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Inspection carried out on 30 August 2016

During a routine inspection

The inspection took place on the 30 and 31 August 2016 and was unannounced.

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.

Laurel Care Home provides accommodation for persons who require nursing or personal care for up to 60 people. At the time of our inspection 56 people were living at the home.

Accommodation at the home is provided over two floors, which can be accessed using stairs or passenger lifts. There are large garden and patio area’s which provide a safe and secure private leisure area for people living at the home.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly.

The provider operated safe and effective recruitment procedures.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained.

Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people's rights were protected.

People were involved in their care planning. Care plans were amended to show any changes and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

Inspection carried out on 18 September 2014

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

During a scheduled inspection in April 2014 we found the home had not met the required standard in respect to the staffing arrangements operated by the service. This was because the numbers of care workers on duty was not always sufficient to meet the needs of people in a timely manner. We also found that the service was not using a dependency assessment tool to inform staffing levels. Dependency tools assist providers to plan staffing levels based on the needs of people using the service. The provider sent us an action plan telling us what action they would take to ensure they met the required standard. The purpose of this inspection was to check whether the provider had made the necessary improvements. We therefore looked at the staffing arrangements within the home to answer the question is the service safe? On the day of the inspection there were 57 people living at the home.

This is a summary of what we found –

Is the service safe?

The provider had taken action to help ensure that people who use the service were safe. Staffing levels had improved and were more consistently in line with the levels determined by the service as being required to meet people’s needs. We found that a dependency assessment tool was now being used to inform staffing levels. The registered manager monitored the dependency assessment records to ensure that staffing levels continued to reflect the needs of people using the service.

We spoke with seven people who used the service. They told us they were able to summon staff if they needed help. One person said, “They come within a few minutes”. Another person said, “They come reasonably quickly when I press my buzzer”. This person told us how pleased they were with the care they received. They explained, “The carers are so brilliant, they are all so cheerful and helpful, I have a laugh with them, they have time to sit down and have a chat with me, they indulge you in every way”. We saw that people received sensitive and unhurried support when they were unable to feed themselves.

Staff told us that there were sufficient staff to meet people’s needs. All of the staff told us that team work was good and that staff really supported one another. When agency workers were required, the same workers were used, where possible, and this helped to ensure better consistency of care.

Arrangements were in place to monitor how quickly staff were able to respond to people’s needs. These arrangements needed further development to ensure that they were an effective tool for monitoring the timeliness of care people receive. However, our observations on the day of the inspection indicated that people were having their needs met in a responsive manner by staff who were familiar with their needs.

Staff were suitably qualified, skilled and experienced to undertake their duties. We found that both nursing staff and care staff updated their essential training, for example moving and handling and fire safety. All of the staff we spoke with confirmed that they received regular supervision which helped to ensure that people were cared for by staff who understood their role and responsibilities.

Inspection carried out on 7 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People’s care records contained assessments which covered the risks associated with staff providing the care and support they needed. This helped to ensure that people who used the service were safe because staff had taken action to identify and assess the risks to their health and wellbeing.

People told us that they felt safe. Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

There were systems in place to help ensure that suitable and competent staff were recruited to care for people who used the service.

The deputy manager was aware of the processes to follow to ensure that staff who were no longer fit to work in health and social care were referred to the appropriate bodies.

Systems were in place to ensure that the service learnt from incidents and accidents, comments and complaints.

We found that the service was not always able to respond to people's needs in a timely manner as it was not consistently operating at the staffing levels determined by the provider.

Is the service effective

People’s needs had been assessed and care and support was planned and delivered in line with their individual care plans. Care plans were detailed and regularly reviewed to ensure they remained up to date.

There were effective systems in place to reduce the risk, and spread, of infection. The provider had an infection control policy which had due regard to the Departments of Health’s Hygiene Code of Practice. We observed that the home was clean and hygienic. One relative told us, “The cleaning staff are very good…they don’t just clean, they move things around to make sure it is really clean”.

Staff we spoke with were informed about people’s needs and were able to tell us about the care they provided. This information was consistent with what was recorded in people’s records.

The service worked effectively with other providers to ensure that people received co-ordinated care, treatment and support.

