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Laurel Bank Residential Care Home Good

Reports


Inspection carried out on 3 December 2018

During a routine inspection

Laurel Bank Residential Care Home 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. Laurel Bank is registered to provide accommodation and personal care for 51 people. It is not registered to provide nursing care.

At the time of the inspection Laurel Bank was accommodating 51 people in one building across 3 floors. All bedrooms were single occupancy, and some had en-suite facilities. There were a variety of communal areas throughout the home available for people to use.

Laurel Bank was last inspected in November 2015 and at the time the service was rated as being good in all domains. At this inspection we found that the service remained good in the domains safe, effective, caring, and responsive but have rated the well led domain as requires improvement.

We have rated the well led section as requires improvement because the health and safety checks had not identified some of the issues we noted on inspection in relation to the environment, medication and infection control. We recommend that the systems in place for checks and audits are reviewed to ensure they cover all potential areas of risk, including those found during the inspection.

The service had a registered manager in place. 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.

People were positive about the registered manager and confident that they would address any concerns people raised. Staff told us they enjoyed working at the home and felt supported by the registered manager.

Staff were aware of their responsibilities in safeguarding people from abuse and demonstrated their understanding of the procedures to follow so that people were kept safe. There were policies and training provided to underpin this.

Staff were caring towards people and we observed positive and compassionate interaction between staff and the people they were supporting.

Individual risk assessments gave staff guidance on how to minimise and manage identified risks.

Equipment used within the home was maintained and serviced appropriately.

People had their nutritional needs met and had access to a range of health care professionals.

The requirements of the Mental Capacity Act 2005 were being met. 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.

Recruitment procedures were in place which ensured staff were safely recruited. Staff received the training, support and supervision they needed to carry out their roles effectively.

There was a programme of activities available but people had expressed a wish for further activities to be available for them to engage with. At the time of inspection, the registered manager was considering options to improve the activities available within the home.

The service kept a record of accident, incident, safeguarding concerns, complaints and compliments. These were analysed for themes and learning to reduce the risk of reoccurrences.

Inspection carried out on 3 and 4 November 2015

During a routine inspection

This inspection was carried out over two days on the 3 and 4 November 2015. Our visit on the 2 November was unannounced.

We last inspected Laurel Bank Residential Care Home in May 2014. At that inspection we found that the service was meeting all the regulations we assessed.

Laurel Bank Residential Care Home is a large building that has been adapted to provide accommodation over three floors. The home provides 24 hour care and support for up to 51 older people who require residential care without nursing.

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.

Those people who used the service, who we asked, told us that Laurel Bank was a safe place in which to live and that they were well looked after.

People were supported by sufficient numbers of suitably trained staff, who had been appropriately and safely recruited to support and meet people’s individual needs.

Staff understood their role in making sure they safeguarded vulnerable people from harm.

Of those care records we examined, we saw that any identified risks had appropriate management strategies in place to minimise the risk as much as possible. The risk assessments we looked at had been reviewed and updated on a regular basis to help make sure the care provided would meet the person’s changing needs.

Each person using the service had a care plan in place that was written in a person centred way. Although people we spoke with told us they had been involved along with their relative in developing their care plan, and our discussions with visiting relatives confirmed this, little evidence had been recorded in the care plan review to demonstrate this. The registered manager told us that this matter would be discussed with staff at the next staff meeting to make sure all details from reviews were appropriately recorded.

Both the registered manager and staff we spoke with were able to demonstrate a good understanding of the Deprivation of Liberty Safeguards (DoLS) procedure and Mental Capacity Act (MCA) 2005.

People said the food served in the home ranged from “The food is very good” to “it’s all right.” There were menu choices available at each meal, but options were not always clearly displayed for people to easily see. We observed a warm interaction between staff and people during the meal at lunch time, with staff smiling and chatting to people and touching them on the shoulder. Staff asked people if they would like to wear a protective apron to protect the person’s clothing, rather than putting them on without asking. People were offered a choice of drinks with their meal.

