Archived: The Laurels

About the service

The Laurels is a residential care home for people living with dementia. The accommodation is spread over two floors with the main communal areas situated on the ground floor. The home is registered to support up to 23 people. At the time of our inspection there were 16 people living in the home.

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

People received a high level of care which met their needs were met. However, systems in place to monitor the quality and safety of people’s care were inconsistent. Further improvement was needed to ensure governance was organised and evidenced decisions being made regarding environmental risks and discussions with staff.

Whilst we did not find people being restricted unnecessarily, records were not fully up to date relating to people’s DoLS and processes relating to people’s mental capacity required development.

Risk associated with people’s care had been identified and assessed. People received their medicines safely. There were enough staff deployed to meet people’s needs. Staff followed good infection control practice and people were protected from the increased risk of infection.

Staff received training relevant to their role. People’s needs were being met in line with their care plans. People were supported to eat and drink well. Staff worked with other agencies to ensure better outcomes for people and health conditions were managed.

Relatives told us staff were extremely caring. People spoke highly of the staff and the care they received. People were encouraged to maintain and re-gain their independence. People’s privacy and dignity was respected by staff who knew them well.

Care records showed people’s needs, abilities and preferences. Staff supported people to communicate in different ways. Most people spoke positively about activities in the service. Staff engaged with people in a meaningful way. People, staff and relatives felt they could approach the registered manager should they wish to make a complaint. Staff were trained to deliver end of life care.

People, staff and relatives highly commended the registered manager, who encouraged an open, positive culture. Staff were empowered to deliver quality care to people. People, relatives and visiting professionals were given the opportunity to feedback regarding their experience.

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 this service was requires improvement (published 22 September 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Laurels is a residential care home for people living with dementia. The accommodation is spread over two floors with the main communal areas situated on the ground floor. The home is registered to support up to 23 people. At the time of our inspection there were 17 people living in the home.

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

The design and decoration of the home was being amended to meet the needs of people living with dementia. Radiators which had been found to be too hot and exposed in communal rooms, had been covered to improve safety of people living at the service, and the rooms were comfortably warm.

The registered manager and provider had worked to improve oversight of the service and had acted to address concerns and issues identified during our last inspection.

Systems and processes had been improved to identify and address risks with the environment or equipment people used. This meant that people were kept safe and risks reduced.

Managers understood the regulatory requirements of CQC, and staff were clear about their roles.

People living at the service told us they were happy and felt safe. A relative told us they had “Peace of mind” knowing their relative was well cared for and happy.

The registered manager knew people well. Staff felt well supported and understood the registered manager’s vision for the service to be like home from home.

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 12 May 2020) and there were two breaches of regulation. These were Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We undertook a focused inspection to review the key questions of safe and well-led only.

The information CQC received about the incident indicated concerns about the management of choking risks. This inspection examined 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 corona virus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this report.

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

Follow up

We will continue to 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

The Laurels is a residential care home for people living with dementia. The accommodation is spread over two floors with the main communal areas situated on the ground floor. The home is registered to support up to 23 people. At the time of our inspection there were 17 people living in the home.

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

The design and decoration of the home did not meet the needs of people in the home living with dementia. Radiators in communal rooms were too hot; measures were put in place immediately to address this as a priority.

Systems and processes had not identified where there were concerns with the safety of the home environment or people's equipment. Risks were not always identified or managed. Some accidents and incident reports had not been reviewed to identify learning.

Managers and staff were unclear about some aspects of their roles as some regulatory requirements were not being met, which could pose a risk to people living at the home.

Consent to care and treatment and best interests decisions had not been obtained in line with legislation and guidance, including the Mental Capacity Act 2005, and the Deprivation of Liberty safeguards. Staff did not understand these requirements. Decision specific mental capacity assessments and best interest decisions had not been undertaken. However, we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported by staff who were kind and caring and treated them as if they were a member of their family. People living at the service told us they were happy, and they felt safe.

People told us they were happy with the food available and were able to choose what they wanted to eat and drink. People were supported where necessary to eat and drink enough.

There had been no complaints. People and relatives knew how to complain and told us they felt confident action would be taken should they complain. Relatives and staff told us they felt people were safe at the home, and staff were aware of how to raise concerns.

The registered manager knew people well. Staff felt well supported and understood the registered managers vision for the service to be like home from home.

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 this service was Good (published 15 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led key question sections of this full report.

Enforcement

We have identified breaches in relation to people safety, consent and quality assurance systems and processes.

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.

At the last inspection on 20 November 2014, the service was rated Good. At this inspection we found the service remained Good.

People continued to receive their care and support from sufficient numbers of staff that provided their care in a way that maintained their safety. People could be assured that they would receive their prescribed medicines safely. Staff were knowledgeable in the steps that they should take if they felt people were at risk of harm and were confident in taking action to safeguard people.

Staff had received the training, support and supervision that they needed to provide people’s care. People were support to eat and drink enough. Staff worked closely with people’s allocated healthcare professionals and made referrals promptly to other professionals or agencies when required.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had developed positive relationships with the staff providing their care and could be assured that they would be treated with dignity and respect. People were involved in the planning of their care and the care that people received was tailored to their individual preferences.

People knew how to make a complaint and were confident that appropriate action would be taken in response to their feedback.

The management team was visible throughout the home and the registered manager who was also the provider knew people well. Staff felt well supported, understood and articulated the registered managers vision for the service and provided consistently person centred care and support to the people living at The Laurels.

Further information is in the detailed findings below

We found that care plans were individualised to each person and were reviewed regularly.

We found that appropriate checks were made before staff worked at the home.

The provider had a process to check the quality of care given to people that lived at the home.

When we visited on 25 February 2013 we saw staff had completed training in safeguarding vulnerable adults from abuse. The staff information file had been updated and contained information on how to raise safeguarding concerns within the home and externally.

Records showed staff training was up to date and refresher training had been arranged where appropriate.

Records showed and a relative told us they had been asked for their opinions on the home. The provider had raised people's awareness of how to make a complaint.

As part of our inspection we spoke with people who lived at the Laurels. They spoke positively about the care they received.

We observed staff giving safe care to people. People were spoken to in a polite manner. We saw care staff respected people at all times.

We saw people's bedrooms. Most people had personal photographs and ornaments on display. The provider told us people were encouraged to have their own possessions.

We also spoke with visiting relatives. Some relatives told us they did not know how to complain. Others said they would speak to the owners if they had a concern.

People and their families were not asked their opinion about the service. There were no resident or relative meetings or satisfaction surveys.

We saw staff did not receive regular supervision or appraisals.

Staff told us the home managers were supportive. One said, 'They always have an open door for us. It's made us a really good team.