Background to this inspection
Updated
27 October 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by one inspector.
Service and service type
Laurel Mount Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Laurel Mount is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post. The service had appointed a manager who was in the process of applying to register with the Care Quality Commission.
Notice of inspection
We gave the service a short period of notice of the inspection. This was because no one was living at the service and we needed to be sure the provider would be there to meet with us.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We reviewed the action plan and other information the provider had submitted since our last inspection. We used this information to plan our inspection.
During the inspection
We spoke with the nominated individual, the manager, nurse in charge and two members of care staff. As there was no one living at Laurel Mount Nursing Home at the time of the inspection, we were unable to speak with people and relatives.
We reviewed a range of records. This included ‘mock’ care records which had been made up by the manager so that we could see what a completed care plan would look like for anyone moving into Laurel Mount Nursing Home. We looked at two staff files in relation to recruitment and training. A variety of records were reviewed relating to the management of the service, including policies and procedures.
Updated
27 October 2022
About the service
Laurel Mount is a residential care home providing personal and nursing care for up to 34 older people, some of who are living with dementia. At the time of the inspection there were 19 people using the service. Accommodation is provided in single rooms over two floors with lift access. There are communal lounge and dining areas on the ground floor.
People’s experience of using this service and what we found
People were not always safe. People were at risk of harm as the provider had not identified, assessed or mitigated risks. This included risks related to people's health and care needs as well as environmental risks, including fire safety.
Government guidance on the prevention and control of infection was not always followed which meant people were put at increased risk. Regular COVID-19 tests were not being carried out on staff or people living in the home. COVID-19 checks on visitors to the home were not carried out in accordance with government guidance. Staff were not wearing PPE correctly.
Staff were not fully checked before starting work in the home. Staff did not receive the induction, training and support they needed for their roles. There were not always enough staff on duty to meet people’s needs and there was no system in place to determine safe staffing levels.
People did not receive person-centred care and care records did not fully reflect their needs. Medicines were not managed safely. People’s nutritional needs were not met.
People were not always treated with respect by staff or had their privacy and dignity maintained. Although some staff were kind and caring, other staff were task focussed and did not respond appropriately to people's needs. There were no activities taking place and there was little to occupy and interest people.
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.
There was a lack of consistent and effective leadership and an ineffective governance structure which meant the service was not appropriately monitored at manager or provider level.
People were supported to keep in touch with family and friends. People had access to healthcare services. Overall people and relatives were satisfied with the service provided.
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 the service under the previous provider was good, published on 12 December 2019.
Why we inspected
The inspection was prompted in part due to whistleblowing concerns relating to the management of the service and care provision. A decision was made for us to inspect and examine those risks.
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 all the sections 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 safe care and treatment, person-centred care, staffing, recruitment, consent, nutrition, privacy and dignity and good governance 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 programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.