Is the service caring?

People were supported by kind and attentive staff. Staff treated people with dignity and respect and we saw that care was delivered in an unhurried and sensitive manner. One person told us that the staff were, “Very kind, they could not treat me any better”. A relative told us, “The staff are top notch, they are second to none”.

People’s preferences, likes and dislikes had been recorded and care and support was provided in accordance with peoples wishes.

Staff were able to tell us how they anticipated people’s needs, for example, by making sure that their pain was managed, or that a person who was photosensitive to light did not have their room too bright.

Is the service responsive?

The service had measures in place to review people’s needs on a regular basis to ensure that their care plans remained up to date and reflected their current needs.

People knew how to complain and told us that they were confident that action would be taken where necessary.

Is the service well led?

The service had a consistent management structure that maintained oversight of the home and provided leadership to the staff team. The management team were supported by a provider who visited the service regularly. One relative told us, “The owners are very good, they muck in and you see them around the place”.

The deputy manager was able to demonstrate a good knowledge of the needs of people who used the service and their care and support needs.

People knew how to complain and told us that they were confident that action would be taken where necessary.

Staff told us that they felt part of a team and that the manager was approachable. One staff member told us, “Coming to work here was like a breath of fresh air….if you need training, you just need to speak with the manager and they have it covered”. Another told us that there was “Good teamwork, the manager is approachable…its not like coming to work…I feel part of a family”.

The service had a robust quality assurance system in place to monitor the quality of the service and identify where improvements could be made.

Inspection carried out on 21 October 2013

During a routine inspection

People told us they were very happy with the care and support provided at the service. One person told us "they do lots of activities here - there is something to do every day. We do bingo, singing and lots more". Another told us "the staff are adaptable and the food is great. I would not change anything".

During the inspection we observed people participating in activities with staff including sketching classes, music sessions and playing board games. People using the service decided how they occupied their time and were provided with a variety of activities to choose from.

A family member told us "the staff are very approachable and friendly. They could be quicker when answering the buzzers as it quite often takes them a very long time. Everyone seems generally well looked after".

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis. One person spoke about staff saying "the staff are lovely. They know what I like and what I don't like and they listen to me. They would never make me do anything I didn't want to do".

Staff we spoke to lacked knowledge and understanding about the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff safeguarding training was out of date and had not been completed since September 2010.

Inspection carried out on 28 December 2012

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

Laurel Care Home was previously inspected on 16 May 2012. At the time of this inspection we found non compliance in relation to the disposal of medicines and non compliance in relation to staff receiving appropriate training and development. This inspection was to check that the home had improved and met compliance in outcomes13, management of medicines and 23, supporting staff.

We looked at medication records for three people and found that medication was disposed of appropriately. We saw that audit systems were in place which ensured that tablets and other forms of medication were accounted for and stored in controlled drugs cabinets prior to disposal. Records we looked at were accurate and medication was stored and disposed of appropriately.

Staff received appropriate professional development. We saw training records that showed us that staff had undertaken an appropriate range of training. We spoke with staff members who told us that they found the training useful as it helped them in providing care to people with different support needs.

Inspection carried out on 16 May 2012

During a routine inspection

We spoke with twelve people who were living at the home. To help us to understand the experiences of people, we spent time observing what was going on in the home. We observed how people spent their time, the support they received from staff and whether they had positive outcomes. We also spoke to two relatives and the staff.

We observed interactions between the staff and people who use the service. People told us that they were treated with respect and that the staff were very good and that they felt safe living at the home. People said that they liked their bedrooms and the views to the garden and surrounding areas.

A relative told us that they visited the home prior to their parent moving into the home and that their relative was ‘very well looked’ after. We were told that the food was ‘very good’ and there was plenty to choose from. People said that choices were available and ‘you can ask for something else if you don’t like what is on the menu‘.

People were confident that they could approach the provider or the manager if they had any concerns. They wanted us to know that they did not have any complaints about the care that they were receiving.

People told us that they were supported to bring in items of personal belongings, which included some small items of furniture. They said it was very nice to be able to do this, as it made them feel at home with their belongings around them.

Reports under our old system of regulation (including those from before CQC was created)