Laurel Villas Limited

Laurel Villas provides personal care for up to 24 older people in the Ashton area of Preston. The home is arranged over two floors with lift access. Accommodation is provided in single rooms with ensuite facilities. There was a variety of well-furnished communal areas for people to socialise in or enjoy some quiet time. The gardens were large and well maintained, one of the people living in the home assisted in the garden. At the time of inspection there were 19 people living in the home.

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

People received safe care from staff who were committed to providing high-quality care. Staff had received training and their competencies had been checked, which helped ensure care quality was maintained.

People living in the home, their relations and staff working in the home praised the caring and approachable nature of the registered manager. People said they were happy living or working in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager did not have consistent oversight of some aspects of the service. Auditing remained irregular and some opportunities to identify hazards had been missed. These had been addressed during the inspection.

Rating at the last inspection and update

The last rating for this service was requires improvement, published 24 April 2020. At our last inspection we recommended that the provider made improvements in relation to; the safe management of medicines, staff recruitment and good governance. At this inspection we found improvements had been made in relation to medicines management and recruitment. However, further improvement was needed in relation to good governance.

Why we inspected

This focused inspection was prompted by a review of the information we held about this service.

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 undertook this inspection at the same time as the Care Quality Commission (CQC), inspected a range of urgent and emergency care services in Lancashire. To understand the experience of social care providers’ and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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.

Laurel Villas provides personal care for up to 24 older people. The home is situated in a suburban area of Ashton in central Preston. The home is not purpose built and arranged over two floors with access provided to all parts of the home via a lift. The accommodation provides a homely atmosphere with plenty of communal space including a large lounge that overlooks a very attractive garden that can be easily accessed. At the time of the inspection there were 20 people receiving personal care at the service.

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

Medicines were not always managed safely. We found examples where people had not been given their medication in line with guidance. We found no impact to people however, people could have been exposed to risk. We have made a recommendation about this.

Staff recruitment was safe, however documentation was not always kept in line with regulation. We have made a recommendation around this. The service was clean and tidy throughout and staff followed infection prevention practices. People told us they felt safe living at Laurel Villas. We were told and could see from observations there were enough staff to meet people's needs. One person told us, "I’ve always felt safe here."

We found some inconsistencies in documentation and the processes to promote safe care and treatment had been implemented but were not fully embedded. We have made a recommendation around this. There was a positive staff culture at the service. We found the management team receptive to feedback and keen to improve the service. The registered manager worked with us in a positive manner and provided all the information we requested.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were involved in their care planning. People told us they enjoyed the food and they were offered choice.

The service had a programme of activities. All the people who lived at the service told us they were happy with the activities and they enjoyed them. One person said, “You’re kept well entertained here, singers, dominoes, bingo, but you can say no.” Staff understood the importance of supporting people to have a good end of life as well as living life to full whilst they were fit and able to do so.

The registered manager and staff were caring. Staff were aware of how to protect people's privacy and dignity and people told us staff did this well. One person said, “I can have a bath when I want, and they always shut the door.” People told us the staff were kind and caring. People felt supported to make decisions about their daily lives.

Rating at last inspection

The last rating for this service was good (published 23 August 2018).

Why we inspected

The inspection was prompted due to concerns found at another registered location for the same provider. A decision was made for us to inspect and examine if similar risks were apparent at this service. We planned to complete a focussed inspection to look at the risks. However, we found some evidence to partially substantiate the concerns. Therefore, as per our guidance we completed a full comprehensive inspection.

Follow up

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

Laurel Villas provides personal care only for up to 24 older people. The home is situated in a suburban area of Ashton in central Preston. The home is close to shops and local amenities. The home is not purpose built and arranged over two floors with access provided to all parts of the home via a lift. The home offers short to long term care or a home for life.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Laurel Villas is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection in September 2017 we rated the service as ‘Requires Improvement’. This was because breaches of legal requirements were found. These related to consent to care and treatment for people who lived at the home. Furthermore, the management team failed to properly assess the quality assurance of the service provided. We made a recommendation to improve quality assurance systems.

