The Laurels and The Limes Care Home

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 requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

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

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The management team had systems and processed in place to review accidents and incidents. Actions were taken to mitigate future risks.

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. The provider had a process in place to support people who transferred to other providers, such as a hospital stay, to ensure all appropriate information was sent with people. This included their life history, medical condition, current medication and care plan summary.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. The current management team had been proactive in identifying safeguarding concerns and had taken action to address them. However, some staff raised concerns about unexplained bruising on people and related this to poor moving and handling techniques. We raised these issues with the current management team, and the interim manager was arranging for all the staff team to receive retraining in moving and handling techniques.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place, when needed, to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The manager maintained a record of DoLS and care plans included information about mental capacity.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks associated with people’s care were not consistently identified. Care plans were detailed and provided clear guidance for staff. For example, care plans described how people should be supported to transfer using a hoist, including the size of sling to use and the required loop configuration. However, we observed staff using different slings and not following the guidance set out in people's care plans. Some people required their food and fluid intake to be monitored due to the risk of weight loss. Food charts did not give the amount of food served or amount eaten and did not describe how food was fortified. This made it difficult for staff to review evaluate or monitor. Hydration stations were situated around the home with drinks and snack on offer. However, people were not always supported to access them. We identified 4 instances where staff records of people's food intake did not accurately reflect what we observed people eating. This meant some records were inaccurate. We raised these concerns with the management team, who took immediate action to review the mealtime experience, risk assessments and staff practices.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. For example, 1 bedroom carpet was presenting a trip hazard, and the garden area was not accessible for people living with dementia. Personal emergency evacuation plans [PEEPS] were in place but not always sufficiently detailed to support safe evacuation. We found a pair of scissors in an accessible cupboard which posed a risk to people living with dementia. The new management team were in the process of refurbishing the service to improve the design for people living at the home. An environmental action plan was in place and issues were being addressed.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. The provider had a recruitment process to assist them in employing suitable staff. We identified some staff training had not taken place in line with the providers training plan. The manager was addressing this. Over recent months staff had not felt supported in their role and had not had the confidence in the previous management team. The interim manager was working with staff to improve support and was offering guidance and direction. Staff told us they found the manager approachable and helpful. One staff member said, “I feel as if I am supported by my current manager and I feel comfortable to express my concerns to her, [manager] reassures staff and listens to them.” The provider used a dependency tool to ensure people had access to sufficient staff to meet their needs. However, we found staff often struggled to meet people’s needs. One staff member said, “There are shifts where I feel rushed and under pressure, but every shift is different, I feel as if we don’t have enough staff to perform our duties to the standard that I would like. On the ground floor of The Limes where there are usually only 2 members of staff for a large quantity of service users, this can be challenging especially with the residents who require 2 carers for transfers and toileting.” The current management team were aware of these concerns and were looking at staff deployment and leadership to improve the experience for people.

The provider did not always assess or manage the risk of infection. We carried out a tour of the home and found most areas were predominantly clean. However, we identified some concerns such as the incorrect storage of mops, clean towel on toilet cistern, dust behind radiators, outside bins and store required cleaning and items of linen stored on the linen room floor. The interim manager addressed these concerns during our inspection. Staff wore personal protective equipment [PPE] and changed gloves and aprons where required.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People received their medicines as prescribed. The provider had policies and procedures in place to support the safe management of medicines, and staff had received appropriate training to administer medicines safely.