Archived: Laureate Court

Laureate Court provides residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units; Byron and Shelly both provide nursing care and Keats which provides residential care. At the time of our inspection there were 57 people using the service.

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

The provider had made improvements to ensure people's medicines and risks were better managed. The provider ensured safeguarding concerns were addressed effectively, which helped keep people safe. The provider had made improvements to make sure there were enough staff to meet people’s needs and staff were recruited safely. The home was clean overall, although there was further room for improvement in this area. The provider monitored and , analysed accidents and incidents and this helped prevent recurrences.

The provider had made significant improvements to the environment, which meant the home was a nicer place for people to live in and was better adapted to suit their needs. Overall, the service supported people to maintain a good diet and hydration, and to maintain good health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff, received good induction, training, supervision and support to help them carry out their roles effectively.

Staff come across as very caring and committed. There was continuity of care and staff had a good knowledge of people's needs and preferences. People and those close to them were involved in formulating their care plans. The service promoted people’s rights and supported their cultural, spiritual and religious needs.

Staff assessed people’s needs and, overall, people’s care plan identified their individual needs well. Staff had a positive approach and knew how people expressed their feelings. Staff provided people with support to engage in activities and help them keeping links with and getting out into the community. We discussed further staff training around providing activities for people with advanced dementia and the registered manager addressed this straightaway. People's choices for their end of life care were recorded and reviewed. The registered manager dealt with any complaints in a fair and open way and used the information positively to improve the service.

The provider had made improvements in the audit used to monitor the safety and quality of service delivery and staff performance. However, these needed embedding into practice, and there remained room for further improvement. For, instance, some cleanliness and infection control audits needed to be strengthened. People, and those who were close to them, were regularly asked about their satisfaction with the service. It was evident the registered manager used people’s comments and ideas to develop and improve the service. It was also evident that the team worked well in partnership with other professionals to provide a service that met people’s needs.

Rating at last inspection and update

The last rating for this service was requires improvement (report published January 2019) and there were multiple breaches of regulation. 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 had made improvements and was no longer in breach of regulations. You can read the report from previous inspection by selecting the ‘all reports’ link on our website at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the previous rating.

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 service was previously inspected in July 2017, the service was given an overall rating of good.

Laureate Court is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation for up to 74 older people in one adapted building, including people living with dementia. It is situated on the outskirts of Rotherham. It is close to the local hospital and bus routes. At the time of our visit there were 63 people using the service.

At the time of our inspection there was a registered manager in post. 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.

Since our last inspection the provider had made changes in the management team, there was a new registered manager, a clinical lead and new nursing staff.

We found the systems in place to monitor the service. However, the management team carrying out the audits were new and although they had identified some areas of concern, we found some issues had not been identified in a timely way. The systems required further embedding into practice and improvements sustained by the new management team.

There were systems in place to manage medication administration and predominantly these were followed. However, we found staff had not always followed the procedures and it had not been identified through the audit system.

Risks associated with people’s care were identified. However, the documented management of the risks did not always give sufficient detail to ensure people’s safety.

There was a dependency tool in place to determine the care hours required to meet people’s needs. However, we found from observation, talking with staff and relatives that on two units there were insufficient staff available to support people who used the service in a timely manner.

The environment of the service in two units had been improved and was to a good standard. However, we found areas of the service that was not well maintained and not kept clean. People were not always protected against the risk of infections.

People were safeguarded from the risk of abuse. Staff confirmed they received training in this subject and could explain what actions they would take if they suspected abuse.

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. Staff received the training and support required for them to carry out their roles effectively. People received support from healthcare professionals when required and their advice was followed.

People were supported to maintain a healthy and balanced diet which included their choices and preferences.

We observed staff were kind, caring and considerate. Staff respected people’s privacy and dignity and involved them in their care and support.

The service was responsive to people’s needs and staff were very knowledgeable about how to support people in line with their preferences. However, care records did not always contain current information required to assist staff in how to support people. People were involved in social activities and enjoyed a range of social events.

The provider had a complaints procedure which was available if people wanted to raise concerns. Complaints were dealt with appropriately and used to improve the service.

Further information is in the detailed findings below.

You can read the report from our last inspections, by selecting the 'all reports' link for 'Laureate Court' on our website at www.cqc.org.uk.'

At this inspection we found that improvements had been made and we have taken the service out of special measures.

