The Care Quality Commission
  • Care Home
  • Care home

Archived: The Laurels Nursing Home

Overall: Requires improvement read more about inspection ratings

South Road, Timsbury, Bath, Avon, BA2 0ER (01761) 470631

Provided and run by:
Sanctuary Care (South West) Limited

Important: The provider of this service changed. See new profile

All Inspections

22 March 2017

During a routine inspection

We carried out this inspection on 22 March 2017. When the service was last inspected in January 2016 there were two breaches of the legal requirements in relation to ‘person centred care’ and ‘need for consent’. Following the inspection in January 2016 the provider wrote to us to say what they would do to meet the legal requirements. At this inspection we checked that the provider had made sufficient improvements. Although they were meeting the legal requirements in relation to the regulations breached at the last inspection there had been a decline in the standard of service. We found breaches of other regulations at this inspection.

The service is a nursing home and is registered to provide care and support for up to 36 older people. On the day of our inspection there were 27 people living at the service.

The service has 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.

The provider had quality monitoring systems in place which were used to bring about improvements to the service. These systems had been ineffective in ensuring that the service was meeting the regulatory standards.

Staffing was not organised in a way to meet people’s individual needs. Whilst we observed staff working with people in a kind and compassionate way, people told us that this was not always reflective of care provided to them. People did not receive adequate person centred personal care.

The home was not suitably clean and maintained. Equipment was not stored safely. Fire risk was not effectively managed.

Records containing confidential information were stored inappropriately.

The staff had received training regarding how to keep people safe and they were aware of the service safeguarding and whistle-blowing policy and procedures.

People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported; however not all care plans contained sufficient information about people's needs. People’s care, treatment and support was personalised to reflect people’s preferences.

The staff had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Meetings had been arranged in order to enable people’s best interest to be assessed when it had been identified that they lacked the capacity to consent to their care and treatment.

There was a robust staff recruitment process in operation designed to employ staff that would have or be able to develop the skills to keep people safe and support people to meet their needs.

Staff demonstrated a detailed knowledge of people’s needs and had received training to support people to be safe and respond to their support needs.

The service maintained daily records of how peoples support needs were met and this included information about medical appointments for example with GP’s and dentists.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded.

We saw that the service took time to work with and understand people’s individual way of communicating in order that the service staff could respond appropriately to the person.

We found four breaches of regulations at this inspection and will be asking the provider to send us a report of the improvements they will make.

29 January 2016

During a routine inspection

This inspection took place on 29 January 2016 and was unannounced. When the service was last inspected in September 2013 there were no breaches of the legal requirements identified.

The Laurels Nursing Home is registered to provide accommodation and nursing care for up to 36 people. At the time of our inspection there were 25 people living at the service.

There was a registered manager in post at the time of inspection. 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’s care plans were not sufficiently detailed to help staff provide personalised care based on current needs. Risks assessments relating to the health, safety and welfare of people were not effectively managed. Three of the four care plans we looked at contained risk assessments for areas such as falls, and moving and handling. The remaining care plan held insufficient details on how to keep the person safe as risk assessments had not been completed.

People’s rights were not consistently being upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

Internal audit reports had failed to identify the issues identified during the inspection, such as the variable quality of the information held in the care plans and the failure to adhere to the principles of the Mental Capacity Act 2005.

Medicines were generally managed efficiently so that people received them safely. The nurse administering the medicines knew people well, knew who had been feeling unwell and who needed to be reviewed by the GP.

People were supported by sufficient numbers of staff to meet their needs. The provider made sure that all new staff were checked to make sure they were suitable to work at the service.

Staff were supported through an adequate training and supervision programme. New staff undertook an induction and mandatory training programme before starting to care for people on their own. Staff we spoke with demonstrated a good understanding of how to recognise and report suspected abuse. Staffing levels were maintained to a sufficient level to keep people safe.

People had their physical and health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

People spoke positively about the staff and told us they were caring. One person told us; “The staff are nice. They’re all helpful. They discuss what I need” .Staff told us they aimed to provide personal, individual care to people.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

The overall feedback about the service and the registered manager had been positive. Staff spoke positively about the manager. People were encouraged to provide feedback on their experience of the service and monitor the quality of service provided. Identified issues were acted upon, such as the need for refurbishment.

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 this report.

30 September 2013

During a routine inspection

"They've been very good to me since I've been here." one person told us. Another person said "For me it's my home. I've been here for three years and I wouldn't be anywhere else. Everyone is so kind."

