Creative Support - The Laurels (Cumbria)

We found the following examples of good practice:

All staff and essential visitors used appropriate personal protective equipment (PPE).

The home had sufficient supplies of appropriate PPE which was stored hygienically and kept safe.

Staff were provided with separate areas to put on and take off and dispose of PPE safely.

Staff supported people's social and emotional wellbeing. Where people required additional support, they were referred to appropriate services.

The provider explained the quality systems they had in place to check the service was providing safe care.

Deep cleaning of all areas of the home was completed and recorded.

All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Staff were encouraged and incentivised to be vaccinated. The provider supported the well-being of their workforce with various schemes including financial aid and the provision of pulse oximeters for personal use.

Further information is in the detailed findings below.

The Laurels is a residential care home for up to 29 older people and people living with dementia. There were 21 people in residence when we inspected. It is operated by Creative Support Ltd who provide residential homes and community support to people throughout England. People had single bedrooms but some rooms could be used as doubles. There were suitable shared facilities and a pleasant garden.

People’s experience of using this service

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.

People told us they felt safe. Staff understood their responsibilities in protecting people from harm and abuse. New members of staff had been suitably vetted. Accidents and incidents were responded to appropriately. Staffing arrangements were under review to ensure there were enough staff to meet people's needs. Medicines were suitably managed.

Staff had a good understanding of individual needs and wishes. The staff team had suitable training and experience in their different roles. Good attention was paid to health needs and people had their nutritional needs met well. People told us they enjoyed their meals and special diets were catered for.

The staff team were caring and supported people in a dignified way that also supported them to be as independent as possible.

Care planning ensured that people had the right levels of care and support. People told us they had plenty of activities and entertainments in the home. The home had employed an artist in residence and there were plans to do this again as people enjoyed this so much. Visitors were made welcome and people went out with family or with staff.

The home was managed by an experienced and suitably qualified registered manager. Senior managers of the company gave her, and the staff team, regular support. Quality was monitored and improvement made as a result. A staff member said, "If I need anything for the residents it is no problem, the management respond quickly which means I can do things that they want."

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

Rating at last inspection:

Requires improvement ( Published 15 March 2019 ).

Why we inspected:

This was a planned inspection based on the previous rating

Follow up

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

The Laurels is a care home that provides accommodation and personal care for up to 29 people, some of whom may be living with dementia. At the time of the inspection there were 19 people living at the service. The accommodation is provided over two floors. There is a range of communal areas on the ground floor. These include dining areas, lounges and a small garden area.

Rating at last inspection: Requires Improvement (last inspection report published 13 September 2018). The overall rating for the service remains the same. This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a planned inspection, which took place on 15 and 16 January 2019 and was unannounced.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe; effective; responsive and well-led to at least good. Although we found that some improvements had been made, further work was required.

People’s experience of using this service:

People told us that they felt safe at the home. There were enough staff on duty to provide safe care to people. Systems were in place to protect people and help keep them safe.

People’s medicines were not always managed safely.

We have made a recommendation about the management of medicines.

Improvements to the risk assessment process had been made. There were some areas that needed further improvement to ensure staff had full details of risks and how to manage them.

Staff knew the needs of the people they supported to provide individual care and records reflected the care provided. People told us they received good quality care, although some people thought there was sometimes and imbalance of support.

People had been involved with the decisions about their care. Staff provided explanations so people could make day to day decisions about their lives.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

The home was clean and there were no unpleasant odours. On the first day of our inspection some painting and re-decoration was taking place. One person told us that the home was “cramped” at times and others felt the home was “in need of a facelift.” There were some aspects of the home that helped people with dementia orientate themselves but these could be improved upon. The provider told us that they had plans in place for the refurbishment of the home.

We have made a recommendation about improvements to the environment, particularly for people living with dementia.

We found that the provider had made improvements to the way in which people were supported with eating and drinking. This included a more organised and calm environment and improved monitoring systems.

There were limited opportunities for people to follow their interests and hobbies but the provider was working on making improvements to this.

We have made a recommendation about supporting people with their hobbies and interests.

Staff received supervision, appraisals and induction training. Further training and specialised training was available to help ensure staff supported people safely and effectively.

There were opportunities for people, relatives and staff to give their views about the service.

Action plans were in place to help keep improvements to the service on track. There were a range of checks in place to help monitor the quality of care provided. However, some staff were not clear about the importance of some checks.

We have made a recommendation about ensuring staff understanding of the audit process.

More information is in the full report

Follow up:

We will continue to monitor the service through the information we receive.

At our last inspection of this service we found that the provider was not meeting the legal requirements and was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always sufficient numbers of support staff to meet the assessed needs of people living in the home.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question ‘safe’ to at least good.

At this inspection we found that there were still insufficient numbers of suitably qualified staff, appropriately deployed, in order to meet the needs of people living at The Laurels. We also found that medicines and risks were not well managed. This meant that the provider had not made the necessary improvements to the key question ‘safe’.

The Laurels is a care home but is not registered to provide nursing care. People in care homes receive accommodation and nursing or personal care as a 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 is registered to accommodate 29 older people, some of whom may be living with dementia, in one adapted building. The home is situated in a residential area not far from the centre of Carlisle. Accommodation is found on the ground and first floor of the property, which is accessed by a passenger lift and stair lift. There is a dining room and three lounges, on the ground floor, that give communal space for people to enjoy. There is also a small garden area.

There was a registered manager for 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.

