Archived: The Laurels

The Laurels is a residential care home that provides emergency care and short term breaks for up to 17 people with a learning disability. At the time of our inspection, there were seven people using the service.

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 manager running at the service at the time of our inspection was not registered, but was the registered manager of another similar home operated by the same provider. The manager was in the process of applying to become registered manager of the home.

We found that people using the service felt safe and that staff were informed of how to recognise and respond to safeguarding concerns. Staff and relatives were comfortable raising concerns with the manager and felt confident that the manager promptly addressed concerns. Our last inspection had identified that the provider was in breach of a regulation relating to safe care and treatment, due to their processes around risk management. We found that the manager had made improvements to the risk management processes and communication at the home and that risks were managed effectively.

Staff were aware of how to respond to emergencies and we found that there were regular health and safety checks in place at the home. The manager had an informal staffing dependency tool in place and we saw that additional staff were brought in to meet people’s needs. The manager and staff told us that this system required improvement so that staff were always effectively deployed. Medicines were stored and administered safely at the home and we saw that there was an effective auditing process in place.

Staff had received training and on-going support to enable them to meet people’s care and support needs. Staff told us that they felt supported in their roles and a professional told us that staff were very engaged in training sessions and honest about their abilities and understanding.

People were supported to make decisions about their care and day-to-day lives and staff ensured that the legal rights of people were upheld and protected. The manager and staff promoted the importance of people having their voices heard and people were supported to make choices wherever possible.

People enjoyed their meals at the service and staff ensured that people’s preferences and nutritional needs in relation to their culture and religion were met. People had good access to healthcare services and staff were proactive in contacting relatives and healthcare professionals if people became unwell or if their needs changed.

People received support from staff who were caring and positive. Relatives and a professional told us that people were always keen to return to the home. People had the privacy they needed at the home and were encouraged to be independent.

Relatives told us that people received the care they needed and staff knew people’s needs and preferences. We found that there were not always enough activities for people to participate in at the home. In addition, people were not supported on a regular basis to become involved in activities or entertainment outside of the home that they found stimulating or enjoyable. People and relatives were involved in developing the care plans that staff updated as people’s needs changed.

Relatives told us that the manager and staff responded to complaints and concerns promptly. The manager had recently introduced feedback surveys for people to complete as they came to the end of their stay at the home.

People and relatives told us that they were happy with the way the home was run and that the manager was effective. Staff told us that they felt supported in their roles and we saw that the management team were involved in the day-to-day running of the home.

The provider and manager had systems in place for reviewing the quality of care at the home and took steps to ensure that people’s needs were being met. We found that the provider and manager had made improvements to the home in response to our last inspection and to on-going quality monitoring audits.

We carried out this review by looking at documents and photographic evidence sent to us by the provider. This showed that appropriate action had been taken to address the issue.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. Some people were using the service for short term breaks, and others had been at the home for several months whilst care professionals sought suitable longer term accommodation for them. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During this inspection we looked at the staff recruitment records for four members of staff. Appropriate checks were undertaken before staff began work.

We spoke to people who used the service who confirmed they felt safe.

We checked people's care plans and found that these were detailed and up to date. Risks were identified and for the most part plans were detailed enough to ensure that people had the care provided safely and risks to them and / or other people were minimised.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted when needed.

We found that a fire risk assessment had been completed in October 2013. This had identified that some improvements were needed to fire safety to include the emergency lighting system. We have asked the provider to tell us what they are going to do to address these shortfalls.

Is the service effective?

People told us they were happy at The Laurels. One person told us, 'I love coming here. The staff are all very nice to me. I'm not frightened of anyone here.'

We observed that where necessary people were supported to be dressed appropriately and maintain their personal appearance. People told us they were able to have a bath or a shower when they wanted to.

Records showed that regular meetings were held with people or their relatives if appropriate, to review their care needs.

Is the service caring?

During our observations we saw that people were supported by kind and attentive staff. We saw and heard that care staff treated people with respect. People we spoke with confirmed that staff were caring.

People using the service were supported in promoting their independence and community involvement. People told us they took part in a range of daily living and recreational activities.

Is the service responsive?

People who had capacity to understand knew how to make a complaint if they were unhappy. People told us they were able to raise any concerns they had. One person told us, 'I could tell staff if I was unhappy but I have not made any complaints.'

Where people who used the service were able, they were asked to comment on the

service provided, this included questions about the support they received.

During our visit we looked at records of complaints and incidents. We found that consideration had been given to these by the registered manager and actions had been taken to reduce the likelihood of similar incidents happening in future.

Is the service well-led?

We found that a fire risk assessment had been completed in October 2013. This had identified that some improvements were needed to fire safety to include the emergency lighting system. At the time of our visit there was no evidence to show that the assessment had been acted on or that any work was scheduled to take place. This meant that the provider did not have an effective system to manage risks to the health and safety of people and staff using the building. We have asked the provider to tell us what they are going to do to address these shortfalls.

We noted that one of the registered manager as mentioned in this report no longer worked at the location. The provider is aware of the need to formally apply for the registration of this person to be cancelled.

Some people were using the service for short term breaks, and others had been at the home for several months whilst care professionals sought suitable longer term accommodation for them.

During our visit we found that staff treated people with dignity and respect. People experienced care, treatment and support that met their needs and protected their rights. One person told us that they liked staying at the home and that staff were ''Nice.''

We found there were systems in place to keep people safe. Staff had been trained to recognise and report signs of abuse and the four staff we spoke with were confident about their responsibility to do this.

There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We found some areas where improvements were needed. Some areas of the environment had not been adequately maintained and record keeping needed to be improved.