During this inspection, we found the provider had made improvements to ensure they met legal requirements. In addition, they had addressed the recommendations from the previous inspection. There now were systems in place to undertake quality audits in a timely manner to ensure the service continued to be monitored and improvements made where required. In addition, consent to care and support had been sought from people and their representatives where possible and evidence they had singed documentation to agree to this was found in care records we looked at.

People who lived at the home and relatives we spoke with told us they were very happy with the care provided at the home and staff were caring and supportive. They told us staff were very kind and respectful and spent quality time with them. One person said, “Lovely staff who respect you as an individual which is nice when we talk together.”

During the inspection visit we observed staff being kind and attentive to people in their care. They were caring, patient and respectful. Comments we received confirmed that.

People who lived at Laurel Villas received their medicines on time and as required. Care records we looked at contained a medication care plan and risk assessment to inform staff about medication details for each individual.

There was a safeguarding procedure document on display in the reception area of the home. This gave people who lived at the home, visitors and staff information about who to report any concerns to. Staff informed us they had received training in safeguarding vulnerable people and records confirmed this.

The registered manager completed risk assessments to guide staff about the mitigation of risk to people who lived at Laurel Villas. Completed accident forms with clear documentation about any injuries and measures introduced to reduce their reoccurrence were kept. Furthermore, the registered manager would look for any patterns or trends that would be addressed to ensure people were kept safe.

The layout of the premises was appropriate for the care and support provided. We found facilities and equipment had been serviced and maintained as required to ensure Laurel Villas was a safe place for people to live.

Staff had been recruited safely, appropriately trained and supported. They had skills and experience required to support people with their care and social needs. One staff member said, “Training has been good and continues to be so.”

The service had sufficient staffing levels in place to provide support people required. We saw staff showed concern for people’s wellbeing and responded quickly when people required their help.

All people we spoke with were highly complementary about the quality of food and comments included, “Great food the cooks are really good and make excellent home made soups and cakes.”

People had been 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.

Care planning followed a person-centred approach and people told us they were involved in this process. We observed staff supported their human rights to good levels of family contact and supported them to meet their diverse needs.

People who lived at the home told us they enjoyed a variety of activities and regular outside entertainers which were organised for their enjoyment. One person said, “The singer yesterday was fantastic he comes often the lounge was full. Ask anyone we all enjoyed it.”

There was a complaints procedure which was made available to people and their family when they commenced using the service. People we spoke with told us they were happy with the support they received from staff and the registered manager and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service. These included informal staff and resident meetings and satisfaction surveys to seek their views about the service provided. In addition, daily ‘handover’ meetings were held to discuss the day’s events and any issues in relation to people who lived at the home.

long term care or a home for life. On road parking is available outside the home.

The last inspection of this service took place on 11 November 2014. At the last inspection the service was rated Good.

The registered manager was present throughout our inspection 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.

This unannounced inspection was conducted on 10 August 2017. At this inspection we identified some concerns and breaches of regulations.

We looked at how the service gained people’s consent to care and treatment in line with the Mental Capacity Act 2005 (MCA). We found the principles of the MCA were not consistently embedded in practice. Written consent to various aspects of care and treatment was observed on some people's files. However, in others, consent forms had not been completed. We also found some examples where consent had been provided by people's family members, but there was no confirmation the people who had provided consent had legal authority to do so.

Evidence was available to demonstrate staff had submitted an authorisation for the Deprivation of Liberty Safeguards (DoLS) application for one person who used the service. However we found multiple examples of restrictive practices contained within the care files. These included the use of door monitors and sensor mats to alert staff to when people were out of bed. In addition we observed the front door was locked with a keypad and people were not always free to leave the building as they wished.

The concerns amounted to a breach of regulation 11 (Consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We have made a recommendation about infection control.

We have made a recommendation about quality and monitoring checks.

When we last inspected this service in November 2014 we made some recommendations to the provider. We checked on this inspection if improvements had been made. During our last inspection, we made a recommendation around medicines audits. At this inspection we checked the audit for medicines and found the provider had implemented a comprehensive medicines audit since our last inspection.

During our last inspection, we made a recommendation around accidents. This was due to the documentation not being retained in a confidential manner. We looked at how accidents and incidents were being managed during this inspection. We found there was a central record for accident and incidents to monitor for trends and patterns and the management had oversight of these.