One of the care plans which we examined provided evidence that people were only deprived of their liberty when this had been appropriately authorised. It was clear that the necessity for the application had been carefully considered and that the requirements of the legislation were understood and complied with.

From the discussion with staff and from the evidence we saw and read it was clear that the provider had taken steps to ensure that any allegation of abuse would be responded to appropriately.

We looked for evidence that the numbers of staff available and their skills and experience were sufficient to meet the needs of the people at the Laurels. We were assured that there were sufficient staff and that the number reflected any changes in assessed needs.

We were shown the most recent monthly review which had been undertaken to ensure high quality care and support was provided to people who used the service. This addressed issues about feedback and investigations into accidents, incidents and complaints and confirmed that people could expect a service which meet their needs.

1 November 2012

During a routine inspection

Two inspectors visited The Laurels. We spoke with people who lived there. We spoke with three care assistants, a senior carer, the activities coordinator and a registered nurse. The registered manager was available all day and the provider's regional manager attended.

We followed up a warning notice we issued in August 2012, when there were not enough staff to meet people's care needs. We found there were sufficient staff. People told us, and we saw, that they received attention when they needed or asked for it. Gaps in the staffing rota, caused for example by staff sickness, were filled by staff offering to work extra hours or by agency staff. There was a programme of staff recruitment.

We observed patient and attentive care by all staff, including ancillary staff. Care plans contained clear guidance to staff on how to meet people's personal care needs. They showed how to support people to take their medicines and how to recognise and respond to signs of pain. A regular visitor to the home told us they were involved in their relative's care planning. We saw that when needs were identified, people were referred to external health professionals as necessary. However, some care plans showed inconsistent or conflicting information. The activities coordinator maintained a high level of involvement with people, through group activities and individual engagement. Care planning for people did not make full use of this work and knowledge.

1 August 2012

During a routine inspection

We visited this service to check on improvements made following a compliance action we issued in March 2012 due to concerns over staffing levels. At this visit we found people who use the service were not cared for by enough suitability skilled and experienced staff. People who use the service were not receiving assistance with their personal care when requested.

People told us they liked living at the home. One person said "It's lovely here. The staff are really nice. There is not enough of them".

Five people who use the service told us there was not sufficient staff on duty to meets their needs. One person told us "last week I had to wait about two hours for staff to help me. It's not their fault there just isn't enough of them on duty".

Five staff members told us they thought there was not sufficient staff on duty to enable them to spend individual time with people and complete their daily tasks.

A visitor, a relative of a person living at the home, told us: 'I don't think there is enough staff here. Two other visitors told us there were not sufficient staff on duty. One person told us 'I often see people waiting a long time for staff to help them. They sometimes get upset".

We have taken enforcement action against the provider for this essential standard to protect the health, safety and welfare of people using this service.

28 March 2012

During an inspection in response to concerns

People said that they appreciated having their own rooms, and being able to choose how they are decorated. One person told us "I have my own television so I can watch what I like. I like spending time in my room'.

People told us that they liked living at the home. One person said "It's nice here. I have lived here for a long time".

A relative told us 'I just wish the staff would notice the things that I notice and do something about them without me asking. I don't want to complain, but it's the little things that don't get done here".

Two people who used the service told us that they felt safe at the home and that staff were "nice girls but there isn't enough of them. They are really busy so we have to wait. It's the only thing wrong really. I wait so long for help to use the toilet that it gets really uncomfortable".

We looked at the recording about wound care that was completed by the trained nurses. We saw that the nurses were not always using the prescribed dressings.

13 September 2011

During an inspection looking at part of the service

At our the last inspection visit on the 13th September 2011 we identified some serious concerns with regard to the care and support people at the home received. This include people who were at risk or who had developed pressure ulcers and for those who were at risk of or who had lost weight. On this inspection we found that people were now receiving the care and support that they required to meet their needs. We found that although some of the care records had improved staff were not completing charts on all occasions. Some of the care plans and assessments still require updating to ensure that they provide clear guidance to staff on the needs of the individuals living at the home.

The service now has a new manager who is currently working to improve the standards at the home.

Since the last inspection a number of new staff have been recruited and have started or are due to commence work in the next few weeks. This has reduced the hours worked by some staff and reduced the need for agency staff at the home.

