Laurel Court (Didsbury)

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 good. At this assessment the rating has changed to requires improvement. This meant people were safe and protected from avoidable harm.

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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Incident and accidents were recorded and reported, however, responses from staff varied on the reporting of an incident or accident and several staff had limited understanding of the incident reporting procedure, often deferring to senior colleagues. We observed a staff member reporting an incident relating to a fall, which had occurred earlier in the day and the senior staff member being required to input all the details of the incident. Staff did not always understand how they should monitor a person’s pain following an accident or incident with some staff reporting, this was completed by seniors and nurses. On reporting incidents staff said, “I’d report it (verbally) to a senior carer or manager.” and “If there is a fall, we go to the senior in charge.”

Pain documentation was inconsistent; for example, 2 people frequently complained of knee pain, yet this was not reflected in their care records. There was insufficient assurance that pain relief was being offered consistently.

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 collaborated effectively with system partners to ensure that care and support were delivered safely during transitions into the home or to alternative services. Comprehensive admission assessments were conducted to identify and document peoples’ immediate needs. Medical diagnoses and relevant health information were accurately recorded within care plans to promote ongoing wellbeing.

The provider maintained oversight of all referrals, as well as inpatient and outpatient medical appointments, to ensure continuity of health and medical care. When people transitioned from the care home, whether to hospital or another setting, the provider ensured that all necessary information was communicated to support a seamless and safe transfer.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff demonstrated a clear understanding of safeguarding procedures and were able to articulate the appropriate actions to take if they suspected a vulnerable person was at risk of abuse. They were also knowledgeable about key indicators of potential abuse, including unexplained bruising and noticeable changes in behaviour.

Staff told us they would raise any concerns with the registered manager or senior staff member and were confident the appropriate action would be taken.

Staff received annual training on safeguarding vulnerable adults, which served to reinforce and maintain their knowledge and competence in this area.

All people we spoke with at Laurel Court (Didsbury) reported feeling safe and expressed confidence in raising any concerns with staff, the registered manager, or senior leadership. Several people also indicated they would feel comfortable discussing any issues with family members.

We observed detailed safeguarding referrals had been appropriately submitted to the local authority for further investigation when concerns were identified. However, we noted one instance where a safeguarding concern was not escalated in a timely manner. This issue was addressed promptly after being brought to the provider’s attention.

On safeguarding, staff said, “I always consult my manager first. Staff will explain the issue to me, and if I think it needs to be escalated, I discuss with managers.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks were assessed and appropriate mitigation strategies were implemented; however, we were not fully assured, all staff members demonstrated a clear understanding of effective risk management practices. A number of people within the home were identified as being at risk of dehydration. Upon reviewing fluid intake records, we noted inconsistencies. Some people appeared to receive insufficient fluids, while others were recorded as consuming large volumes at the same time each day, raising concerns about the accuracy of documentation. Although no-one was observed to be dehydrated during our visit, we did witness instances where staff retrospectively recorded fluid intake without having been present during consumption. These entries were reportedly based on second-hand information provided by other staff members, which may undermine the reliability of the records and compromise the accuracy of fluid intake documentation. This practice could place people at increased risk of dehydration due to potential discrepancies between recorded and actual consumption.

Moving and handling risks were appropriately identified, and suitable equipment was readily available for use by trained staff. However, we observed an incident had occurred where a person was transferred from their bed to a chair using a toilet sling, resulting in significant bruising to their upper torso and arms. Toilet slings are not universally appropriate for all individuals, and in this case, the use of such equipment had not been adequately risk assessed to ensure its suitability and safety.

Staff said, “There is good equipment, and good training. We’ve had a lot of e-learning and in house training this year. However, I think we have some residents who don’t really need to be hoisted as much as we do. They can support their own body weight, and I think they only need the standing aids and don’t always need the hoists. I don’t do the risk assessment though; I think the senior carers might do the risk assessment.”

People told us, “Yes, I need equipment to help me. Staff are on hand and know what they are doing.”

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.