We found that the service did not always manage and administer people’s medicines in a safe way. Records were not accurately maintained and we observed some unsafe practices by staff. We reviewed the ways in which the service responded to accidents and incidents. We found that risk assessments and assessments of people’s care needs were not accurately reflected, nor did they provide clear guidance for staff to follow. This meant that the service did not consistently protect people from the risks of receiving unsafe care.

The food provided at The Laurels was freshly prepared on site. People were able to choose what they would like to eat at each meal. People who needed help with eating and drinking were not always supported effectively. Where people had been identified as being at risk of poor nutrition, staff had not always robustly monitored people’s body weight or nutritional intake. This meant that accurate information could not be passed on to the doctor or dietician if needed. The provider did not have adapted cutlery and crockery to help people eat and drink more independently. Staff were not effectively deployed at mealtimes and people did not consistently provide the support people needed.

We found that checks (audits) on the quality and safety of the service were not carried out robustly. There were shortfalls in the way the service was led and the provider was not meeting some of the regulations.

There were breaches of the regulations relating to, staffing; safe care and treatment; meeting nutritional needs and good governance.

You can see what action we told the provider to take at the back of the full version of the report.

Although we saw that staff were mindful of infection control risks, there were some aspects of infection control and prevention that needed to be improved at the service, particularly when staff were supporting people with meals. There was some equipment at the home that was used by anyone. The service did not have a robust system in place to ensure these items were properly and consistently cleaned. In between our visits the registered manager had replaced waste bins with a more suitable design to help reduce the risks of contamination.

We have made a recommendation about the management of infection control and prevention.

The provider told us that they intend to upgrade and refurbish The Laurels. However, from the information they provided the improvements were not due to start until early 2019. The home was formerly a large house and therefore not fully adapted as a care home. The provider had plans in place to develop and upgrade the home.

The provider’s recruitment process helped to make sure that only suitable staff were employed at the home. There were some gaps in the record keeping but the registered manager addressed these matters straight away.

People were mostly supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service mostly support this practice. Where people’s level of capacity had changed, the provider took their previous wishes and choices into account. The service also liaised with the community mental health team. However, where people needed to have their medicines hidden in food (covert administration) the service had not acted appropriately. Most of the staff at the home had not received training with regards to the Mental Capacity Act 2005. There were other aspects of staff training that needed to be addressed by the provider.

We observed that staff treated people with respect and kindness. People told us that they were happy with the staff and that they were treated well. Care records were not always up to date and the service did not always fully support the independence of people living with dementia or sensory loss.

We have made a recommendation about involving people in decisions about their care and support.

We did not receive any complaints or concerns during our visits to the home. The provider had a complaints process in place and people were able to raise matters through this process or directly with the registered manager. The service held residents and relatives’ meetings which also provided a platform for people to have their say.

Social and leisure activities at the home were limited. People told us that there were not many things to do. Sometimes external entertainers visited the home and some people occasionally went out. Activities were provided on a ‘ad-hoc’ basis with no real thought about people’s interests or individual needs.

We have made a recommendation about supporting people with their leisure and social interests.

The people we spoke with during our inspection visits thought that the registered manager was approachable and supportive. People were confident that the registered manager would listen to what they had to say.

The provider has developed and interim action plan and has arranged for one of their quality managers to visit the service and review the auditing processes.

The Laurels is a care home providing care and accommodation for up to 29 people some of whom may be living with varying forms of dementia. The home is situated in a residential area not far from the centre of Carlisle. Residents' accommodation is found on the second floor which is accessed by a passenger lift and stair lift. There is a dining room and three lounges that give ample communal space for residents to enjoy. There is also a small, well- tended garden area.

There was a manager in post on the day of our visit who had recently applied to become registered with the Care Quality Commission (CQC). On the day of our inspection visit she confirmed she had cancelled her application but was to remain with the provider by returning to her previous role. A new manager had been appointed who was already registered with CQC and had applied to have a new location added to her registration. However the current manager was to remain in her post for a period of time to mentor the new manager and complete a formal handover of the role and responsibilities.

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.

We found at this inspection that there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always sufficient numbers of support staff to meet the assessed needs of people living in the home.

We spoke to people who lived The Laurels and they spoke positively about what it was like to live in the home. People living there told us that care staff respected their privacy and treated them with respect. People said, “I feel very safe here and the staff are wonderful”. Relatives told us they were happy with the care and support provided to their family members.

We spent time in all the areas of the home and saw there was not always sufficient care staff on duty to meet the all needs of people who lived in the home. Catering and domestic staff were employed to support the care staff in providing appropriate levels of care and support.

The registered provider had systems in place to make sure people living tin The Laurels were protected from abuse and avoidable harm. Staff were trained and knew the action to take if they were concerned about the safety or welfare of anyone.

We saw that people had nutritional assessments and plans in place. This ensured people received a balanced diet and were not at risk of becoming malnourished or dehydrated.

Medicines were being safely administered and stored and we saw that accurate records were kept of medicines received and disposed of so they could be accounted for.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves. The service worked well with local GPs and health care professionals and external agencies such as social services and mental health services to provide appropriate care to meet people’s different physical, psychological and emotional needs.

Effective systems were in place for the recruitment of staff and for their induction and ongoing training and development. Staff training and development was organised corporately and staff said they were well supported to access the training they needed and to develop their skills.

There were quality monitoring systems in operation to assess and review the quality of the services provided. We saw from the audits that had been done that the manager had identified areas of service provision that needed to be improved to meet their internal quality standards and to find ways they could continue to improve the service.

People knew how they could complain about the service they received and information on this was displayed in the home. People and their relatives told us they were confident any complaint or concern they had would be listened to and dealt with as soon as possible.