Following the last inspection we received some concerns from visiting professionals about poor moving and handling techniques used by staff and the poor repair of some equipment. Since our last visit a new hoist and five new slings have been purchased.

Moving and handling training for all staff has been organised and all staff will have completed this over the next few weeks.

All other training has been reviewed. Training has been delivered or is planned to take place over the next few weeks.

New carpets and flooring has been laid in a number of areas including the corridors and dining areas.

People living at the home told us that they felt that the care and support they received had improved and that if they asked for staff help that they did not have to wait as long as they did previously.

13 September 2011

During an inspection in response to concerns

The Care Quality Commission received a number of concerns since our last review in July 2011, including cases that were being investigated under Bath and North East Somerset's safeguarding procedures. We visited The Laurels on the 13th September 2011, following this visit we received additional concerns with regard to moving and handling practises at the home.

Some people at the home told us that they were happy with the care and support provided at the home. Other people told us that staffing levels were not sufficient and that they had to wait to receive support from staff.

We found that care was not always adequate, particularly for one individual who had a pressure ulcer (sometimes called a bed sore). This individual had not been supported to have a regular change of position. The lack of change of position will have impacted on the deterioration of the wound.

Diet and fluids were not recorded and we could not see how the records were being used to influence the care being delivered. Diet and fluids were not given for long periods of time and we could not see that when diet or fluids were refused that staff were proactive in addressing this. The care planning documentation did not give clear guidance to staff.

Staff had not received training in order to meet the needs of the people living at the home. There was little evidence that registered nurses had been given opportunities to update their clinical skills to meet the needs of people being cared for in the home.

We found that since our last review improvements had been made to the environment . The home now has a number of functioning showers and baths. The replacement of some flooring in the home had started and was due to be completed over the next few weeks.

The home has not had a manager registered with us for some time. A new manager has now been employed and we were told they will apply to register with us in due course.

13 September 2011

During an inspection in response to concerns

We completed this review in response to some concerns raised from relatives of people who use the service and professionals from the funding authority who visit the service. This review was completed with a member of the contracts and commissioning team.

During the visit people told us that the manager has been seconded to work at another home within the group. The provider had informed us of this and the interim managerial arrangements. Since the visit we have been told that the manager will not be returning to the home at the current time. Again the provider has informed us of the arrangements that they have out into place. There has not been a manager registered with us for a significant period of time.

People told us that 'they missed having the manager around'.

We saw that staff were respectful in their interactions with people. People were very complimentary about the staff that were employed by the home. Comments included 'the staff are lovely' and 'when they help me they are very kind' We did find however that there was not always enough staff on duty to meet the needs of people living at the home

We observed the lunchtime meal during our visit. We saw that everyone who had their meal in the dining room was wearing a 'clothes protector'. We heard one staff member referring to these as a 'bib'. The use of this equipment for all people does not respect people's choices. The use of the term 'bib' by staff does not respect people's dignity. Some of the terminology used in the care plans did not respect people at the home.

We found that people's hygiene needs were met but that some people would like the opportunity to bathe or shower more often. One person told us that they had not been offered'for a long time'. Another person told us 'I have a bath but not that often'. We found that the home currently only has one functioning bathroom. This may impact on the ability of people at the home to maintain their personal hygiene.

Some of the equipment at the home looks worn and dirty. The carpets although well hoovered are stained and worn.

24, 27 January 2011

During a routine inspection

We spoke with people living at the home or their relatives / friends during the site visit. People told us that they felt safe at the home and that staff were 'kind and caring'. They felt that the food was usually 'excellent' or 'lovely' and that they were given plenty to eat at times that suited them. People said that they could eat meals in their rooms if they did not wish to go to the dining room.

People said that their rooms were warm and comfortable and that they felt safe. They said there was always staff around. They also said that they were able to go to their room for privacy when they wished and that staff left them alone for a reasonable time when they did not want to be disturbed.

People said that they were supported to have regular baths or showers and helped to maintain personal hygiene where this was needed. Otherwise, staff respected their privacy and dignity and they were able to attend to their own personal hygiene on their own if they were able.

People said that the home provided activities for them to participate in each week. People told us that they enjoyed the opportunities that this gave them. People were complimentary about the manager of the home.

During our review we have identified some areas where the home needs to make improvements to maintain compliance. We found the service was not meeting the required standards for the support and training of the staff. This means people who use the service may not always get care that is safe and that meets peoples health and welfare needs.