We carried out a review of the data available to us about The Laurels Care and Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Laurels Care and Nursing Home, you can give feedback on this service.
People’s experience of using this service and what we found
People said they were satisfied with the variety and quality of the meals provided at the service. However, we found people's mealtime choices and offering a balanced diet could be better. We have therefore made a recommendation for improvement.
Some parts of the accommodation and outside areas needed improvement. The provider had plans in place to develop the service for people’s comfort and wellbeing. We have made a recommendation about re-furbishing the service in response to people’s needs.
People's needs were being assessed, planned for and reviewed. Each person had a care plan which was designed to meet their needs and choices. People were supported with their healthcare needs. Changes in people's health and well-being were monitored and responded to. Where necessary, people received appropriate medical attention.
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 told us they felt safe at the service. We observed people were relaxed and content in the company of staff and managers. Recruitment records were being further developed, to show all the appropriate checks were carried out before staff started work. There were enough qualified staff available to provide safe care and support; staffing arrangements were kept under review. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns.
Health and safety was promoted, this included maintenance of the premises, servicing and checking systems. Risks to people's individual well-being were assessed and managed. Staff followed processes which aimed to manage people's medicines safely.
People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.
There were opportunities for people to engage in a range of group and individual activities. Visiting arrangements were flexible, relatives and friends were made welcome at the service. Processes were in place to support people with making complaints. Complaints records and management systems were being further developed.
Management and leadership arrangements supported the effective day to day running of the service. The Laurels Care and Nursing Home had a welcoming and friendly atmosphere. The provider used a range of systems to regularly monitor and improve the service. Further systems were being introduced. There were processes to consult with people who used the service and others, to assess and monitor the quality of their experiences and make improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rating for this service was good (published 4 March 2017)
Why we inspected
This was a planned inspection based on the previous rating
Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.
During this inspection we found evidence improvements had been consistently maintained and the service was meeting the current regulations.
The Laurels Care and Nursing Home provides accommodation and nursing and personal care for up to 28 people, most of who are living with dementia. The service is located close to the centre of Bacup and all local amenities. It is an older type grade 2 listed property with facilities on three floors. The majority of bedrooms do not have en-suite facilities although bathroom and toilet facilities are available on both floors. There are well maintained gardens and a car park for visitors. At the time of this inspection there were 18 people resident at the home.
There was a manager in post who was registered with the Care Quality Commission. A 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.
All the people, their relatives, and a visiting professional we spoke with told us the service provided a good level of care and support that placed people at the heart of their care. We found people’s rights to privacy, dignity, and freedom of choice was embedded into the culture of the home and people’s diversity was embraced.
People living in the home told us they felt safe and very well cared for. They considered staff were always available to support them when they needed any help.
Recruitment processes and procedures that were followed ensured new staff were suitable to work with vulnerable people. We found there were enough staff deployed to support people effectively at all times.
Safeguarding referral procedures were in place and staff had a good understanding around recognising the signs of abuse and had undertaken safeguarding training. Staff was clear about their responsibilities for reporting incidents in line with local guidance and staff knew how to report any poor practice.
Risks to people’s health, welfare and safety were managed well. Risk assessments relating to people’s care were good and staff were familiar with the needs of people at risk of poor nutrition, falls, and pressure ulcers. Charts used to monitor people at risk were being used effectively.
There were appropriate arrangements in place in relation to the safe storage, receipt, administration and disposal of medicines. Staff responsible for administering medicines had been trained.
All people spoken with were very positive about staff knowledge and skills and felt their needs were being met appropriately. Staff felt confident in their roles and they were supported by the registered manager to gain further skills and qualifications relevant to their work. They were motivated and committed to provide a high quality of care.
Training was being provided to support the staff to deliver safe and effective care and support. Staff training needs was being routinely assessed and planned for and staff received regular supervision.
Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.
People told us they enjoyed the meals. They were provided with a nutritionally balanced diet that catered for their dietary needs. Staff worked closely with healthcare professionals to ensure people’s dietary needs were met.
