The Laurels and Pine Lodge

We found the following examples of good practice.

The premises were visibly clean. People who lived at the service and visitors told us the building was always kept clean.

Visitors told us they were able to visit by arrangement, subject on each occasion to temperature checks, a negative lateral flow test result and the use of PPE (a face mask) in line with government guidance. The provider shared the current government guidance and local procedures for visitors with people’s families and regular visitors. Visitors confirmed there was good communication.

Although there were hour long time slots for visitors, to be booked the day before, the service where possible allowed visits to be longer than an hour, provided there were not too many people in the building. Visits took place in people’s rooms. Some people chose to receive visitors outdoors, which we observed during the inspection.

No visitors were currently using Essential Care Giver status, although the provider had informed people and their families and close friends about this.

There were temperature checks and lateral flow result checks for everyone entering the building. Professional visitors and contractors were expected to provide evidence of double vaccination against COVID-19 or of medical exemption.

People and visitors confirmed, and we observed, that staff wore face masks and where appropriate, disposable aprons and gloves. There were ample supplies of personal protective equipment.

People, including those who had languages other than English as their first language and those who had impaired hearing, had adapted to staff using masks. Where required, adaptations were made such as providing whiteboards so things could be written down to assist communication.

People at the service and staff were part of a regular coronavirus testing scheme.

New wet rooms had been installed so people did not have to move between floors in order to have a shower.

Lighting in many areas had been adapted so it was operated by movement sensors, to reduce the number of surfaces touched by multiple people.

There was a programme under way for replacing some worn carpets, furniture and soft furnishings, which, although intact, were becoming shabby. This had been highlighted in the service’s regular infection prevention and control audits.

Policies and procedures relating to infection prevention and control were in line with current government guidance.

The Laurels and Pine Lodge is a residential care home and during our inspection was providing personal care to 43 older people, some living with a dementia. The service is registered to accommodate up to 55 older people. Accommodation is provided across two wings of a converted building, each of which have separate adapted facilities. Communal lounges and dining facilities were provided in each wing of the premises.

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

The provider had undertaken some improvements to the premises which included installing three wet rooms and installing some new flooring. However, during our inspection we highlighted further areas that needed improving, in order to reduce the risks to people’s health and safety. These included improvements to the main driveway and replacement of worn vinyl flooring and stained and worn carpets. Risk assessments had been completed to mitigate the risks. The newly recruited manager had raised these concerns with the provider when they were appointed in February 2021 but work had not yet been scheduled.

We have made a recommendation to improve the driveway and internal flooring.

There was a calm, welcoming and friendly atmosphere at The Laurels and Pine Lodge. Staff knew people well and were attentive to their needs. Potential risks to people’s health and welfare had been assessed and regularly reviewed. Risk assessments were detailed and covered areas including, falls, skin damage, nutrition and hydration and evacuating people in an emergency situation.

There was a system in place to review people's nutrition and hydration, this was in the early stages and improvements were taking place. We have made a recommendation for the service to maintain its efforts to improve people’s nutrition and hydration, to ensure people receive high quality person-centred care.

Relatives and people told us they felt safe living at The Laurels and Pine Lodge and staff talked knowledgably about the system for reporting any potential signs of abuse.

There was an ongoing programme of staff recruitment. When required consistent agency staff were used to ensure staffing levels were maintained at the correct level to ensure people were cared for safely. Staff told us they enjoyed working at the home and felt well supported at all times.

People’s medicines were managed safely, stored securely and administered by trained staff. People received assistance to take their medicines as prescribed.

People, staff and visitors to The Laurels and Pine Lodge were protected from risks of infection as policies and staff practices were reflective of current best practice guidance. Staff had access to personal protective equipment (PPE), and the home was active in carrying out whole home testing in response to the coronavirus health risk.

People received person centred care which suited their individual health needs and reflected their wishes and choices. People were cared for safely whilst maintaining and promoting their independence and wellbeing.

The COVID-19 pandemic had restricted the amount of activities people could enjoy due to independent entertainers not being able to visit the home. However, additional activities had been run from the home which included a range of hobbies and one to one activities for people to reduce the risk of people becoming socially isolated at this difficult time. An activity member of staff was in the process of being recruited and would be commencing their employment at the home in June.

