• Care Home
  • Care home

Archived: Laurieston House

Overall: Good read more about inspection ratings

78 Bristol Road, Chippenham, Wiltshire, SN15 1NS (01249) 444722

Provided and run by:
Mrs J Jobbins

All Inspections

15 April 2021

During an inspection looking at part of the service

About the service

Laurieston House is a care home providing care and support for 12 people, some of whom live with dementia. At the site there is a main home for up to nine people and there are bungalows in the grounds. At the time of the inspection there were five people living in the main home.

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

People had visits from family members once relatives had completed a lateral flow test and had their temperatures checked. Personal protective equipment (PPE) was provided for visitors to wear. All visiting had to be booked in advance so safety measures could be put in place, such as social distancing and enhanced cleaning of the visiting area.

Staff were observed wearing PPE safely and the provider had ample supplies of stock. Staff had been trained on how to put on and remove their PPE and how to dispose of used items safely. There were posters up to give staff guidance on washing their hands and COVID-19. Staff had received training and guidance on infection prevention and control.

People and staff were being tested as per the government guidance. There had been no COVID-19 positive cases at the home throughout the pandemic. We observed the home was clean and smelt fresh. Additional cleaning had been put in place for high contact areas such as door handles.

People’s medicines were managed safely. Staff had received medicines training and were observed to check their competence. People were able to see their GP when needed and referred to other healthcare professionals in a timely way. Staff worked with professionals to make sure people’s health needs were assessed and met.

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. Staff were working to the principles of the Mental Capacity Act 2005.

Risks had been assessed and there were management plans in place. Risk assessments were kept under review and updated when needed. Improvements had been made to daily recording which made it clear what support people had been given.

Staff received support from the provider to help them carry out their roles. They had supervisions, training and were able to attend staff meetings. Staff understood their role in protecting people from abuse and knew how to report concerns. Staff told us morale was good and felt they worked well as a team.

Incidents and accidents had been reviewed and measures taken to try and prevent reoccurrence. The provider had carried out quality monitoring checks to monitor areas of the service. Notifications had been submitted to CQC as required by law and when needed referrals had been made to the local authority safeguarding team.

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

The last rating for this service was requires improvement (published 8 March 2021).

Following the last inspection, we met with the provider to discuss our concerns and findings. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 12 November 2020. Three breaches of legal requirements were found. We issued the provider three warning notices for the breaches of regulations.

We undertook this focused inspection to check they had made the required improvement 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, Effective and Well-led which contain those requirements.

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.

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 changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Laurieston House on our website at www.cqc.org.uk.

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.

12 November 2020

During an inspection looking at part of the service

About the service

Laurieston House is a care home providing care and support for 12 people, some of whom have dementia. At the time of our inspection there were five people living at the service. The home comprised of a main house which had five rooms. Three of these rooms could be shared. At the time of our inspection one room was shared by two people. There were also five bungalows in the grounds, three of which could be used for people who may require support with some aspects of personal care. Two of the bungalows were for people who lived independently.

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

People were at risk of harm as the provider had not made sure safe and appropriate measures were in place to keep them safe at all times. We have made one safeguarding referral as a result of findings during this inspection.

People were not being supported by sufficient numbers of staff at all times which placed them at risk of harm. Staff had not received up to date training in all areas to enable them to carry out their duties.

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.

Quality monitoring systems were not robust to assess, monitor and improve the quality and safety of the service. The provider was not following current good practice guidance for all areas of care and support. This placed people at risk of harm. There was one incident which had not been notified to CQC as required by law. The provider took immediate action to address this shortfall.

Records of people’s care and support were not always clear about what action staff had taken. Care plans were not updated with new guidance in a timely way.

People were living in a home that was clean and measures were in place to ensure safe visiting. People and staff were being regularly tested for COVID-19 as outlined by the government. Staff were observed to be wearing personal protective equipment safely and they had access to adequate supplies of stock.

People, relatives and staff spoke positively about experiences of care and support. Staff told us they had been supported by the provider through the pandemic and given up to date guidance.

People had support from staff to manage their medicines. Medicines administration records had been completed with no gaps in recording and medicines were in stock. One healthcare professional we spoke with talked positively about the care and support provided.

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 - The last rating for this service was requires improvement (published 10 April 2020) and there were two 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 March 2020. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the need for consent and good governance.

We undertook this focused inspection 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, Effective and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

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 the same, Requires Improvement. This is based on the findings at this inspection. This is the third consecutive Requires Improvement rating for this service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Laurieston House 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 the need for consent, good governance, staffing and failing to notify CQC of all incidents at this inspection. We served warning notices to the provider for the breaches of regulation found.

Follow up

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 to check improvement has been carried out. If we receive any concerning information we may inspect sooner.

3 March 2020

During a routine inspection

About the service

Laurieston House is a residential care home providing personal care to seven people aged 65 and over at the time of the inspection. The service accommodated five people in one adapted building and a further two people in bungalows on the site. The service can support up to 12 people at one time.

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

During this inspection we found one breach of regulation regarding the need for consent. People were not always supported to have maximum choice and control of their lives and staff did not support always them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

There were systems in place to safeguard people from abuse and staff received training in safeguarding. Risks to people were assessed, this included individual risks and environmental risks, however environmental risks were not always managed safely.

Accidents and incidents were recorded and reviewed by the manager, however actions taken as a result of the incident were not always clear. Due to the small size of the service there was no over-arching analysis of accidents and incidents however trends were identified and recorded in people's care notes. Medicines were administered safely.