Multiple concerns were raised by staff regarding ongoing construction work at the home. Staff reported needing to be hyper-vigilant due to tools and equipment being left in accessible areas, posing risks to people living at the home. Additional concerns included limited access to running water and flushing toilets, with staff sharing they were not consistently informed of disruptions. Staff said, “A memo was shared of where there weren’t any running water or toilets which flushed but it was hard to remember when a resident needed supporting suddenly with personal care or wanted access to hand washing facilities.” We found the risk assessment completed for the provision of the building work, was focused solely on the construction workforce and did not address risks to people living at the home, staff, or visitors.

Fire safety was compromised in the loft area, and the fire risk assessment had not been updated during the works. Removal of false ceilings and exposed wiring were not adequately addressed in the risk assessment.

There was clear signage, appropriate lighting and accessible emergency exits. The remainder of the premises was free from avoidable hazards and there were internal and external checks of safety and maintenance systems completed by a competent person.

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. Staff recruitment practices were found to be safe and compliant with current legislation and organisational procedures. All staff received an induction and role-specific training. However, feedback regarding training on the use of the electronic care planning system, was mixed. Some staff reported insufficient training, and one staff member demonstrated the system using a device with a distorted screen which left them unable to properly read the care plan effectively. Several staff indicated they either lacked access to care plans or were unfamiliar with the system. During observation, one staff member who had not witnessed fluid intake asked a colleague about a persons' consumption and entered the data into the electronic records retrospectively. We raised these concerns with the provider who arranged for further training and adaptations of the electronic system to ensure the care planning system was effectively used to meet people's needs. Feedback on staffing levels varied among staff and people living at the home. While some people reported long waits for assistance, it was unclear whether call bells were consistently used. A review of call bell records did not indicate prolonged delays. Staff, particularly on the first floor, described staffing levels as challenging due to people requiring two-person care and exhibiting confusion or wandering behaviours. Concerns were raised about agency staff, including a lack of understanding of roles and inadequate training in moving and handling. A staff member expressed concerns about unequal deployment across floors, impacting on the continuity of care. A dependency tool was used to determine suitable staffing levels for the home which incorporated people's need's. Staff said, "There's been some issues with staffing levels but for me, the issue is more to do with staff skill level. If we have agency staff, you'll end up instructing them and repeating things which increases the amount of time it takes to do a task. This happens frequently. Up until a couple of weeks ago, I'd say we'd have an agency staff member on every week. About 3 weeks ago, I got moved to the ground floor. I was working with an agency senior that didn't know the floor as well as other staff. At that time, I'd say maybe 1 out of 3 staff who were there knew the floor. I don't think this is right for the residents." People told us, they felt staff were trained and knew how to support them.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The home was consistently clean and well-maintained, with housekeeping staff on duty daily to uphold hygiene standards.

Staff had ready access to personal protective equipment (PPE), which was stored securely and appropriately. The provider adhered to current national guidance in assessing and managing infection risks, ensuring that all equipment was used and maintained to the highest standards of cleanliness.

All staff received training in infection prevention and control, including hand hygiene and the safe disposal of waste.

The service did not make sure that medicines and treatments were safe and met people's needs, capacities and preferences. We found one person had not had their pain relief patch applied when it was due to be changed. The provider had not identified this error, however once they were aware they took the appropriate action. The rotation of the site of application of the patches was not always done in line with the manufacturer's guidelines, this meant there was a risk of skin irritation. The Medicines Administration Records (MAR) did not always include people's allergy information. There was a risk people would be given a medicine they had previously reacted to. We found medicine related documents were not always kept up to date when there were changes to people's medicines. There was a risk the differences in the documentation might cause confusion and lead to a medicine error. Staff did not always record when thickened fluids were being given to people who were at risk of choking and aspiration. From reviewing the records, we could not be sure prescribed thickening agents were being managed safely, and this placed people at risk of choking. For people prescribed medicines to be given 'when required', protocols did not always contain correct and person-centred information to ensure staff could give these when appropriate. When people were prescribed a medicine with an option to give 1 or 2, there was not always information to support staff to know which dose to give. There was a risk people would not get the most appropriate dose. The MAR did not always include all of the special instructions, for example before food, there was a risk people were not given their medicines in line with the manufacturer's instructions. We found when medicines did need to be given before food the MAR did not always show the medicine had been given correctly. There was a risk the medicine might not work properly. Staff completed medicines training and had their competency to administer medicines assessed. The provider completed audits; however, they had not identified all of the issues we found during the inspection.