Staff we spoke with had a good and clear understanding of the care and support people required and people we saw looked well cared for and comfortable in their surroundings.

We saw that staff cared for people with dignity and respect and attended to their needs discreetly.

We saw that staff had access to a range of appropriate training, such as moving and handling and infection control and staff we spoke with confirmed this. They also told us that they had support from their colleagues and found the manager and senior team to be very approachable and supportive.

People told us they were happy with the service provided and the level of support they received from the staff. They also told us they knew who to speak with should they want to raise a concern or complaint. A system for dealing with complaints was displayed in prominent areas throughout the home.

We found the building to be well maintained, clean, and tidy and odour free.

To help make sure that people received safe and effective care, systems had been put in place to monitor the quality of service being provided. These systems included regular checks on all aspects of the management of the service.

Inspection carried out on 21 May 2014

During a routine inspection

During our inspection we spoke with the registered manager, team leader and the other staff on duty. We also spoke with three people who lived at Laurel Bank. We spent some time observing the interactions between staff and the people who lived at Laurel Bank. We looked at a selection of the providers’s records, including a sample of people’s care records.

We considered the evidence under the outcomes we reviewed and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We observed how staff supported people and treated them with respect and dignity. People told us they felt safe living at Laurel Bank. Safeguarding procedures were in place and staff spoken with understood how to safeguard the people they supported.

Where people were at risk of poor food and fluid intake, daily records were being maintained of all food and drinks a person had during the day/night. However it was noted that these documents were not being completed on a consistent basis. This was discussed with the registered manager who confirmed that action would be taken to ensure these records would be properly maintained at all times.

One person using the service told us, “I feel very safe and comfortable living here”. Another person told us, “I would tell [team leader] if I had any worries about my safety, which I don’t have”.

Medicines were safely administered to people, Only those staff who had received appropriate training had responsibility for the administering of medicines in the home.

We found the provider had effective systems in place to monitor the quality of the service provided.

We saw evidence that demonstrated that all staff received a full pre-employment check before starting work in the home. This meant that only suitable people were being considered for employment in the home.

Is the service effective?

One visiting healthcare professional told us, “This is a very good service”.

Staff we spoke with were able to tell us how they met people’s individual needs based upon the care plan information and how they would report any concerns directly to their line manager.

We had the opportunity to speak with the chef who was very clear about his role and was able to demonstrate a good understanding of providing a balanced and nutritious range of menus to meet people’s individual dietary requirements.

The registered manager told us that they had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguarding (DoLS). This is legislation which help’s to protect the interests of people who may lack the capacity to make decisions.

The staff we spoke with had a good understanding of the needs of the people living in the home. They also demonstrated a basic understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The registered manager confirmed that staff would be receiving further training in this subject.

Is the service caring?

People using the service were given time to make choices and decisions about the care they wished to receive. Care staff were seen to support people sensitively and with patience. One person using the service told us, “I wouldn’t want to live anywhere else”.

One visiting healthcare professional told us, “I have no concerns or issues about this service”.

Is the service responsive?

Evidence was available in records to demonstrate that other healthcare professionals were involved in meeting people’s care and support needs where appropriate. For example, the district nursing service, visiting chiropodist, speech and language therapist and optometrists. This meant that people using the service received co-ordinated care and support.

One visiting healthcare professional told us, “The staff are very responsive and supportive”.

Is the service well led?

The service had a manager in post who was registered with the Care Quality Commission.

The provider had effective systems in place to monitor the quality of service provided. We found monthly audits of care plans and medication systems were carried out by the manager. Audits of the kitchen and environmental cleaning were also carried out. This meant that the service was able to identify and respond to any shortfalls found in the service, as well as recognising the strengths of the service people received.

Staff told us that they felt supported by the management team, and there were clear lines of accountability in place.

