The quality of the service was monitored and reviewed on a regular basis.