The Laurels

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although processes existed to review events and identify trends,some improvements were needed to ensure opportunities for learning were not missed. For example, where someone had fallen from a shower chair, the incident log stated that staff must be vigilant and support the shower chair during any movements that could cause instability, but when we reviewed the person’s care plan, it had not been updated to reflect the importance of staff vigilance and the necessary actions to ensure it remained relevant and effective.The incident and complaints log did not always provide person centred detail to ensure lessons had been learnt to continually identify and embed good practice.The provider told us there were monthly governance meetings to review incidents and complaints fully, however, the logs in place within the service were not sufficiently detailed.This meant that opportunities for learning and improvement were not always fully in place for staff.

The registered manager understood their responsibilities under duty of candour and shared information with the relevant stakeholders.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. One relative told us, “When [my relative] was admitted to hospital the staff stayed with them day and night, they never left them.” The service worked with people and relatives to establish a plan for care and support prior to people moving in. One relative told us, “Before they came here the staff did multiple visits to them at home so they got to know the staff, it was very good.” Care plans included strategies related to supporting people during health appointments and potential anxiety or distress which may occur.

Hospital passports were in place for use in circumstances when people were transferred to other facilities so staff could support people effectively.However, the detail in these was sometimes not correct, or required updating to ensure people’s changing needs were reflected fully. The deputy manager begun updating these immediately.

Staff received training in safeguarding adults and children and the Mental Capacity Act 2005 (MCA). However, records did not always evidence that people were supported to understand information, communicate and make decisions about their life, care and treatment in line with the MCA. Restrictive practices were only being used as a last resort, and personal behaviour support plans (PBS) were in place which outlined strategies staff would use to diffuse behaviours that might challenge, before the person became distressed. Deprivation of Liberties Safeguard (DoLS) applications had been completed where required. Some DoLS had conditions attached. These were logged by the registered manager, some of which remained in progress, as they were awaiting appointments with relevant clinicians.

The service reported concerns of abuse to the local authority safeguarding team, and in accordance with their legal responsibilities in relation to the submission of statutory notifications to the Care Quality Commission (CQC).We were made aware of an incident involving verbal abuse towards a person using the service.The provider took the correct actions to safeguard people and worked in line with their disciplinary procedures, some of which were on-going.

The provider did not manage risks effectively, risk assessments were not always updated or lacked essential detail to prevent and reduce risks of avoidable harm for people.Risks relating to constipation, choking, and monitoring of people’s skin were not sufficiently robust. Where risk assessments were in place, some were overdue review. Daily notes completed by staff did not always describe how food was being prepared for those at risk of choking, and therefore we could not be fully assured that staff were following people’s assessed needs when preparing food. Some risk assessments such as the risk of falling, did not outline how the risk could be mitigated. Skin integrity records were not kept up to date to ensure injuries were monitored for healing, and it was not always clear how skin injuries had occurred. Care plans and risk assessments were not always updated promptly when risk to people had changed. The registered manager took action to update risk assessments and put in place increased oversight of food preparation.They also intended to implement training workshops for staff to improve this area of people’s care. Some people experienced periods of anxiety or distress in response to certain situations. There was guidance for staff on how to approach and divert people to promote positive outcomes at such times within people’s care plans. However, this could be further improved by the use of one-page profiles. A one-page profile captures all the important information about a person on a single sheet of paper, such as how to communicate, how to diffuse situations, or trigger words to avoid.New staff were working in the service, and some people could display distressed behaviours if the incorrect approach or certain trigger words were used. Having this key information at hand would reduce the risk of people becoming upset and would support staff and people to remain safe.These gaps in risk management and personalised guidance placed people at risk of avoidable harm, inconsistent care, and unnecessary distress.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The home was in a good state of repair. Maintenance issues were managed in a timely way, and we observed the maintenance person working in the service. Systems were in place to manage the environment people lived in, such as health and safety audits. Staff received fire training and fire drills were undertaken periodically, including for night staff.

Some relatives told us that they would like to see improvements in the garden area, such as replacing the patio paving to make it a smoother,more accessible area for wheelchairs. We also discussed this with the provider who later confirmed that the cost for renewing his had been agreed, and they were awaiting contractors to begin the work.The registered manager also told us of the ideas they had to improve the garden areas in the spring by planting flowers and consideration of interactive items for people to enjoy. Some relatives told us that additional soft furnishings in communal areas would make the service feel more homely, along with carpets on the stairways.

The registered manager told us the staffing levels met the commissioned support hours for the service, but they were improving the recording of this for the funding authorities to evidence the hours were being used effectively, for example, when people were taking part in activities in the community. Staff received training relevant to their role, including the Oliver McGowan Mandatory Training on Learning Disability and Autism, which is the standardised training recommended for health and social care staff. One staff member told us, “Since I have started working at The Laurels, I have attended many in depth training courses which have helped me in my job role both online and face to face.” Staff told us they felt they could approach the management team if they needed to and did not share any concerns in relation to training. Most staff were positive about the current staffing levels in the home. Some staff referred to staffing levels being an issue earlier in the year but said this was now much better. One staff member told us, “From my experience, staffing levels on [shift] have been safe. We also have out-of-hours support available, and on the occasions I’ve needed it the response was quick, calm and very supportive.”

Recruitment procedures were in place which included the necessary checks to ensure staff were suitable for the role. New staff had started working in the service and they told us they received a good induction which included shadowing of experienced staff, and time to get to know people. One staff member told us, “The help and support that I have been given since I started by management and staff has been truly amazing as I was completely out of my comfort zone when I started here”. Another told us, “My induction has been really good, I am given time to get to know people.” The majority of staff told us they received supervision sessions to discuss their practice and any concerns they had. One staff member said, “We receive monthly supervisions to discuss any concerns or training needs that we may have.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service was clean throughout including in people’s bedrooms. Staff had access to personal protective equipment (PPE) to keep people and themselves safe in line with infection prevention and control guidance.

Medicines management systems were not always effective in keeping people safe. Medicines were stored safely and securely and at appropriate temperatures. Records we checked showed that people received their medicines as prescribed and that prescribers reviewed people’s medicines. Staff regularly had their competence assessed around medicine management to ensure they managed people’s medicines safely. However, we found that this did not include staff competences around managing people’s medicines administered via Percutaneous Endoscopic Gastrostomy (PEG) feeding tubes inserted into their stomach. There was detailed and person-centred care planned information available for staff to refer to when giving people their medicines. However, for laxative medicines prescribed for occasional use (PRN medicines), there was a lack of detailed guidance for staff about the use of multiple laxatives and how long the medicines should be used before referral to a clinician increasing risks to people’s health.