Inspection carried out on 10 October 2013

During an inspection to make sure that the improvements required had been made

We spoke with people who used the service. They told us the home was "safe", "peaceful and quiet" and "relaxing". People spoke positively about the manager, saying they were "very good" and "the boss", and agreed that the manager "keeps the staff in line." We observed staff engaging with people in a positive way, although some staff communicated better than others.

We found the home had made improvements since the last inspection, such as more regular and thorough meetings for supervisions and appraisals. Staff received additional support in improving moving and handling skills, and we saw staff generally communicated well with each other and used equipment appropriately to move people safely. People's care records were person-centred and regularly reviewed by senior staff. Staff were familiar with people's needs, and people received support from relevant professionals, such as district nurses, when necessary.

Most people were happy with the type and amount of activities in the home. We observed people kept similar routines and relied on staff to make decisions for them, such as when to have a drink, where to sit, and when to go to bed. Staff explained that this routine reduced people's distress. People with more capacity told us that they were content with this routine. We observed that people in the home appeared content and comfortable.

Inspection carried out on 3 May 2013

During a routine inspection

People told us: "I like it here," "It is much better than the other place I was" and "The staff are very nice." We spoke with family members of people who used the service who told us their relatives were well looked after, but un-stimulated. Some people using the service told us that they felt bored.

At this visit, we followed up on non-compliance found in a previous inspection visit. We saw that, despite updated training, some staff continued to use unsafe moving and handling methods. The manager told us that they did not appraise staff against agreed objectives.

We saw that the provider responded promptly to concerns about the care and welfare of people who used the service. People looked comfortable. We found there was enough staff on duty to meet their needs, although staff did not engage consistently with people using the service. We saw that some staff did not support people to eat and drink in a dignified way. The provider did not always plan and deliver care according to people’s individual needs.

The care home was a large older property that frequently fell into disrepair, but we saw that the provider responded promptly in fixing the property or the equipment when required. The property had benefited from a recent renovation, although we did not observe people taking advantage of the new quiet lounge.

Inspection carried out on 31 January 2013

During a routine inspection

People told us that they liked living in the care home. One person said the care home was “very good.” Another person said it was clean and they liked it. Another person said they were happy living there. We saw results from a survey in June 2012 in which people using the service and their relatives said the care home was pleasant and clean. People described the staff as “warm and friendly” and praised the “care and attention.”

We observed that people using the service approached staff to raise concerns about their care. We saw that staff listened to and responded to these concerns appropriately. We observed staff informing people and asking for consent before proceeding with care. We saw that the care home had been renovated recently and offered a range of lounges, rooms and dining areas for people using the service.

We saw that records were well-organised. We saw evidence that the provider regularly audited different parts of the service and monitored trends in incidents in the care home. We observed that staff had difficulty moving and handling those people who were using the service. We saw that not all staff had completed core training, such as moving and handling. We saw that the night staff had not had recent supervision meetings.

Inspection carried out on 16 June 2011

During a routine inspection

People at Laurel Bank told us that they were satisfied in the way staff provided care and support to them. They said that they felt they could approach the manager or the staff with any concerns they might have, and felt confident in making a complaint if they felt the need to do so.

Comments from people living in the home included:

"The staff are very helpful and very nice. They try to cheer me up when I'm down".

"I have never had a problem, but if I did I could talk to the staff".

"I enjoy the meals here- there's a choice and if you don't like something the staff will get you something else".

Relatives of the people living in the home were complimentary about the staff and about the way the home was run. They told us that staff were very caring and that they made every effort to keep them well informed on their relatives changes in care needs. Their comments included:

"There is good communication between us and the staff, they really keep us up to date with things".

"We find the staff to be very patient and kind and we honestly feel our relative is safe here".

There were mixed reviews about the opportunities to engage in leisure and social activities, and the manager said this was an area the service would be looking into.