The Laurels Care Centre Limited

The Laurels is a care home that was providing nursing and personal care to 17 older people at the time of our inspection. The service can support up to a maximum of 68 people.

The premises is divided into three separate units, each of which has their own adapted facilities (the 2nd floor unit remains closed indefinitely for refurbishment).

Approximately half the people using the service were living with dementia.

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

The provider still needed to make substantial improvements to ensure the service was suitably governed. Staff had not received up to date infection control training in light of the COVID-19 pandemic, nor did they always wear Personal Protective Equipment (PPE) correctly.

Management did not ensure that people received care in line with their assessed care needs, nor did staff always receive appropriate training to support them to care for people's specific needs. Best practice was not adhered to when seeking consent from people.

Quality assurance systems were not always completed to ensure care delivery was appropriately delivered and reviewed.

Monitoring of incidents and accidents still required improvement to ensure they were appropriately recorded and investigated. People’s risk assessments had improved to ensure they were clearer in defining people’s specific needs. Staff were safely recruited, and there were suitable safeguarding processes in place to support staff to express any concerns.

Staff, people and relatives felt that management support had improved. The service worked effectively with partnership agencies to ensure that people’s care needs were met.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 18 September 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed the action plan they sent us and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Is the service Safe, Effective and Well-led?, which contain those requirements.

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.

No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Laurels Care Centre Limited is a residential care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection.

The Laurels Care Centre Limited accommodates up to 63 people in one adapted building. At the time of the inspection the second floor was closed for refurbishment.

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

Staff did not always receive regular supervision of their work, and staff had not had an annual appraisal. Registered nurses were not up to date with medicines training and competency, with the provider ensuring this was booked following inspection. Furthermore, staff reported low morale amongst the workforce and did not feel that management were approachable.

The provider recognised that improvements were needed to ensure people’s care plans were relevant and covered each area of people’s support needs.

Medicines were safely managed and risks to people were suitably assessed. The provider reviewed staffing levels to ensure they met people’s needs and recruited staff safely. Safeguarding allegations were reported and investigated. Steps were taken to prevent the spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, DoLS applications were not always submitted in a timely manner.

People received support to eat and drink in line with their preferences. When people needed to access healthcare professionals staff supported them to do so. The premises were suitable to meet the needs of people living there.

People felt well cared for and that staff treated them well. Staff supported people with their independence and ensured they maintained their privacy and dignity. People and relatives were consulted on their care needs, with their cultural and religious needs being met.

A range of activities were on offer, with people participating regularly. People were supported to maintain important relationships. Where end of life care was required people were supported to express their wishes where they were able to. Complaints and concerns were responded to appropriately.

The provider had taken steps to identify areas for improvement across the home, and an action plan was in place. The provider worked alongside other agencies to support care delivery across the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 14 November 2017).

Why we inspected

This was a planned inspection based on the previous rating. The inspection was also prompted in part due to concerns received about falls management, medicines errors and staff wellbeing. A decision was made to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

We have found evidence that the provider needs to make improvement. Please see the ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-led’ sections of this full report.

Enforcement

We have identified breaches in relation to staff support and training and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Laurels Care Centre provides nursing care for up to 63 people, some of whom have dementia. The home is accessible to people who use wheelchairs, built over three floors and is based in the London Borough of Lambeth. At the time of the inspection there were 40 people using the service.

At the last inspection, the service was rated Good. At this inspection we found the service remained good.

People were protected against the risk of harm and abuse as staff received on-going training in safeguarding. Staff were able to identify, report and escalate any suspected abuse and told us they would whistleblow should their concerns not be acted on. The service had developed risk management plans that gave staff the guidance on how to safely respond to identified risks. Risk management plans were reviewed regularly.

People were protected against an unsafe environment. The service had systems and processes in place that monitored the environment and issues identified were acted on in a timely manner.

The service employed sufficient numbers of suitably vetted staff to keep people safe. Staff were supported to reflect on their working practices through supervisions and appraisals.

People received their medicines in line with good practice and as prescribed. Records confirmed the storage, administration, recording and disposal of medicines was managed in a way that kept people safe.

Staff received training to effectively meet people’s needs. Staff confirmed training received enabled them to carry out their roles and responsibilities in line with the providers policies.

People had their consent to care and treatment sought prior to it being delivered. People were encouraged and supported to make decisions about their care, by staff that gave them information in a way they understood. People’s decisions were respected.

People were supported to access food and drink that met their dietary needs and requirements. The service employed two chefs that were aware of people’s dietary needs and ensured people’s specific requirements were catered to.

People received care and support from staff who were compassionate and treated them with dignity and respect. People’s cultural and religious needs were supported, encouraged and respected.

People’s care and support was person centred and tailored to their individual needs and wishes. Care plans were comprehensive and gave staff clear guidance on how to meet people’s needs. Care plans were regularly reviewed and where possible people and their relatives were encouraged to participate in the development of their care plan.

People were supported to access activities that met their needs and preferences. The service employed an activities coordinator and encouraged people to engage with activities.

The service had a system in place to monitor and respond to concerns and complaints raised, in a timely manner. People and their relatives we spoke with knew how to raise a complaint and felt confident action would be taken to address their concerns.