People we spoke with considered staff were kind and caring. We found staff were very respectful to people, attentive to their needs and treated them with kindness in their day to day care. We observed people’s dignity and privacy was being respected. Staff had a good understanding of people’s personal values and needs and had been trained to ensure people’s right to privacy, dignity, independence, choice and rights was central to their care.
People had a plan of care that covered all aspects of their daily lives and embraced their diverse needs such as faith and gender issues. Care plans provided staff with guidance and direction on how best to support people and to be mindful of what was important in people’s lives when providing their support.
People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.
Communication between all staff was good. People's care and support needs were discussed on a daily basis.
Activities were varied and meaningful and people benefitted from individual and group sessions that provided stimulation. People were encouraged at their meetings to put forward ideas for activities and there was evidence their suggestions was acted upon.
The complaints procedure was displayed in the home and we found processes were in place to record, investigate and respond to complaints. Complaints raised were taken seriously and action taken to bring about resolution.
People using the service, relatives, health care professionals and staff considered the management of the service was good and they had confidence in the registered manager.
There were systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being. We found regular quality audits and checks were completed to ensure any improvements needed within the service had been considered and action taken.
We undertook this focused inspection on 10 March 2016 to check whether the provider had followed their plan and to confirm that they were meeting legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Laurels Care and Nursing Home on our website at www.cqc.org.uk.
The Laurels Care and Nursing Home provides accommodation and nursing and personal care for up to 28 people, most of who are living with dementia. The service is located close to the centre of Bacup and all local amenities. It is an older type grade 2 listed property with facilities on three floors. The majority of bedrooms do not have en-suite facilities although bathroom and toilet facilities are available on both floors. There are well maintained gardens and a car park for visitors.
There was a registered manager in post at the time of our inspection. 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.
At this inspection we found that the provider had followed their plan and legal requirements were being met.
We saw evidence risk assessments had been completed to ensure people’s health, welfare and safety. Adjustments had been made to the environment as a result of these. People using the service had a personal evacuation plan which meant staff knew how to support people in the event of an emergency.
People’s care records were being maintained properly which helped determine people were receiving their care safely, consistently and appropriately. These records were audited daily by senior staff.
We saw evidence that people’s medicines were being managed properly and safely. Medicines management policies and procedures had been updated to reflect current practice and best practice guidance. Staff had received training in medicines management and their competence to administer medicines safely had been assessed. There were appropriate processes in place for the ordering, storage, administration and disposal of medicines.
Recruitment processes and procedures had improved which meant applicants applying for jobs would be properly checked to ensure their suitability.
Infection control had improved at the service. Guidance relating to infection control was available to staff. The home environment was clean and there were no unpleasant odours.
Improvements had been made to the home environment, making it more suitable for people living with dementia. Some furniture and flooring had been replaced and some areas of the home had been redecorated.
A manager had been registered with CQC.
Audits were completed in relation to many areas of the service. We saw evidence that they were effective in ensuring that appropriate levels of care and safety were achieved and the improvements required following the last inspection had been made.
Whilst improvements had been made, we could not improve the rating for the service from 'requires improvement' because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection to look at the overall quality of the service, and to provide a new rating for the service under the Care Act 2014.
We carried out an unannounced inspection of The Laurels Care and Nursing Home on 27 and 28 August and 1 & 2 September 2015.
The Laurels Care and Nursing Home provides accommodation and nursing and personal care for up to 28 people, most of who are living with dementia. At the time of the inspection there were 23 people accommodated in the home.
The service is located close to the centre of Bacup and all local amenities. It is an older type grade 2 listed property with facilities on three floors. The majority of bedrooms do not have en-suite facilities although bathroom and toilet facilities are available on both floors. There are well maintained gardens and a car park for visitors.
The registration requirements for the provider stated the home should have a registered manager in place. There was no registered manager in post on the day of our inspection as the registered manager had left on the first day of 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.
At the previous inspection on 24 & 26 March and 1 April 2015 we found the service was not meeting all the regulations in respect of keeping the premises clean and free from odours, failing to make sure records were complete and accurate and failing to ensure people were protected against the risks associated with the door locking systems. The registered provider was asked to take action to make improvements. The registered provider did not send us a formal action plan. The registered provider had told us in a letter, prior to the report being published, that action had been taken to address all the breaches in regulation apart from replacement of the door locks.