The manager had some quality assurance processes in place, however these had not identified concerns regarding environmental risks or mental capacity.

People had care plans that were personalised to them. Staff worked effectively with other health care professionals in order to meet peoples care needs. People were supported with their nutrition and hydration.

Staff provided care with kindness and in a way that promoted dignity and independence. People and their relatives told us they were happy with the care they received. People were supported to maintain social networks with their relatives and local community.

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)

The last rating for this service was requires improvement (published 22 January 2019). There were breaches in regulation relating to need for consent and good governance. 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 made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the need for consent.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

12 October 2018

During a routine inspection

Laurieston House 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 home is registered to provide accommodation and personal care for up to 12 older people in the main building and in three self-contained bungalows in the grounds. At the time of the inspection eight people were living at the service. People who use the service are referred to as 'residents' throughout the report at their request.

The inspection took place on 12 and 15 October 2018. The first day was unannounced.

There was 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 was also the provider.

At the previous inspection on 20 February 2016 the service was rated as Good. At this inspection we found that the service Requires Improvement. This is the first time the service has been rated Requires Improvement.

The service was not always assessing people’s capacity to consent to aspects of their care. Although some residents had a diagnosis of dementia, capacity assessments had not been regularly reviewed. No Deprivation of Liberty Safeguards (DoLS) applications had been made despite some residents being deprived of their liberty. Best interest decisions had been made but the documentation in place did not detail how decisions had been reached, whether less restrictive options had been considered or who had been involved in the decision making process. Residents were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice

Quality assurance audits were carried out. However these did not include audits of care plans or mental capacity assessments and DoLS which meant the issues we identified above had not been identified by the provider.

Residents said they felt safe at the service. Staff understood their responsibilities to keep the residents safe. Risk assessments had been carried out. Safe recruitment practise was followed and there was enough staff on duty to meet resident’s needs. Medicines were managed safely.

Staff were trained to carry out their roles and had regular supervision sessions. Residents were supported to have enough to eat and drink. Residents told us the food was “excellent.” Residents had access to ongoing healthcare.

The residents told us staff were kind and caring and we observed many positive interactions between residents and staff. There was a relaxed and friendly atmosphere. The registered manager regularly sought feedback from residents.

Care plans were person centred. Policies and procedures did not always reflect current best practise. Residents had access to a range of activities and regularly accessed the local community.

Residents, their relatives and staff spoke highly of the registered manager. The provider’s values were embedded in the service.

We found two breaches 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.

20 February 2016

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 20 February 2016 and was unannounced. The inspection was undertaken by one inspector. Prior to the inspection we looked at all information available to us. This included looking at any notifications submitted by the service. Notifications are information about specific events that the provider is required to tell us about.

As part of our inspection we reviewed the care records for three people living in the home and also looked at staff records to see how they were trained and supported. We made observations of the care people received. This was because they were unable to tell us verbally of their experience of living in the home. We spoke with three members of staff. We looked at other records relating to the running of the home which included audits, staff supervision and training records and meeting minutes.

14 May 2013

During a routine inspection

During the day we spoke with five people who lived in the home. We also observed the care of people who were not able to verbalise their experience of living in the home. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We observed that people living in the home looked well cared for. One person said, "I'm lucky to live here, they really care about us and look after us so well".

There were effective systems in place to reduce the risk and spread of infection. We found the home smelt fresh and was clean throughout. The home had schedules in place which listed the areas of the home to be cleaned and which included the cleaning of fixtures and fittings.

We spoke with a senior care worker who explained the home's system for the management of medicines.There were appropriate arrangements in place in relation to obtaining, recording, handling, dispensing, disposal and the safe administration of medicines. We inspected all areas of the home and found it had been adequately maintained and provided a comfortable environment. The home had consulted with people about their wishes, for example people had been asked to give their suggestions of items to put in the new back garden, some responded with, 'Windmills', 'A Bird Table' and 'Nice smelling plants and fauna'.

30 April 2012

During a routine inspection

People said they were happy living in the home and with the support they received from staff. Relatives were very positive about the care people received.

We observed staff treating people with sensitivity and respect. Staff listened and responded to people, supporting them to make decisions and choices about their lifestyles.

People had access to a range of day and evening activities which they participated in, such as, knitting, puzzles, reading and bingo. One person told us how they had been to the theatre twice in the last month which they had really enjoyed. People told us they regularly went shopping with staff or to the local garden centre and trips to the seaside were a favourite.

Relatives told us how the home informed them of any changes for people and sought support from them with making decisions about care and treatment. People told us they were involved in their care planning and said staff would always ask permission. One person said, 'I am very involved, nothing is done without me understanding what is happening, the staff are very respectful and wouldn't presume to do anything without my consent'.

25 August 2011

During a routine inspection

We spoke with a person who told us they had regular visitors. The person said they were 'very happy' at the home, that the food was 'very good' and there were 'marvelous staff'. Another person said that they were in regular contact with relatives by telephone.

One person's relative said that they were very pleased with the choice of home and felt very welcome when visiting. They said they particularly liked that it was small and 'not like an institution' adding that the person was settled there.

Another relative confirmed this saying they had also liked the home because it was 'small and personal' and that staff did not wear uniforms. They said it was like 'home' and commented on the 'low staff turnover'.

People told us about their recent trip to Weston super Mare.