Staff supported people to communicate in ways they preferred. People were included and involved in decisions about their care, support and day to day lives.

The provider had a clear complaints policy and information explaining how to complain was on display around the premises. Relatives felt any concerns would be listened to, although they stated they had not yet had to complain.

People’s end of life wishes were known and respected, these included any spiritual or cultural preferences. Families were given full support through those difficult times. A member of staff told us, “We are really good at end of life care and providing support to all, we do that really, really well.”

There was an effective governance system that had recently been put in place. There were a variety of action plans, audits, policies, spot checks, systems and procedures to monitor the quality and safety of the service. These ensured a culture of continuous improvement and learning took place and highlighted any potential shortfalls to improve the safety and quality of care people received.

Staff felt well supported and spoke positively of the manager and management team. Staff were committed and motivated to delivering quality person-centred care to people.

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 good (published 31 October 2018).

Why we inspected

We received concerns about people’s care in relation to their skin integrity, nutrition and concerns around some aspects of the safety of the premises. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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 coronavirus 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 inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for this service is good. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Laurels and Pine Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Laurels and Pine Lodge accommodates up to 55 older people across two wings of a converted building, each of which have separate adapted facilities. One of the wings, Pine Lodge, specialises in providing care to people who live with dementia. At the time of the inspection, around 45 people were living or staying at the service.

The two units were overseen by one 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 service had an open and friendly feel. People commented positively on the atmosphere, for example, “To my way of looking at it the home is well led. It is a very nice home to be a resident in." The registered manager sought to operate an ‘open door’ policy and during the inspection spent much time on the floor with people and staff, who responded as if this was a regular occurrence. Open communication was promoted through daily ‘10 at 10’ meetings between senior staff from all departments. Staff received updates through handovers, supervision and staff meetings.

People were treated with kindness, respect and compassion. Care staff and managers knew and cared about people who used the service. Staff respected people’s privacy and promoted their dignity. There were many positive interactions, while staff supported people and as they were passing by. Staff were attentive, noticing when people looked uncomfortable or upset. They quickly offered the care and support needed.

People received care that met their individual needs. Wherever possible, staff promoted people’s independence. Care was planned and delivered based on people’s individually assessed needs and preferences. People consented to their care, or if they lacked the mental capacity to do so, care was provided in their best interests in line with the Mental Capacity Act 2005. Assessments and care plans were reviewed and updated regularly, with the involvement of people and their relatives. Activities were available and helped people to maintain community links.

People had access to healthcare services and were supported to manage their health. They were supported to eat and drink enough to maintain a balanced diet. They had a choice of meals and drinks. Special dietary needs and preferences were catered for. Where people needed assistance to eat or drink, staff helped them attentively and with sensitivity. People were weighed at least monthly, or more frequently if there was concern about weight loss. Prompt action was taken to address unplanned weight loss.

Staff had the knowledge and skills needed to carry out their roles. Recruitment systems were robust and helped ensure only suitable staff were recruited. Staff had access to the training they needed. They were committed to their work but expressed differing views of the leadership of the service. Most were positive, but two felt that there was sometimes too much to do in the time available and were unsure whether this would be addressed. People told us there were enough staff around to provide the care and support they needed.

Medicines-competent staff were not always available on site at night. This could result in delays for people who needed ‘as required’ medicines at night. We have made a recommendation in relation to ensuring there are always medicines-competent staff on site.

People were protected from abuse, infection and avoidable harm. Staff understood their responsibilities in relation to safeguarding adults. They knew how to raise concerns about poor practice. The premises and equipment were kept clean and in good order. There was a team of maintenance staff and a regular maintenance programme. Both parts of the premises were adapted so they were accessible to people with mobility difficulties. Medicines were stored securely. Some information about people’s individual risks was out of date and records did not always reflect the support staff had given, for example, when they helped people reposition to reduce the risk of pressure sores. The management team acted immediately on the issues we drew to their attention and were already working on plans to improve record keeping. We have made a recommendation in relation to the provider’s policies for the use of anticoagulant medication and the management of falls.