The service carried out regular audits to monitor and improve the service provision. Issues identified during the audits were actioned and lessons learnt to minimise repeat incidents. Quality assurance questionnaires were sent to people, their relative and staff to gather their views.

The registered manager encouraged and sought partnership working from other healthcare professionals. Records confirmed where guidance and support was given through partnership working, this was then implemented in to the service delivery.

When we visited 43 people were living at the home, some of whom had dementia. The home is split into three units, at the time of our visit two of these were in use and one was closed.

The home has a manager who was appointed in July 2016. He has applied to the Care Quality Commission to become the 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.

A comprehensive inspection of the home took place in January 2016 when we found two breaches of regulations. A focused inspection was held on 8 June 2016 to follow up these breaches. We found some improvements had been made however the provider continued to fail to meet all the standards of the regulations. We found one continued breach and three new breaches of regulations. The home was rated as ‘requires improvement’. You can read the reports from our last inspections, by selecting the 'all reports' link for The Laurels Care Centre on our website at www.cqc.org.uk.

At this inspection on 30 November 2016 we looked at the areas of concern identified at the last inspections. We found improvements had been made in all of the areas in which we previously had concerns and we did not find any breaches of regulation.

Communal areas on the first floor were clean and hygienic because furniture and flooring had been replaced. This meant people spent time in a pleasant environment which was clean and fresh. People were treated by staff in a way that maintained their dignity and privacy. Staff had received relevant training and we had no concerns in this area. Staff had also received training in dementia awareness. The interaction we saw between people and staff was respectful, kind and warm. The home’s CQC rating was displayed as required at the home and on their website.

The new manager had identified areas for improvement in the home and was addressing them. People and staff were positive about the home and felt changes were being made to improve the quality of care.

The Laurels Care Centre Limited is registered to provide nursing care for up to 63 people. The home has three units, two of which provide care for people who have dementia. The third unit provides care for people with general nursing needs. The home is accessible to people who use wheelchairs and parking is available. A lift allows access to all floors of the building. When we visited 54 people were using the service.

The previously appointed registered manager left the home in May 2016. The deputy manager has been managing the service in the absence of a permanent post holder. 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 was last inspected on 11 and 19 January 2016. At that inspection we found two breaches of regulations. They related to safe care and treatment and the need for the provider to establish systems to monitor and mitigate the risks to people in the home. We also made a recommendation about staff being provided with advice and guidance about how to assist people properly at mealtimes. This was a focused inspection to follow up progress on these issues.

At this inspection we found three regulations were breached. The provider had failed to address one of the previously identified breaches of regulation and establish systems to effectively mitigate the risks to people at the home. We also found that when people needed to have a record made of their food and fluid intake accurate and complete records not were kept. People’s privacy was not protected by staff. We observed an instance of a staff member showing a lack of kindness towards a person. The provider did not display at the home or on their website the rating awarded to the service at the last inspection.

We are considering the action to take in response to the breaches.

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Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure and relatives felt that the people they cared for were safe.

The staff that we spoke with knew how to report concerns about people’s safety.

Systems were in place to make sure managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). A recent DoLS application had been made, it was an appropriate application and the manager had informed the Care Quality Commission as required. They were aware of the need to review the restrictions in place and this helped keep people safe.

Medicines were managed safely and the systems used protected people from the risks associated with the administration of medicines.

There were sufficient staff on duty to meet people’s needs throughout the day and night. People received a consistent and safe level of support.

Procedures for dealing with emergencies were in place.

Is the service effective?

People all had an individual care plan which set out their care needs. Assessments included needs for any equipment, mobility aids and specialist dietary requirements. Risks associated with people’s conditions were assessed and actions were planned to minimise them.

People had access to a range of health care professionals, some of whom visited the home. Some of these people were specialists in particular conditions, for example pressure area care, and they advised staff working in Laurels Care Centre so they could meet people’s needs. This meant that people were sure that their care needs were planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff at all levels showed patience and kindness when talking with and supporting people.

Staff were aware of people’s preferences, interests, and diverse needs. Our observations, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

People told us they had been consulted about the daily menus and suggested some changes. They said changes had been made and they were pleased their views had been listened to.

People knew how to make a complaint if they were unhappy with any aspect of the service.

A range of activities was arranged in the home and some people told us they enjoyed being supported to go out in the local area.

The service had made referrals when they had identified a person had needs which required specialist support. Examples included referrals to dieticians, audiology specialists and tissue viability nurses.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People’s personal care records, and other records kept in the home, were accurate and complete.

People who lived at the service, relatives and staff found the manager approachable and felt able to raise issues of concern.

There were quality assurance systems which included seeking the views of people living at the service, their relatives, staff and organisations involved with the service.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People were happy with the care they received, one person said: “Everything’s OK” and another person said: “The staff are lovely- they are so kind to me."

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. A relative who visited every day said: "I have never seen or heard anything that worries me when I visit."

The lift had been broken since August 2013 . This meant that some people on the upper floors had not been able to go out in the community or to the garden. There were temporary arrangements so that people could leave the building if they needed to go to hospital.

There were qualified, skilled and experienced staff, however sometimes there were insufficient staff to meet people’s needs.

There was an effective system in place to assess the quality of the service.