Prior to this inspection visit there had been concerns raised regarding the delivery of people’s care and a number of safeguarding alerts were raised. We brought our planned inspection forward.
During this inspection visit we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe recruitment practices, quality assurance systems, maintaining accurate care records, medicines management and identifying risks to people’s safety.
At the last inspection we asked the registered provider to take action to remove the risks associated with unsuitable locking devices on people’s bedroom doors. New locks had been ordered but were unsuitable. Prior to our inspection visit the provider had to be asked to disable the existing locks as we were made aware that people were still at risk. This action has been completed and new locks were fitted following the inspection.
At the last inspection we asked the registered provider to take action to improve individual assessments of risks to people’s health and welfare. This action has been completed and risk assessments were recorded and kept under review.
We reviewed how the service managed risk. We found assessments were not available for risks such as door locks, call bells, safe fire evacuation, portable heaters, access from the corridors to the stairways and reduced access to toilets caused by the corridor ramps. You can see what action we told the provider to take at the back of the full version of the report.
At the last inspection the registered provider was asked to make improvements to the way people’s care was recorded. During this inspection we looked at people’s care charts and found gaps which made it difficult to determine whether they were receiving their care safely and appropriately. We were told new documentation was being introduced which would improve this. You can see what action we told the provider to take at the back of the full version of the report.
We looked at how the service managed people’s medicines and found deficiencies in the way they were managed. You can see what action we told the provider to take at the back of the full version of the report.
We looked at the way new staff were recruited. We found safe and robust recruitment and selection processes had not been followed. We found suitable checks had not been completed which could place people at risk from unsuitable staff. You can see what action we told the provider to take at the back of the full version of the report.
The number of shortfalls that we found during this inspection indicated quality assurance and auditing processes had not been effective as matters needing attention had either not been recognised or had not been addressed. You can see what action we told the provider to take at the back of the full version of the report.
At our last inspection we found a breach of regulation because the registered provider had failed to ensure parts of the home were clean and free from odours. During this inspection we found whilst some areas of the home were clean and odour free we found others that remained malodourous. The local authority infection control lead nurse visited the home during our inspection. We were told she had no immediate concerns. We made a recommendation that the service followed advice and guidance regarding infection and prevention control practices.
Prior to our inspection the local authority safeguarding team told us they had concerns about people being left unattended. During this inspection we observed there were sufficient staff to meet people’s needs but we had concerns about how staff were deployed and the lack of leadership and direction they received. However, following our initial visit the registered provider had provided appropriate management cover and had appointed a manager. In addition we found staff were working more effectively as a team, were available in all areas of the home and were responding to people’s needs and requests in a timely way.
During our visit we observed staff talking gently and calmly to people to try to resolve difficult situations. There were clear instructions recorded to guide staff with dealing with behaviours that challenged the service. However, not all staff had received training in this area which would help to keep themselves and others safe. We made a recommendation that the service provided staff with appropriate training to safely support people with behaviours that challenged the service.
We found most staff had received a range of appropriate induction, supervision and training to give them the necessary skills and knowledge to help them look after people properly. However there were a number of gaps in the training record and it was difficult to determine whether bank and agency staff had received appropriate induction and training.
People told us they enjoyed the meals and said they were offered meal choices and alternatives to the menu were provided. We saw people being sensitively supported and encouraged to eat their meals.
Staff had an understanding of abuse and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. We observed people being asked to give their consent to care and treatment by staff.
At our last inspection we found some areas of the environment were in need of improvement. During this inspection we looked at all areas of the home. We found some areas were well maintained whilst other were still in need of improvement. We also noted the environment was not well designed for people living with dementia. However, there was a development plan that included areas for improvement within appropriate timescales.
People told us they were happy with their bedrooms. Some had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments. We made recommendations that the service obtained guidance and advice regarding providing a suitable and interesting environment for people living with a dementia and that they complied with the dates on the improvement plan.