Quality assurance processes were in place to monitor the service’s performance and drive improvement. These included regular meetings with people who used the service and with relatives to gain feedback, as well as giving news about recent events and forthcoming developments. There were occasional surveys and regular audits and checks, with action plans to address any shortfalls found. There was a system for bringing about learning and improvement when things went wrong. The registered manager exercised their duty of candour, keeping people and where appropriate their relatives informed about what had happened in relation to accidents and incidents. Complaints and concerns were taken seriously and used to improve the quality of care. The service worked openly and cooperatively with other organisations to ensure people were safe and received the care and support they needed.

The Laurels and Pine Lodge is registered to accommodate and provide personal care for up to 54 people. The home is divided into two units. The Laurels, which provides care and support to older people with frailty of old age and some people living with mild to moderate dementia, and Pine Lodge, that provides care to people living with dementia. At the time of inspection there were 43 people living at the home.

At our last inspection, carried out in May 2015, the provider was required to make improvements to comply with regulations on meeting assessed staffing levels and good governance. At this inspection we found the provider had made the necessary improvements.

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. At the time of this inspection there was no registered manager; however, a manager had been appointed and had started work at the home in November 2015. They had submitted an application form to become the registered manager.

Overall, people were very positive about the home and there was an improvement in morale and overall management of the home.

People felt safe living at The Laurels and Pine Lodge. There were established monitoring and auditing systems to make sure that the environment and the way people were looked after were safe. Risk assessments had been completed to make sure that care was delivered safely with action taken to minimise identified hazards. The premises had been risk assessed to make sure the environment was safe for people.

Staff had been trained in safeguarding adults and were knowledgeable about the types of abuse and how to take action if they had concerns.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce likelihood of their recurrence.

Sufficient staff were employed at the home to meet the needs of people accommodated.

Recruitment procedures were being followed to make sure that suitable, qualified staff were employed at the home.

Medicines were administered by trained staff and issues identified as a risk to safe management of medicines were addressed before completion of the inspection.

The staff team were both knowledgeable and informed about people’s care and support needs. There were good communication systems in place to make sure that staff were kept up to date with any changes in people’s routines or care requirements.

Staff were well-supported through supervision sessions with a line manager, an annual performance review and also direct on the floor supervision.

Staff and the manager were aware of the requirements of the Mental Capacity Act 2005 and acted in people’s best interest where people lacked capacity to make specific decisions. People were consulted and supported to gain their consent about their care and support.

The home was compliant with the Deprivation of Liberty Safeguards by close of the inspection with better systems in place to monitor applications. Appropriate referrals were made to the local authority.

People were provided with a good standard of food and their nutritional needs met.

People’s care needs had been thoroughly assessed and care plans put in place to inform staff of how to care for people. The plans were person centred, covered all areas of people’s needs and were up to date and accurate.

People and staff were very positive about the standards of care provided at the home. People were treated compassionately as individuals with staff knowing people’s needs.

Communal and individual activities were arranged to keep people meaningfully occupied.

There were complaint systems in place and people were aware of how to make a complaint.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed on so that people could experience continuity of care.

The home was well-led. There was a very positive, open culture in the home with staff much improved since the last inspection.

There were systems in place to audit and monitor the quality of service provided to people.

We looked at the care records relating to people's care and support and saw that risks to their health had been managed effectively. People's wishes had been taken into account in planning their care. The home had a clear and effective management structure in place which was supported by dedicated staff.

We spoke with five people who were able to tell us about their experiences of living in the home and three relatives. People told us they felt well cared for and one relative said "I go home at night knowing my wife is safe".

We spoke with three members of staff who told us they felt well supported working in the home. One member of staff told us "I've been here for 23 years and I love it".

People were not all able to tell us about their experiences due to their condition. Therefore, in addition to speaking with two individuals we gathered evidence by observing care, reviewing records, and speaking with the manager and four staff. We also spoke with two relatives and two visiting health care professionals.

People's privacy, dignity and independence were respected. Their views and experiences were taken into account in the way the service was delivered. We observed that staff were friendly and respectful. They spoke with people discreetly when they needed any personal care.

People experienced care, treatment and support that met their needs. We found that people's needs were assessed and care and treatment was planned and delivered in line with individual care plans. People looked contented and relaxed. We noted that staff understood and attended patiently to their needs.

There were suitable medication management systems in place.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff told us their colleagues and managers were very supportive, but would challenge them if needed.

There was an effective complaints system. Comments and complaints people made were responded to appropriately. One person said 'they're very approachable' if they had any concerns.