Laureate Court provides residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units; Byron and Shelly both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 41 people using the service, 19 people receiving nursing care and 22 people in receipt of residential care, including people living with dementia.

At our last inspection there had been changes in the way staff were deployed due to the temporary closure of the Byron unit. This unit was still closed at this inspection. The unit was being refurbished. Therefore there were still only two out of three units open at the time of our inspection.

The service had a 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.

The provider had a safeguarding policy in place and staff were aware of the procedures to follow to safeguard people from abuse.

Risks were identified and managed so that people avoided injury or harm. The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people's care needs. However, there was not sufficient staff to be able to meet peoples social needs. Recruitment systems were followed to ensure staff were suitable to support people.

Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we identified some improvements could be made and the records were not always accurate.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found the requirements of the act were being met.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People received adequate nutrition and hydration to maintain their health and wellbeing. The premises was being refurbished and improved at the time of our inspection to be able to meet the needs of the people who used the service.

Staff recruitment processes were robust. We found all the required pre-employment checks had been carried out. Staff received supervision and an annual appraisal of their work. Staff told us they felt supported in their role.

We found staff approached people in a kindly manner and were respectful. People and their relatives told us staff were kind and very caring. Staff demonstrated a good awareness of how they respected people’s preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s individual needs and preferences while supporting them.

People's needs had been assessed the care files we checked reflected people's care and support needs, choices and preferences. These had been reviewed and updated since our last inspection.

Activities in the home were infrequent. Relatives and people who used the service raised concerns about the lack of social stimulation. The registered manager told us they needed to recruit a full time activity coordinator as the previous one had left. They did have a part time coordinator but this was not sufficient for the number of people to ensure their social needs were met.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. Some complaints had been raised. We found the registered manager had recorded these and investigated and recorded outcomes. People told us they were listened to.

There were processes in place to monitor the quality and safety of the service. These were effective and had identified the issues we found during our inspection.

Laureate Court providers residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units, Byron and Shelly both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 48 people using the service, 20 people receiving nursing care and 28 people in receipt of residential care.

There had been recent changes in the way staff were deployed due to the temporary closure of the Byron unit. This was due to a planned refurbishment. Therefore there were only two out of three units open at the time of our inspection.

The service did not have 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. A manager had been appointed by the provider in January 2016. This person had left the service and another manager was in place who had commenced their employment with the organisation approximately four weeks prior to our inspection. This person was present throughout the inspection.

During this inspection we looked to see if improvements had been made and embedded in to practice from our last inspection. We found insufficient progress had been made. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Systems were in place to ensure people received their medications in a safe and timely way from staff who were appropriately trained. However, we identified some areas that could be further improved. People were not protected against the risks associated with infection prevention and control as safe procedures were not followed.

People who used the service, and their relatives we spoke with, told us they were happy with how care and support was provided at the home. All people we spoke with told us the staff were very good and they felt safe.

At our inspection of November 2016 we found improvements had been made in staffing levels and staff worked together better as a team. However, we found that the deployment of staff was not always effective to ensure people’s needs were met.

We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

Our observations showed most people were supported to eat and drink sufficient to maintain a balanced diet and adequate hydration. However documentation did not always support this and at times we saw some people were not adequately supported with their meals.

Staff told us they had not received regular supervision but felt supported with the new manager in post. Staff training had also been identified by the new manager as an area that required attention and they had arranged dates for training.

We saw evidence of involvement from health care professions when required. For example, we saw referrals to speech and language therapists when people presented with swallowing difficulties.

The service was a purpose built home but was in need of refurbishment. The environment was not well maintained or dementia friendly. The provider was aware of this and had a refurbishment plan. Since our last inspection in June 2016 the provider had closed one unit, Byron, in preparation for the refurbishments to take place.

People’s needs had been assessed and most of the care files we checked reflected people’s care and support needs choices and preferences. These were all in the process of being reviewed, updated and transferred to new paperwork at the time of our inspection.

The service had an activity co-ordinator who planned and organised social stimulation for people. This person had been on leave for four weeks. An additional activity co-ordinator had commenced employment the day of our inspection. This had an impact on the activities provided over the past few weeks

Complaints were dealt with in a timely manner and in line with the provider’s policy and procedure. People who used the service felt they could approach staff if they had a concern.