Records showed the service had good links with other health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care. A visiting healthcare professional told us staff kept them up to date with any changes to people’s health, would contact them for advice and would follow any recommendations made. Another healthcare professional told us they had no concerns about the care provided at the home.
During our visits we observed staff responding to people in a caring and considerate manner and staff taking time to sit and listen to people. Some people were able to make choices and were involved in decisions about their day. We heard staff speaking to people in a respectful way and saw people were dressed smartly and appropriately in suitable clothing of their choice.
People who used the service and their relatives were encouraged to discuss any concerns during meetings and day to day discussions with staff and management and also as part of the annual customer satisfaction survey. Records had been maintained of people’s concerns and records showed the service had responded in line with procedures. We were told people’s concerns and complaints were monitored to help improve the service.
There were systems in place to seek people’s views and opinions about the running of the home. People’s views were taken into consideration and there was evidence changes had been made as a result of this to areas such as the provision of activities and the display of complaints guidance.
Before a person moved into the home a detailed assessment was carried out about their needs. People were able to visit the home and meet with staff and other people who used the service before making any decision to move in.
Each person had a care plan that was personal to them which included information and specific instructions about the care and support they needed and wanted. Information had been improved since our last inspection. The care plans had been updated by staff regularly and in line with any changing needs. Records showed some people living in the home, or their relatives, had been involved in decisions about their care. However, we made a recommendation the service should seek guidance in relation to the recording of and management of Do Not Attempt Resuscitation (DNAR) orders.
There was an activities person who was responsible for the provision of daily activities. Activities provided included games, the use of memory boxes, shopping, films, gardening, church services, hand and nail care, one to one sessions, reading and arts and crafts. People told us they were able to keep in contact with families and friends. Visitors told us they were made to feel welcome.
We last inspected The Laurels Care and Nursing Home on the 4 October 2013 to check whether requirements relating to staffing had been met. Prior to this we had visited the service on 12 July 2013.
This inspection took place on 24 and 26 March and 1 April 2015 and was an unannounced inspection which meant the provider and staff did not know we were coming. The home is registered to provide care for up to 28 people. At the time of our visit there were 22 people living in the home. The home was providing care for older people including people living with dementia and people with nursing care needs.
The registration requirements for the provider stated the home should have a registered manager in place. There was no registered manager in post on the day of our inspection. The Care Quality Commission has however received an application from the home manager to register as registered manager. 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.
We asked people who used the service if they felt safe in the home and if they had any cause to be concerned about how they were treated. Some people could not express their views and family members spoke on their behalf. One relative said, “I think they (staff) are very patient with people. They deal with all sorts of challenges on a daily basis. They work hard.” Another relative told us, “They do their best. I would know if there was anything untoward regarding her care. She is always clean and tidy when I visit. I find the staff to be well mannered and caring.”
We were concerned over the risk of bedroom locks being used when staff were not issued with master keys. This meant staff could not enter people’s bedrooms easily in an emergency situation. You can see what action we told the provider to take at the back of the full version of the report
We found individual risks had been identified and recorded in people’s care plans. However we found records used to support staff to monitor risks such as skin integrity and nutrition were not being completed properly This placed people at increased risk of not receiving the right care and support. You can see what action we told the provider to take at the back of the full version of the report.
Each person had an individual care plan. These were sufficiently detailed to ensure people’s care was personalised and they were kept under review. Staff discussed people’s needs on a daily basis and people were given additional support when they required this. Communication between staff needed to improve to be effective and help make sure people received safe and effective care. Referrals had been made to the relevant health professionals for advice and support when people’s needs had changed. This meant people received co-ordinated care.
People we spoke with told us they had their medicine when they needed it. We found medicines were managed well and appropriate arrangements were in place in relation to the safe storage, receipt, administration and disposal of medicines.
People were cared for by staff that had been recruited safely and were both trained and receiving training to support them in their duties. We heard positive comments about the staff and we observed staff were respectful to people and treated people with kindness in their day to day care. One person told us, “I am spoilt, I’m well looked after and have nothing at all to grumble about.” Relatives we spoke with described staff as being ‘kind’, ‘thoughtful’ and ‘very good’.