During our last inspection, we made a recommendation around the induction process for staff. We looked at this process during the inspection and found changes had been made. We spoke to staff members who had recently started working at the service. One staff member told us, “I have had lots of training and support; I completed shadow shifts and did not begin working on my own until I was confident.”

During our last inspection, we made a recommendation around peoples dietary needs being recorded into their care plans. We looked at peoples care records during this inspection and found the service was pro-active in supporting people to have sufficient nutrition and hydration.

During our last inspection we made a recommendation around involving people and their relatives in the care planning process. We checked improvements had been made at this inspection. The management team and staff told us they fully involved people and their families in their care planning. People told us they were aware of their care plan and felt able to input to it if they wished One relative told us, “I’ve been involved in the care plan from the beginning.”

At this inspection people who lived at Laurel Villas told us they felt safe and supported by staff and the management team. Systems were used to reduce people being at risk of harm and potential abuse. Staff had received up to date safeguarding training and understood the provider's safeguarding adult’s procedures. People told us there was enough staff on duty and staff came quickly to any requests for support. One person told us, “There are definitely enough staff.”

We looked at how risks to people were being managed; we found people were protected from risks associated with their care because the registered provider had completed risk assessments.

People were protected by suitable procedures for the recruitment of staff. Maintenance records showed safety checks and servicing in the home including the emergency equipment, water temperatures, fire alarm, call bells and electrical systems testing.

People received care which was relevant to their needs and effective because they were supported by an established staff team. They also had received appropriate training such as moving and handling and had a good understanding of people’s needs. We confirmed this by our observations during the day.

We observed lunch being served, people ate in a relaxed manner and they enjoyed their meals. People had a choice of what they wanted to eat and staff were aware of people’s needs in this area. People told us, “I’ve had a lovely dinner.” Also, “The food is very good.”

Care plans showed where appropriate the service had made referrals to health care professionals such as the community nursing team and GP's.

We received consistent positive feedback about care provided at Laurel Villas from people who lived at the home. People's beliefs, likes and wishes were explored within care records and guidance in these records reflected what staff and people told us about their preferences.

We saw care records were written in a person centred way and observed staff followed guidance in care records. We found assessments were undertaken by management prior to any person being accepted into the home. Assessments took place to ensure people’s needs could be met by the service.

We saw people engaged in activities positively with staff. People were supported and encouraged to take part in activities, these were provided by the care staff and included one to one time and games. During the afternoon of the inspection visit there was a group of people being supported by staff to play dominoes in the garden.

People were encouraged to raise any concerns or complaints. The service had a complaints procedure and we saw evidence this was followed.

People who lived at the home and relatives told us the home was well led. We found the registered manager to be familiar with people who used the service and their needs.

We found minutes of meetings were retained and staff confirmed they had meetings, so they could get together and discuss any relevant topics in an open forum.

We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

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

We spoke to three people who lived at the home and five visiting relatives. Each person we spoke to was happy with the standard of care offered at the home. Comments we received included, 'The staff are lovely. They treat me right'. and 'The staff really know me and what I need. I'm happy here."

We found that people were supported to access help and support from health professionals when they needed it. We spoke to a district nurse who told us the staff at Laurel Villas listened to and acted upon their guidance and advice.

We found there were effective recruitment and quality assurance processes in place.

We observed that staff interaction with people was very good. Staff engaged with them in conversations. They spoke to them respectfully, communicated well and appropriately, and offered assistance when needed. It was evidenced that where possible independence was promoted. People requiring assistance to eat was given this with dignity and patience.

People told us they were given the help and support they needed. They said staff was, 'Friendly and kind', 'Do what I want them to do', "Very patient with these ladies", 'Will sit and have a chat to you when your feel worried' and "Nothing is too much trouble for them'.

We observed people in the home were relaxed around staff. They were able to express themselves freely and openly. People who were able to express themselves told us staff treated them well and they had no cause for concern. There were no rules to follow and no rigid routines.

We observed how people engaged with staff in various activities of daily living. Staff was always present around people and available to offer assistance when needed.