Audits were in place to monitor the quality of service provision, however, they were not always effective and the Systems needed embedding in to practice.

The new manager had commenced meetings with staff and people who used the service and their relatives. However, these had only recently occurred since the new manager had been in post.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

Laureate Court provides residential and nursing care for up to 82 people who are living with dementia and other mental health problems. The home has three units; Byron and Shelley both provide nursing care and Keats which provides residential care. The home is located close to Rotherham town centre. At the time of our inspection there were 56 people using the service, 26 people receiving nursing care and 30 people in receipt of residential care.

The service did not have 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. A manager had been appointed by the provider in January 2016. This person was present throughout the inspection.

During this inspection we looked to see if improvements had been embedded in to practice from our last inspection. We found insufficient progress had been made. We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We spoke with the manager and regional manager who told us the reason was due to the change of management company which had taken place in January 2016, and this had had an impact on progressing the service. However, the provider had remained the same.

During our inspection we observed people had to wait at times for assistance and staff were not always present in communal areas to ensure people’s safety. Staff and relatives we spoke with told us at certain times they could do with more staff to ensure people’s needs were met in a timely way and maintain their safety.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role. However, we identified these had not always been followed and people did not always receive their medication as prescribed.

We found some people, who were prescribed medication to be given as and when required, were given this regularly as a means to control their agitation. Other methods to monitor and manage anxiety had not been considered.

People were not protected against the risks associated with infection prevention and control. Safe procedures were not followed.

Staff we spoke with were knowledgeable about safeguarding people from abuse. They told us they would report any concerns straight away.

The provider had a system in place to ensure people were recruited in a safe way. The manager was currently working through staff files to ensure that all correct documentation was present.

Staff we spoke with told us communication was poor; there was a lack of staff meeting, supervision and leadership. Staff morale was very low which was impacting on the people who used the service.

Staff told us that they had not received much training until recently. Most training was completed via eLearning although some recent training sessions had been arranged face to face. The provider's training records showed staff training was required.

People were not always supported to eat and drink sufficient amounts to maintain a balanced diet. Some mealtimes were disorganised which led to staff not ensuring people received adequate drinks and meals. We saw lots of plates being taken from people without them eating much, but this was not addressed by staff.

We looked at people’s care plans and found their needs were not always addressed and health care services not considered or used when needs changed. For example we found one person had lost considerable weight over three months, there was no nutritional care plan and there had been no referral to a dietician.

The manager was aware of their duties in relation to the MCA 2005, and had arranged for best interest meetings to take place where required.

We observed staff interacting with people who used the service and found that most of the time interactions were task orientated. There were several occasions where there was a lack of regard for people’s dignity and respect.

We checked people’s care records that were using the service at the time of the inspection. We found that care plans had not always identified people's care needs. Where care plans had been reviewed notes had been recorded in the evaluation record and not the care plan. This made it confusing to the reader as to what people’s current care needs were.

The home employed two activity co-ordinators whose role it was to arrange social stimulation for people. We received positive feedback from people living on Keats unit, but negative feedback from Shelley and Byron. In the main activity events took place on Keats unit, which left the other two units with little or no social stimulation.

The service had a complaints procedure and people told us they would tell staff if they had a concern although some people were not confident that things would be resolved. We looked at records and found no evidence to suggest that complaints had been investigated.

We found some systems were in place to monitor the quality of service provision. However, these were not effective and did not always identify concerns. Where concerns had been identified there was little evidence to show what actions had been taken to address them. Some concerns identified at the beginning of March 2016 were still awaiting action.

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.

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.

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.

We inspected the service on 25 February 2014 and found the provider to be compliant.

People were protected from the risk of infection because appropriate guidance had been followed.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

Before people received care and treatment they were asked for their consent and the provider acted in accordance with their wishes. The appropriate procedure was followed where people were not able to give consent.

People who used the service had a care plan which was relevant to their individual needs. We spoke with relatives who were very happy with the care provided. One person said, 'Nothing's too much trouble, the staff are great.' Another person said, 'I am always made to feel welcome when I visit my relative.'

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with said that the food was lovely and well presented.

People were not cared for in a clean and hygienic environment.

We found that the provider had an effective recruitment procedure in place. Appropriate checks were undertaken before staff began work.

The provider did not have an effective system in place to regularly assess and monitor the quality of service that people receive.