People we spoke with had mixed views about the staffing levels and availability of staff. They said, “There seems to be plenty of staff around.” One relative commented, “There is not enough staff around.” We were given an example of how they felt this had impacted on their relatives care. There appeared to be plenty of staff on duty but how staff were deployed meant that at times people were left unattended. The manager dealt with this immediately.
We undertook a tour of the building. The home was clean and hygienic in most areas; however we found acceptable standards of hygiene had not been maintained in three people’s bedrooms and on one corridor. Plans had been made to improve the environment with dementia care needs in mind and there was evidence work had commenced. For example the patterned carpet in the communal areas was to be replaced and some bedrooms had been refurbished. Some of the bedrooms needed redecorating as they were sparse and basically furnished. We found there was ongoing work to upgrade the premises and create a more dementia friendly environment for people living with dementia. Specialist equipment in use was clean and maintained.
Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. Staff were aware of people’s ability to make decisions for themselves and knew the principles of having best interest decisions made to support and protect people. We were told the provider was ‘generous’ when it came to food. Staff were made aware of people’s dietary preferences and of any risks associated with their nutritional needs. People’s weight was checked at regular intervals and we saw appropriate professional advice and support had been sought when needed. Staff supervision however was not effective in making sure people had the support they needed at mealtimes which means people may be at risk of not receiving adequate nutrition. This was addressed by the manager during our visit.
We have made recommendations about meeting nutritional needs.
Staff were seen to be patient, friendly and supportive when they were helping people. We noted people were well dressed with attention given to detail with personal touches such as wearing makeup and jewellery. This helped to support people retain their identity and dignity. One relative told us, “He has always liked to look smart. He is always clean and tidy when I come and dressed in the clothes he likes.”
People had been given the opportunity to discuss and document their wishes regarding end of life care. This meant people and those who matter to them could have peace of mind knowing their wishes were made known to staff.
Activities provided were limited and included entertainers visiting the home and usual festive and birthday celebrations. We were told the activity co-ordinator recently employed in this position was to have training. We were given details of plans they had made to improve this and people would have a personalised plan to help them engage in daily life. Visiting arrangements were good and visitors told us they were made to feel welcome.
We have made a recommendation about improving activities provided for people.
There was a clear complaints procedure. This was displayed for all to see together with other useful information such as advocacy services. People were encouraged to discuss any concerns during meetings, during day to day discussions with staff and management and also as part of the annual survey to give feedback on the service provided.
People told us the management of the service was good. The manager was relatively new and had applied to be registered as a registered manager with CQC. Staff commented, “The manager is lovely. We can always talk to her. She is very approachable.” “She’s very much hands on to help us when we need it. I could go to her with any problem and I know she will listen.” “Yes, she is nice and I can knock on her door at any time; I have no problems. If I want to see the owners they never turn me away and they are always around.”
There were informal and formal systems to assess and monitor the quality of the service which would help identify any improvements needed and provide an opportunity for people to express their views. However these were not entirely effective. Completed quality monitoring with people using the service showed an overall satisfaction with the service.
We have made a recommendation about ensuring improved systems were in place to effectively monitor the quality of the service provision.
People said they enjoyed the meals and there was a choice of menu. People's weight was monitored and when necessary advice was sought from other healthcare professionals.
We noted that procedures and training for all members of staff was in place for the prevention and control of infection.
We saw that members of staff were attentive to people's needs. However, we observed that at lunch time there were insufficient members of staff available to serve the meal and assist people with a dementia who required help with feeding.
We found that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about the care and facilities provided at the home.
We saw that people were treated with respect and leisure activities were routinely organised at the home. One visitor said, 'They talk to people properly.'
We found that members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.
Members of staff told us they received the training they needed in order to provide safe and appropriate care for people using the service.
We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about all aspects of the care and facilities provided at the home.
One visitor told us the staff were lovely and looked after her relative.
Some people explained that although staff sometimes discussed their care with them they were not routinely involved in reviewing their care plan.
One person said, "There's not enough to do, there's too much sitting around but they are trying to do more."
A number of people commented that the home was always clean.
People said they could choose when to get up and go to bed.
All the people we asked said the food was good.