Archived: The Laurels Nursing Home

The Laurels Nursing Home is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 30 people. The care home is in an old house with a modern single-story extension.

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

The provider had failed to ensure that there was adequate management at the home. The registered manager was away from the home for a prolonged period and arrangements put in place to manage the home were inadequate and ineffective.

There was a lack of oversight at the home. Audits had not been completed to monitor the quality and safety of the care provided. When concerns were raised effective action was not taken to keep people safe.

Risks to people were not properly assessed and care was not provided in a manner to reduce risks to people. Medicines were not safely managed and infection control processes in the home did not keep people safe from the risk of infection.

There were not enough staff in the home to meet people’s needs in a timely fashion and staff did not have the skills needed to care for people safely.

Staff had failed to report concerns raised to them about possible abuse in the home.

People’s rights had not been respected. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 requires improvement (published 20 August 2020).

We also inspected the home with reports published on 15 January 2021 and 24 February 2021. These were targeted inspections and we did not review entire key questions, therefore we did not review the rating at these inspections.

Why we inspected

We received concerns in relation to people’s safety at the home, the management of medicines and the management of the home. 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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings 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.

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.

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 the safeguarding of people from abuse, management of risks, medicines, infection control, staffing and the management of the home at this inspection.

We imposed conditions on the registration of this provider to restrict admissions to the home and drive improvements in care. Furthermore, we took action to close the service under The Health and Social Care Act 2008 and this action was successful.

Follow up

We will continue to monitor information we receive about the service until we 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 of 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.

The Laurel’s Nursing Home is a residential care home providing personal and nursing care to 13 people at the time of the inspection. The service can support up to 30 people in one adapted and extended building over two floors.

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

The infection prevention and control practices at the service had shown a marked improvement since our last visit. People were supported by staff who followed good infection prevention practices. Staff had been supported with further update training on donning and doffing personal protective equipment (PPE).

The environment people lived in was clean and well maintained, the risks to people from COVID 19 had been assessed and safe measures were in place to support people.

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

Rating at last inspection (and update)

We undertook a focused inspection on 4 August 2020, looking at safe and well Led, at this inspection we rated the service as Requires Improvement. Following this we undertook a targeted Infection Prevention and Control (IPC) inspection on 22 December 2020, following an outbreak of COVID 19 at the service. We did this to look at the risks to people living in the service. We found the provider was in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, we issued a warning notice to the provider.

Why we inspected

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

We undertook this targeted inspection to check whether the provider had met the breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) 2014 and that the Warning Notice we previously served had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is an old building set over two floors with a purpose built ground floor extension.

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

Infection prevention and control was not always well managed. Staff did not always follow good practice when putting on and removing (donning and doffing) personal protective equipment (PPE). During a recent outbreak of Covid 19 the environment had not been optimised to reduce possible further spread of the infection.

People's care records had not been up dated to include specific risks for them in relation to Covid 19.

Some areas of the service were in poor repair, this impacted on staff’s ability to effectively clean these areas. Some areas lacked hand washing equipment and were not cleaned effectively. Cleaning records were not always completed to evidence good cleaning practices were taking place.

We found areas of good practice

Information and guidance on COVID- 19 restrictions was available and visible for staff, people and visitors.

There were sufficient stocks of PPE. This included masks, gloves, aprons and visors. There were also sufficient stocks of hand sanitiser and cleaning materials.

People who lived at the service and staff underwent regular Covid 19 testing in line with government guidance. People admitted to the service were supported in line with government guidance on managing new admissions during the Covid 19 pandemic.

Since the outbreak the provider had maintained a no visiting policy with an exception for people who were nearing the end of their life. People were supported to keep in touch with their relatives and friends through telephone calls, video calls, and window visits.

Further information is in the detailed findings below

Rating at last inspection

The last rating for this service was requires improvement (published 20 August 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider was in breach of regulations.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about infection control. A decision was made for us to carry out an infection control inspection and examine those risks.

We have found evidence that the provider needs to make improvements.

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 inspection, by selecting the 'all reports' link for The Laurel’s Nursing Home 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 infection control at this inspection.

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 program. If we receive any concerning information we may inspect sooner.

The laurels Nursing Home is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The care home can accommodate 30 people in one adapted and extended building.

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

Although we found people were protected from abuse, the registered manager had not informed us of a safeguarding event. They had also not informed us of significant events which occurred at the service. The risks to people’s care were assessed and measures in place to mitigate these risks. People were supported with adequate numbers of staff who had received training for their roles. Staff were recruited safely.

People’s medicines were managed safely and the environment they lived in was clean.

People received care in a person-centred way and the registered manager undertook a range of quality audits to monitor the care people received. Relatives told us they were involved in their family member’s care and staff worked with health professionals to support the people in their care.

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 Requires Improvement published 23 May 2019 they were in breach of one of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 23 May 2019). The service remains rated requires improvement. This service had been rated inadequate or requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to follow up on concerns we had received and to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The failure to notify us of events at the service.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

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

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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

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.

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 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.